Institutional legacies, employment and professional integration of non EU/EEA doctors in France

Internationally, policies for attracting highly-skilled migrants have become the guidelines mainly used by the Organisation for Economic Co-operation and Development (OECD) countries. Governments are implementing specific procedures to capture and facilitate their mobility. However, all professions are not equal when it comes to welcoming highly-skilled migrants. The medical profession, as a protective market, is one of these. Taking the case of non-EU/EEA doctors in France, this paper shows that the medical profession defined as the closed labour market, remains the most controversial in terms of professional integration of migrants, protectionist barriers to migrant competition and challenge of medical shortage. Based on the path-dependency approach, this paper argues that non-EU/EEA doctors' issues in France derive from a complex historical process of interaction between standards settled in the past, particularly the historical power of medical corporatism, the unexpected long-term effects of French hospital reforms of 1958, and budgetary pressures. Theoretically, this paper shows two significant findings. Firstly, the French medical system has undergone a series of transformations unthinkable in the strict sense of a path-dependence approach: an opening of the medical profession to foreign physicians in the context of the Europeanisation of public policy, acceptance of non-EU/EEA doctors in a context of medical shortage and budgetary pressures. Secondly, there is no change of the overall paradigm: significantly, the recruitment policies of non-EU/EEA doctors continue to highlight the imprint of the past and reveal a significant persistence of prejudices. Non-EU/EEA doctors are not considered legitimate doctors even if they have the qualifications of physicians which are legitimate in their country and which can be recognised in other receiving countries.

Professional sports and gambling regulation in Finland - Examining the institutional factors of gambling affecting professional sport clubs in Finland

This study examines how to institutional environment of gambling is currently in motion both in Europe and Finland. Furthermore, it examines the criticism by Finnish professional sport clubs directed towards the national gambling monopolies, especially Veikkaus Oy. This criticism addresses the acclaimed issue of low or non-existing sponsorship funds coming to the clubs despite the clubs’ duties to promote Veikkaus Oy in their stadiums etc. In essence the main research objective was to examine the interaction and institutional environments of both Finnish professional sport clubs and gambling regulation. This was done through three sub-objectives: 1) to analyze professional sport as business and its institutional environment 2) to analyze the institutions of gambling in their current state and their potential future 3) to evaluate the potential impact of an institutional change in gambling legislation to the professional sport clubs The findings from Finland were then compared to those of Denmark where an institutional change had occurred in gambling regulation. Empirical data was collected through multiple interviews. Interviewees represented sport clubs (7), sport association (1), sport league (1), Finnish monopoly representatives (2), commercial gambling providers (1), Danish monopoly system representatives (1), Danish sport club (1). In addition a vast amount of secondary data (e.g. Green and white books by EU, court decisions, a variety of studies etc.). Theoretically this study combines the aspects of institutional theory with the theory of professional sports as business. This proved to be a rather new approach and no published literature was found to have done specifically this. The findings of this study are twofold, on the European level it is clear that the momentum if towards a more liberated gambling market while Finland is at the moment trying to go the opposite direction and uphold its monopoly. From the sport club’s level the findings suggest that currently sport clubs do not directly benefit from the funds originated from Veikkaus Oy as these funds are more or less used on the association/league levels. However, the clubs themselves are also lacking in self-criticism as they are lacking in clear sponsorship packages/programs which Veikkaus Oy might be interested in participating. If liberation of the gambling market would occur it is highly possible that that the largest clubs in football and ice-hockey would be the main beneficiaries while smaller clubs and sports could possibly be worse off than currently. These interpretations were well supported by the findings from Denmark.

Disability and mobility: interaction of two public policies for sustainable development

This issue of the FAL Bulletin analyses institutional alternatives and international best practices for the development of transportation services that explicitly include and integrate users with some type of disability.

A study to determine the association between medical decision-making and the performance of an institutional ethics committee

This study developed proxy measures to test the independent effects of medical specialty, institutional ethics committee (IEC) and the interaction between the two, upon a proxy for the dependent variable of the medical decision to withhold/withdraw care for the dying--the resuscitation index (R-index). Five clinical vignettes were constructed and validated to convey the realism and contextual factors implicit in the decision to withhold/withdraw care. A scale was developed to determine the range of contact by an IEC in terms of physician knowledge and use of IEC policy.^ This study was composed of a sample of 215 physicians in a teaching hospital in the Southwest where proxy measures were tested for two competing influences, medical specialty and IEC, which alternately oppose and support the decision to withhold/withdraw care for the dying. A sub-sample of surgeons supported the hypothesis that an IEC is influential in opposing the medical training imperative to prolong life.^ Those surgeons with a low IEC score were 326 percent more likely to continue care than were surgeons with a high IEC score when compared to all other specialties. IEC alone was also found to significantly predict the decision to withhold/withdraw care. Interaction of IEC with the specialty of surgery was found to be the best predictor for a decision to withhold/withdraw care for the dying. ^

Aiming at improving access to research output through the institutional repository

The paper is to introduce the institutional repository (IR) as a powerful tool to support the researchers of the institution to archive and disseminate their research findings freely to the scholarly community on the Internet. The IR can improve the access to an institution’s research output enormously. The operations of an IR also require various interactions with researchers, which enables the library to gain a solid understanding of research needs and expectations. Through such interaction, the relationship and mutual trust between researchers and the library are strengthened. The experiences of the Institute of Developing Economies (IDE) library can be useful to other special libraries.

THE KYOTO PROTOCOL AND THE WTO: INSTITUTIONAL EVOLUTION AND ADAPTATION. CEPS Policy Brief No. 28/December

Overview. Questions about the interface between the multilateral climate regime embodied in the Kyoto Protocol and the multilateral trade regime embodied in the World Trade Organisation (WTO) have become especially timely since the fall of 2001. At that time, ministerial-level meetings in Marrakech and Doha agreed to advance the agendas, respectively, for the implementation of the Kyoto Protocol and for negotiations on further agreements at the WTO. There have been concerns that each of these multilateral arrangements could constrain the effectiveness of the other, and these concerns will become more salient with the entry into force of the Kyoto Protocol. There are questions about whether and how the rights and obligations of the members of the WTO and the parties to the Protocol may conflict. Of particular concern is whether provisions in the Protocol, as well as government policies and business activities undertaken in keeping with those provisions, may conflict with the WTO non-discrimination principles of national treatment and most-favoured nation treatment. The WTO agreements that are potentially relevant to climate change issues include many of the individual Uruguay Round agreements and subsequent agreements as well. The principal elements of the Kyoto Protocol that are particularly relevant are its provisions concerning emissions trading, the Clean Development Mechanism, Joint Implementation, enforcement, and parties’ policies and measures. In combination, therefore, there are numerous potential points of intersection between the elements of the Kyoto Protocol and the WTO agreements. Previous studies have clarified many issues, as they have focused on particular aspects of the regimes’ relationships. Yet, some analyses suggest that the two regimes are largely compatible and even mutually reinforcing, while others suggest that there are significant conflicts between them. Those and other studies are referenced in the ‘suggestions for further reading’ section at the end of the paper.1 The present paper seeks to expand on those studies by providing additional breadth and depth to understanding of the issues. The analysis gives special attention to key issues on the agenda – i.e. issues that are particularly problematic because of the likelihood of occurrence of specific conflicts and the significance of their economic and/or political consequences. The paper adopts a modified ‘triage’ approach, which classifies points of intersection as (a) highly problematic and clearly in need of further attention, (b) perhaps problematic but less urgent, and (c) apparently not problematic, at least at this point in time. The principal conclusions are that: · The missions and objectives of the two regimes are largely compatible, and their operations are potentially mutually reinforcing in several respects. · Some provisions of the multilateral agreements that may superficially seem at odds are not likely to become particularly problematic in practice. · ‘Domestic policies and measures’ that governments may undertake in the context of the Protocol could pose difficult issues in the context of WTO dispute cases. · Recent WTO agreements and dispute cases acknowledge the legitimacy of the ‘precautionary principle’ and are thus consistent with the environmental protection objectives of the Protocol. · The relative newness of the climate regime creates opportunities for institutional adaptation, as compared with the constraints of tradition in the trade-investment regime. · The prospect of largely independent evolutionary paths for the two regimes poses a series of issues about future international regime design and management, which may require new institutional arrangements. In sum, the present paper thus finds that although there are some areas of interaction that are problematic, the two regimes may nevertheless co-exist in relative harmony in other respects –more like ‘neighbours’ than either ‘friends’ or ‘foes’, as Krist (2001) has suggested.

'Institutional Shopping' for Natural Resource Management in a Protected Area and Indigenous Territory in the Bolivian Amazon.

Focusing on an overlapping protected area and indigenous territory in the Bolivian Amazon, this article discusses how indigenous people continue to negotiate access to natural resources. Using the theoretical framework of New Institutionalism, ethnographic data from participatory observations, and interviews with Takana indigenous resource users and park management staff, we identified four phases of institutional change. We argue that under the current institutionally pluralistic setting in the overlapping area, indigenous users apply “institutional shopping” to choose, according to their power and knowledge, the most advantageous institutional framework in a situation. Indigenous users strategically employed arguments of conservation, indigeneity, or long-term occupation to legitimize their claims based on the chosen institution. Our results highlight the importance of ideologies and bargaining power in shaping the interaction of individuals and institutions. As a potential application of our research to practice, we suggest that rather than seeing institutional pluralism solely as a threat to successful resource management, the strengths of different frameworks may be combined to build robust institutions from the bottom up that are adapted to the local context. This requires taking into account local informal institutions, such as cultural values and beliefs, and integrating them with conservation priorities through cross-cultural participatory planning.

Crisis and institutional change in urban governance

Recent studies of new institutional spaces typically underplay the uneven and contested process of institutional change by undervaluing the role of inherited institutions and discourses. This is a critical issue as neoliberal networked forms of governance interact with inherited institutional arrangements, characterised by important path dependencies that guide actors. Contradiction and tensions can emerge, culminating in crisis tendencies, and producing both discursive and material contestation between actors. It is with an understanding of path dependencies, ideas (structured into discourses), and (perceived and actual) crisis tendencies that this paper examines contested institutional change through a case-study analysis of one city, and a critical engagement with neoinstitutionalism. The purpose is to examine, firstly, the significance of inherited path-dependent arrangements in fostering conflict and crisis tendencies during interaction with emergent state action; secondly, the extent to which crisis is evident in processes of institutional change and the form that this takes; and, thirdly, the importance of ideas in producing institutional transformation. It is found that institutional conflict is evident between inherited institutions and emergent state action, and stems both from the way agents are organised by the state and from certain path dependencies, but that this does not lead to an actual material crisis. Rather, the nation-state, in partnership with senior city government actors, use ideational/discursive ‘crisis talk’ as a means by which to induce institutional change. The role of ideas has been in critical in this process as the nation-state frames problems and solutions in line with its existing policy paradigm and institutional arrangements, and with discourses further reinforcing existing material power relations.

Institutional shifts in inter-municipal service delivery:an analysis of developments in eight Western European countries

Comparative research on inter-municipal cooperation in eight European countries shows that there is a great variety of institutional arrangements for cooperation across the different countries. Also, these arrangements tend to change over time in terms of the scope of cooperation among partners, their composition and the degree of organizational integration. This article describes and analyzes the variety of and shifts in institutional arrangements for a specific class of inter-municipal cooperation arrangements: those that are set up to provide for the joint delivery of public services. It is argued that specific arrangements are typically the outcomes of interaction between national institutional contexts,?environmental factors and local preferences.

The contract management responsibility system in China : an institutional interpretation

Thesis is about the enterprise reform in China in general, and the Contract Management Responsibility System (the CMRS) in particular. The latter is a new institutional arrangement to deal with the relation between the government and the state-owned enterprise which has always been at the centre of the enterprise reform. The focus of the research is on the process of institutionalization in order to study the problems of the emergence of a free enterprise system in China. The research is conducted by four in-depth case studies to reveal how the CMRS is running and what interaction is taking place between the government and the state-owned enterprise under the system. Drawing on the empirical work, the thesis analyzes the features of the CMRS and the characteristics of its implementation process with respect to the structural-institutional paradigm, and the property rights approach. The research shows that to establish a market-type relation between the government and the enterprise is a complicated and dynamic process. It involves the understanding of the two different economic mechanisms, market and planning, and the interations taken by two parties. It concludes that the CMRS is an unstable system, either going back to the previous system or moving towards a market system, because its dynamic and control dimension are dysfunctional.

Speaking out of turn? Taking the initiative in teacher-fronted classroom interaction.

Teacher-fronted interaction is generally seen to place limitations on the contributions that learners can make to classroom discourse and the conclusion is that learners are unable to experiment with, for example, turn-taking mechanisms. This article looks at teacher-fronted interaction in the language classroom from the perspective of learner talk by examining how learners might take the initiative during this apparently more rigid form of interaction. Detailed microanalysis of classroom episodes, using a conversation analysis institutional discourse approach, shows how learners orient to the institutional context to make sophisticated and effective use of turn-taking mechanisms to take the initiative and direct the interaction, even in the controlled environment of teacher-fronted talk. The article describes some of the functions of such learner initiative, examines how learners and teachers co-construct interaction and how learners can create learning opportunities for themselves. It also briefly looks at teacher reactions to such initiative. The article concludes that learner initiative in teacher-fronted interaction may constitute a significant opportunity for learning and that teachers should find ways of encouraging such interaction patterns.

Personal and institutional factors: Relationship to self-efficacy of persistence to the senior year in college among self-identified Black undergraduate students in a Hispanic serving institution

While undergraduate enrollment of all racial groups in United States higher education institutions has increased, 6-year graduation rates of Blacks (39%) remain low compared to other races; Asians (69%), Whites (62%), and Hispanics (50%; NCES, 2010). Women's graduation rate is higher than men's; 58% compared to men's at 53% in public institutions (IPEDS, 2011). Retention literature does not address the perceptions of Black ethnic groups' experiences in college, particularly in Hispanic serving institutions. Informed by Tinto's (1975, 1987, 1993) student academic and social integration model, Guiffrida's (2003, 2004, 2005, 2006) model of relationships while at college, and ex-post facto research design, the study investigated personal and institutional factors that relate to Black students' self-efficacy and persistence to the senior year in college. Data about Black ethnic undergraduate seniors' (N = 236) academic and social experiences in college were collected using the Student Institutional Integration Survey (SIIS), an online questionnaire. Descriptive statistics were used to collect background information about the sample, correlation was calculated to indicate the degree of relationship between the variables, and multiple linear regressions were used to identify variables that are predictors of self-efficacy of persistence. Independent samples t-test and analyses of variance were computed to determine whether differences in perceptions of personal and institutional factors that relate to self-efficacy of persistence to the senior year in college could be identified between gender and ethnicity. Frequency was summarized to identify themes of participants' primary motivation for finishing undergraduate degree programs. These themes were: (a) self-pride/personal goal, (b) professional aspiration/career (c) motivation to support family, (d) desire to have financial independence/better job, (e) to serve community, (f) opportunity to go to college, (g) being first-generation college student, and (h) prove to family the value of higher education. The research findings support the tenets of academic and social integration theories which suggest that students' interaction with peer and faculty, relationships with family and friends, and involvement in institutional activities and organizations influence their persistence in college. Implications based on the findings affect institutional policy, curriculum, and program improvements that relate to Black undergraduate students' academic and social support.

Personal and Institutional Factors: Relationship to Self-Efficacy of Persistence to the Senior Year in College among Self-Identified Black Undergraduate Students in a Hispanic Serving Institution

While undergraduate enrollment of all racial groups in United States higher education institutions has increased, 6-year graduation rates of Blacks (39%) remain low compared to other races; Asians (69%), Whites (62%), and Hispanics (50%; NCES, 2010). Women’s graduation rate is higher than men’s; 58% compared to men’s at 53% in public institutions (IPEDS, 2011). Retention literature does not address the perceptions of Black ethnic groups’ experiences in college, particularly in Hispanic serving institutions. Informed by Tinto’s (1975, 1987, 1993) student academic and social integration model, Guiffrida’s (2003, 2004, 2005, 2006) model of relationships while at college, and ex-post facto research design, the study investigated personal and institutional factors that relate to Black students’ self-efficacy and persistence to the senior year in college. Data about Black ethnic undergraduate seniors’ (N = 236) academic and social experiences in college were collected using the Student Institutional Integration Survey (SIIS), an online questionnaire. Descriptive statistics were used to collect background information about the sample, correlation was calculated to indicate the degree of relationship between the variables, and multiple linear regressions were used to identify variables that are predictors of self-efficacy of persistence. Independent samples t-test and analyses of variance were computed to determine whether differences in perceptions of personal and institutional factors that relate to self-efficacy of persistence to the senior year in college could be identified between gender and ethnicity. Frequency was summarized to identify themes of participants’ primary motivation for finishing undergraduate degree programs. These themes were: (a) self-pride/personal goal, (b) professional aspiration/career (c) motivation to support family, (d) desire to have financial independence/better job, (e) to serve community, (f) opportunity to go to college, (g) being first-generation college student, and (h) prove to family the value of higher education. The research findings support the tenets of academic and social integration theories which suggest that students’ interaction with peer and faculty, relationships with family and friends, and involvement in institutional activities and organizations influence their persistence in college. Implications based on the findings affect institutional policy, curriculum, and program improvements that relate to Black undergraduate students’ academic and social support.

Metropolitan Governance and Institutional Design: Transportation in the Jakarta Metropolitan Region

In the Jakarta Metropolitan Region (JMR), the lack of co-ordination and appropriate governance has resulted in paralyzing traffic jams at the metropolitan scale that cannot be resolved by a single government entity. The issue of metropolitan governance is especially crucial here as the JMR lacks an established and formally pre-designed system of governance (e.g., in a constitution or other legal regulations). Instead, it relies on the interaction, coordination and cooperation of a multitude of different stakeholders, ranging from local and regional authorities to private entities and citizens. This chapter offers a discussion on the various governance approaches relating to an appropriate institutional design required for transportation issues at the metropolitan scale. The case used is a regional Bus Rapid Transit (BRT) system as an extension to the metropolitan transport system. Institutional design analysis is applied to the case and three possible improvements - i) a ‘Megapolitan’ concept, ii) a regional spatial plan and iii) inter-local government cooperation; were identified that correspond to current debates on metropolitan governance approaches of regionalism, localism and new regionalism. The findings, which are relevant to similar metropolitan regions, suggest that i) improvements at the meso-level of institutional design are more readily accepted and effective than improvements at the macro-level and ii) that the appropriate institutional design for governing metropolitan transportation in the JMR requires enhanced coordination and cooperation amongst four important actors - local governments, the regional agency, the central government, and private companies.

Identity Text: an educational intervention to foster cultural interaction

Background: Sociocultural theories state that learning results from people participating in contexts where social interaction is facilitated. There is a need to create such facilitated pedagogical spaces where participants share their ways of knowing and doing. The aim of this exploratory study was to introduce pedagogical space for sociocultural interaction using ‘Identity Text’.
Methods: Identity texts are sociocultural artifacts produced by participants, which can be written, spoken, visual, musical, or multimodal. In 2013, participants of an international medical education fellowship program were asked to create their own Identity Texts to promote discussion about participants’ cultural backgrounds. Thematic analysis was used to make the analysis relevant to studying the pedagogical utility of the intervention.
Result: The Identity Text intervention created two spaces: a ‘reflective space’ helped
participants reflect on sensitive topics like institutional environments, roles in
interdisciplinary teams, and gender discrimination. A ‘narrative space’ allowed
participants to tell powerful stories that provided cultural insights and challenged cultural hegemony; they described the conscious and subconscious transformation in identity that evolved secondary to struggles with local power dynamics and social demands involving the impact of family, peers and country of origin.
Conclusion: Whilst the impact of providing pedagogical space using Identity Text on
cognitive engagement and enhanced learning requires further research, the findings of
this study suggest that it is a useful pedagogical strategy to support cross-cultural
education.