An examination of adverse drug reaction reporting to the yellow card scheme

Chief pharmacists in 209 hospitals were surveyed about ADR reporting schemes, the priority given to ADR reporting, and attitudes towards ADR reporting. ADR reporting had a low managerial priority. Local reporting schemes were found to be operating in 37% trusts, but there were few plans to start new schemes. Few problems were discovered by the introduction of pharmacist ADR reporting. Chief pharmacists had concerns about the competence of hospital pharmacists to detect ADRs and were in favour of increased training. Lack of time on wards, and recruitment difficulties were suggested as reasons for hospital pharmacist under-reporting. Teaching hospitals appeared to have an increased interest in ADR reporting. A retrospective analysis of reporting trends within the West Midlands region from 1994, showed increasing or stable reporting rates for most sectors of reporters, except for general practitioners (GPs). The West Midlands region maintained higher ADR reporting rates than the rest of the UK. National reporting figures showed a worrying decline in ADR reports from healthcare professionals. Variation was found in the ADR reporting rates of Acute NHS Hospital Trusts and Primary Care Trusts (PCTs) in the West Midlands region, including correlations with prescribing rates and other PCT characteristics. Qualitative research into attitudes of GPs towards the Yellow Card scheme was undertaken. A series of qualitative interviews with GPs discovered barriers and positive motivators for their involvement in the Yellow Card scheme. A grounded theory of GP involvement in the Yellow Card scheme was developed to explain GP behaviour, and which could be used to inform potential solutions to halt declining rates of reporting. Under-reporting of ADRs continues to be a major concern to those who administer spontaneous reporting schemes.

User interface design support for the development of knowledge-based systems

The present scarcity of operational knowledge-based systems (KBS) has been attributed, in part, to an inadequate consideration shown to user interface design during development. From a human factors perspective the problem has stemmed from an overall lack of user-centred design principles. Consequently the integration of human factors principles and techniques is seen as a necessary and important precursor to ensuring the implementation of KBS which are useful to, and usable by, the end-users for whom they are intended. Focussing upon KBS work taking place within commercial and industrial environments, this research set out to assess both the extent to which human factors support was presently being utilised within development, and the future path for human factors integration. The assessment consisted of interviews conducted with a number of commercial and industrial organisations involved in KBS development; and a set of three detailed case studies of individual KBS projects. Two of the studies were carried out within a collaborative Alvey project, involving the Interdisciplinary Higher Degrees Scheme (IHD) at the University of Aston in Birmingham, BIS Applied Systems Ltd (BIS), and the British Steel Corporation. This project, which had provided the initial basis and funding for the research, was concerned with the application of KBS to the design of commercial data processing (DP) systems. The third study stemmed from involvement on a KBS project being carried out by the Technology Division of the Trustees Saving Bank Group plc. The preliminary research highlighted poor human factors integration. In particular, there was a lack of early consideration of end-user requirements definition and user-centred evaluation. Instead concentration was given to the construction of the knowledge base and prototype evaluation with the expert(s). In response to this identified problem, a set of methods was developed that was aimed at encouraging developers to consider user interface requirements early on in a project. These methods were then applied in the two further projects, and their uptake within the overall development process was monitored. Experience from the two studies demonstrated that early consideration of user interface requirements was both feasible, and instructive for guiding future development work. In particular, it was shown a user interface prototype could be used as a basis for capturing requirements at the functional (task) level, and at the interface dialogue level. Extrapolating from this experience, a KBS life-cycle model is proposed which incorporates user interface design (and within that, user evaluation) as a largely parallel, rather than subsequent, activity to knowledge base construction. Further to this, there is a discussion of several key elements which can be seen as inhibiting the integration of human factors within KBS development. These elements stem from characteristics of present KBS development practice; from constraints within the commercial and industrial development environments; and from the state of existing human factors support.

The 'Healthy Passport' intervention with older people in an English urban environment:effects of incentives and peer-group organisers in promoting healthy living

This paper reports the evaluation of the effectiveness of incentives (viz. points and prizes) and of peer-group organisers ('older people's champions') in the outcomes of a health-improvement programme for people aged 50 + years in a multi-ethnic district of the West Midlands, England. Health promotion activities Were provided, and adherence, outcome variables and barriers to adherence were assessed over six months, using a `passport' format. Those aged in the fifties and of Asian origin Were under represented, but people of Afro-Caribbean origin were well represented and proportionately most likely to stay in the project. Those of greater age and With more illness were most likely to drop out. There were significant improvements in exercise, diet and the uptake of influenza vaccines and eyesight tests, but slighter improvements in wellbeing. Positive outcomes related to the incentives and to liking the format. The number of reported barriers was associated with lower involvement and lack of change, as was finding activities too difficult, the level of understanding, and transport and mobility problems, but when these were controlled, age did not predict involvement. Enjoying the scheme was related to positive changes, and this was associated with support from the older people's champions.

The role of manufacturing and market managers in strategy development:lessons from three companies

According to researchers and managers, there is a lack of agreement between marketing and manufacturing managers on critical strategic issues. However, most of the literature on the subject is anecdotal and little formal empirical research has been done. Three companies are investigated to study the extent of agreement/disagreement between manufacturing and marketing managers on strategy content and process. A novel method permits the study of agreement between the two different functional managers on the process of developing strategy. The findings consistently show that manufacturing managers operate under a wider range of strategic priorities than marketing managers, and that manufacturing managers participate less than marketing managers in the strategy development process. Further, both marketing and manufacturing managers show higher involvement in the strategy development process in the latter stages of the Hayes and Wheelwright four-stage model of manufacturing’s strategic role.

Revolution or evolution:the challenges of conceptualizing patient and public involvement in a consumerist world

Background Changing the relationship between citizens and the state is at the heart of current policy reforms. Across England and the developed world, from Oslo to Ontario, Newcastle to Newquay, giving the public a more direct say in shaping the organization and delivery of healthcare services is central to the current health reform agenda. Realigning public services around those they serve, based on evidence from service user's experiences, and designed with and by the people rather than simply on their behalf, is challenging the dominance of managerialism, marketization and bureaucratic expertise. Despite this attention there is limited conceptual and theoretical work to underpin policy and practice. Objective This article proposes a conceptual framework for patient and public involvement (PPI) and goes on to explore the different justifications for involvement and the implications of a rights-based rather than a regulatory approach. These issues are highlighted through exploring the particular evolution of English health policy in relation to PPI on the one hand and patient choice on the other before turning to similar patterns apparent in the United States and more broadly. Conclusions A framework for conceptualizing PPI is presented that differentiates between the different types and aims of involvement and their potential impact. Approaches to involvement are different in those countries that adopt a rights-based rather than a regulatory approach. I conclude with a discussion of the tension and interaction apparent in the globalization of both involvement and patient choice in both policy and practice. © 2009 Blackwell Publishing Ltd.

Developing user involvement in a UK cancer network:professionals’ and users’ perspectives

This paper explores the results of a consensus development exercise that explored diverse perspectives and sought to identify key principles for the development of user involvement in a cancer network. The exercise took place within one of 34 UK cancer networks and was a collaboration between the NHS, two universities and two voluntary sector organizations. The paper explores professionals’ and users’ perspectives on user involvement with reference to the current sociopolitical context of user participation. British policy documents have placed increasing emphasis on issues of patient and public participation in the evaluation and development of health services, and the issue of lay participation represents an important aspect of a critical public health agenda. The project presented here shows that developing user involvement may be a complex task, with lack of consensus on key issues representing a significant barrier. Further, the data suggest that professional responses can partly be understood in relation to specific occupational standpoints and strategies that potentially allow professionals to define and limit users’ involvement. The implications of these findings and the impact of the consensus development process itself are discussed.

[Review of] Ivo Mijnssen, The Quest for an Ideal Youth in Putin’s Russia I. Back to Our Future! History, Modernity and Patriotism According to Nashi, 2005–2012. Soviet and Post-Soviet Politics and Society, Stuttgart: Ibidem Verlag, 2012, 202pp., e 34.90 p/b

THE YOUTH MOVEMENT NASHI (OURS) WAS FOUNDED IN THE SPRING of 2005 against the backdrop of Ukraine’s ‘Orange Revolution’. Its aim was to stabilise Russia’s political system and take back the streets from opposition demonstrators. Personally loyal to Putin and taking its ideological orientation from Surkov’s concept of ‘sovereign democracy’, Nashi has sought to turn the tide on ‘defeatism’ and develop Russian youth into a patriotic new elite that ‘believes in the future of Russia’ (p. 15). Combining a wealth of empirical detail and the application of insights from discourse theory, Ivo Mijnssen analyses the organisation’s development between 2005 and 2012. His analysis focuses on three key moments—the organisation’s foundation, the apogee of its mobilisation around the Bronze Soldier dispute with Estonia, and the 2010 Seliger youth camp—to help understand Nashi’s organisation, purpose and ideational outlook as well as the limitations and challenges it faces. As such,the book is insightful both for those with an interest in post-Soviet Russian youth culture, and for scholars seeking a rounded understanding of the Kremlin’s initiatives to return a sense of identity and purpose to Russian national life.The first chapter, ‘Background and Context’, outlines the conceptual toolkit provided by Ernesto Laclau and Chantal Mouffe to help make sense of developments on the terrain of identity politics. In their terms, since the collapse of the Soviet Union, Russia has experienced acute dislocation of its identity. With the tangible loss of great power status, Russian realities have become unfixed from a discourse enabling national life to be constructed, albeit inherently contingently, as meaningful. The lack of a Gramscian hegemonic discourse to provide a unifying national idea was securitised as an existential threat demanding special measures. Accordingly, the identification of those who are ‘notUs’ has been a recurrent theme of Nashi’s discourse and activity. With the victory in World War II held up as a foundational moment, a constitutive other is found in the notion of ‘unusual fascists’. This notion includes not just neo-Nazis, but reflects a chain of equivalence that expands to include a range of perceived enemies of Putin’s consolidation project such as oligarchs and pro-Western liberals.The empirical background is provided by the second chapter, ‘Russia’s Youth, the Orange Revolution, and Nashi’, which traces the emergence of Nashi amid the climate of political instability of 2004 and 2005. A particularly note-worthy aspect of Mijnssen’s work is the inclusion of citations from his interviews with Nashicommissars; the youth movement’s cadres. Although relatively few in number, such insider conversations provide insight into the ethos of Nashi’s organisation and the outlook of those who have pledged their involvement. Besides the discussion of Nashi’s manifesto, the reader thus gains insight into the motivations of some participants and behind-the-scenes details of Nashi’s activities in response to the perceived threat of anti-government protests. The third chapter, ‘Nashi’s Bronze Soldier’, charts Nashi’s role in elevating the removal of a World War II monument from downtown Tallinn into an international dispute over the interpretation of history. The events subsequent to this securitisation of memory are charted in detail, concluding that Nashi’s activities were ultimately unsuccessful as their demands received little official support.The fourth chapter, ‘Seliger: The Foundry of Modernisation’, presents a distinctive feature of Mijnssen’s study, namely his ethnographic account as a participant observer in the Youth International Forum at Seliger. In the early years of the camp (2005–2007), Russian participants received extensive training, including master classes in ‘methods of forestalling mass unrest’ (p. 131), and the camp served to foster a sense of group identity and purpose among activists. After 2009 the event was no longer officially run as a Nashi camp, and its role became that of a forum for the exchange of ideas about innovation, although camp spirit remained a central feature. In 2010 the camp welcomed international attendees for the first time. As one of about 700 international participants in that year the author provides a fascinating account based on fieldwork diaries.Despite the polemical nature of the topic, Mijnssen’s analysis remains even-handed, exemplified in his balanced assessment of the Seliger experience. While he details the frustrations and disappointments of the international participants with regard to the unaccustomed strict camp discipline, organisational and communication failures, and the controlled format of many discussions,he does not neglect to note the camp’s successes in generating a gratifying collective dynamic between the participants, even among the international attendees who spent only a week there.In addition to the useful bibliography, the book is back-ended by two appendices, which provide the reader with important Russian-language primary source materials. The first is Nashi’s ‘Unusual Fascism’ (Neobyknovennyi fashizm) brochure, and the second is the booklet entitled ‘Some Uncomfortable Questions to the Russian Authorities’ (Neskol’ko neudobnykh voprosov rossiiskoivlasti) which was provided to the Seliger 2010 instructors to guide them in responding to probing questions from foreign participants. Given that these are not readily publicly available even now, they constitute a useful resource from the historical perspective.

A lean termelési rendszer munkásokra gyakorolt hatása (Effects of lean production on quality of working life from workers’ point of view)

A lean termelési rendszer munkásokra gyakorolt hatásaival foglalkozó irodalomban nincsen egyetértés annak megítélésében, hogy a hatásokban a negatív vagy pozitív hatások dominálnak-e. A szerző tanulmánya ehhez a vitához a pszichológiai, egészségügyi, munkahelyi jellemzőkre és a dolgozói elégedettségre vonatkozó eredmények áttekintésével kapcsolódik. A munkások elégedettségének vizsgálata arra utal, hogy a lean termelési rendszer egyszerre növeli és csökkenti is az elégedettséget, így az összességében nem változik más termelési rendszerekhez képest. A lean termelés kritikusai azt hangsúlyozzák, hogy a többi tényező negatívan hat a munkásokra. Megállapításaik megalapozottsága a nagyon kevés empirikus munka miatt megkérdőjelezhető. Ugyanakkor a tevékenységmenedzsment kutatói érdemben nem tudják cáfolni a stressz, a sérülések és betegségek kockázatának növekedését és a munka intenzívebbé válását. A negatív hatások és a várt pozitív hatások hiányának kiemelése felveti, hogy a munkavállalók bevonásán alapuló lean termelési rendszer nehezen ültethető át a gyakorlatba, illetve hogy a lean termelés intenzifikáción alapuló modellje is elterjedt. _____________ This literature review contributes to the debate related to the effects of lean production on workers. The study reviews different dimensions of the debate and focuses on issues like worker’s satisfaction, psychological effects, health and safety aspects, and workplace characteristics. Findings of researches reviewed in this paper cannot confirm that from workers’ point of view lean production is better than other production initiatives. Lean production enhances and decreases worker’s satisfaction at the same time, altogether, the satisfaction of workers does not change significantly compared to other systems. The negative impact of the other factors (psychological etc.) on workers is usually emphasized in the critique of lean production. Although, the limited number of (empirical) studies doubts these critical voices. However, Operations Management can not reject negative effects like increasing level of stress, increased risks of health and safety problems or intensification of work. The emphasis of the negative effects and the lack of positive effects can refer to the difficult employment of lean involvement system, or simply reflect that the model of lean intensification system is widely spread.

Marketing practices and their effectiveness in Taiwan's colleges of technology

The main purpose of this study was to investigate marketing practices in Taiwan's institutions of higher education and their relationship with students' college choice behaviors and attitudes. The study was conducted in 11 Taiwan's colleges of technology. It employed a multistrand conversion mixed model design, consisting of a qualitative and a quantitative strand. Funnel-sequenced interviews were conducted with 19 college administrators and the results were content analyzed using a constant-comparative method. The administrator interview data were also quantitized and used in cluster analysis of the institutions. Questionnaire data were collected from 1474 freshmen students, and analyzed using several univariate and multivariate statistical techniques including factor analysis, MANOVA, and correspondence analysis. ^ Analyses indicated that a weak relationship existed between institutions' marketing intensity and students' college choice. Students did not consider institutions' recruitment activities useful in their college searching process. They also reported little knowledge of their current school when they were deciding to enroll. Data analysis also revealed that students were practically oriented in their college selection. Academic resources, employability after graduation, and tuition were the most important attributes in students' college selection. Parents and students' social network such as friends and high school teachers were significant personal sources in enrollment decisions while institutions' representatives (i.e., recruiters) were considered the least influential. ^ Using cluster analysis, institutions were divided into three groups based on intensity of marketing efforts. Multivariate analysis of variance did not reveal significant differences between the college choice behaviors and attitudes of students who entered these three types of institutions. ^ Content analysis of the administrators' interviews indicated that the majority of them practiced passive marketing. This was primarily as a result of resistance to active marketing, lack of leadership commitment, insufficient financial and human resources, little faculty involvement, and inexperience in marketing. In comparison to public institutions, private institutions showed a more favorable attitude towards marketing concepts. They were well advanced in their recruitment activities while public schools were relatively hesitant to use marketing. Curriculum issues were not well represented in marketing activities and did not seem to be impacted by marketing needs. Based on the analysis of qualitative and quantitative data, it can be concluded that in these colleges, curriculum was more driven by commercial and industrial interest than by students' demands. ^ Theoretical, policy, and methodological implementation of the results were discussed. ^

Quality of student involvement and college contribution toward development of traditional and nontraditional undergraduate students

Nontraditional students differ from traditional students on characteristics such as age, employment status, marital status, and parental status. The quality of a student's experience is important as it relates to his or her transformation and is a reflection of the quality of the college. ^ Using theory of involvement as a framework, the purpose of this study was to test if there were differences between traditional and nontraditional undergraduate students in their ratings of quality of college involvement (academic, co-curricular, student interactions, and faculty interactions) and perceptions of college contribution toward development (intellectual, personal, social, and career). A two part survey was distributed to a random cluster sample of sophomore and higher level undergraduate classes equaling 400 undergraduate students. ^ Results of a 2 x 4 repeated measures ANOVA indicated that traditional students rated quality for co-curricular involvement and student involvement significantly higher than nontraditional students. Both traditional and nontraditional students had similar ratings of college contribution toward development. There were different patterns of correlations between involvement and development. Traditional students' ratings of academic and student involvement were more highly correlated with development than were the ratings of nontraditional students. However, nontraditional students' ratings of academic and faculty involvement were more highly correlated with development. When testing for differences in correlations between quality of involvement and college contribution toward development, the largest observed differences were quality of student involvement and college contribution toward personal and social development. Although not significantly different, traditional students had stronger correlations between those factors than did the nontraditional students. ^ This research demonstrates the importance of using social role when defining student type. It contributes to involvement theory by explaining how traditional and nontraditional students differ in their ratings of quality of involvement. Further, it identifies different patterns of correlations between ratings of quality of involvement and college contribution toward development for the two types of students. While traditional students may need a more rounded college experience that includes more social and co-curricular experiences, nontraditional students use the classroom as their stage for learning. ^

Parental involvement: Its relation to achievement in a multiethnic sample of newly immigrated students

The current study examined how parental involvement is related to the academic adaptation and performance of a multiethnic sample of newly immigrant students from South America and the Caribbean---Argentina, Colombia, Cuba, Haiti, and English-speaking Caribbean countries. Six hundred twenty-two participants attending elementary, middle and high school in Miami-Dade and Broward Counties were interviewed during two consecutive years at their respective schools. Parents completed surveys at home and returned them by mail. ^ Three forms of parent involvement were chosen as predictor variables---(1) parental contact and communication with school, (2) parental monitoring of children's school-related activities at home, and (3) parental expectations regarding children's academic achievement. Academic performance indicators obtained from school records were students' grade point averages for math and reading (GPA), FCAT-SSS (Florida Comprehensive Assessment Test-Sunshine State Standards) scores, and FCAT-NRT (Norm Referenced Test) scores. Hypotheses were (a) that the forms of parent involvement would differ across the different cultural groups and (b) that parent involvement would relate to students' achievement, regardless of the specific form of involvement. ^ Results indicated that Cuban and Colombian parents differed significantly in terms of monitoring school-related activities of their children and had higher expectations for their children than Haitian, West-Indian, or Argentinean parents. Cuban parents were more likely to be actively engaged in communication with their children's schools than parents of the other ethnic groups. Multiple regression analyses indicated that the three forms of parent involvement accounted for a significant proportion of GPA and FCAT-SSS scores, after controlling for the effects of demographic variables---grade level, gender, and ethnicity. Given interactions of the parent involvement variables by country of origin for GPA, separate analyses indicated that parent involvement appeared to be most effective for Cubans and West Indians. Results are discussed in terms of the need for experimental intervention studies to identify causal relationships between parent involvement and academic achievement. ^

GRE as a predictor of graduate student success at a Hispanic serving institution of higher education

Accurately predicting the success of graduate students is an important aspect of determining which students should be admitted into graduate programs. The GRE is a pivotal factor to examine since it is one of the most widely used criteria for graduate school admission. Even though the GRE is advertised as an accurate tool for predicting first year graduate GPA, there is a lack of research on long term success factors such as time to degree and graduate rate (Luthy, 1996; Powers, 2004). Furthermore, since most studies have low minority sample sizes, the validity of the GRE may not be the same across all groups (ETS, 2008b; Kuncel, Hezlett, & Ones, 2001). Another gap in GRE studies is that few researchers analyze student characteristics, which may alter or moderate the prediction validity of the GRE. Thus, student characteristics such as degree of academic involvement, mentorship interactions, and other academic and social experiences have not been widely examined in this context. These gaps in the analysis of GRE validity are especially relevant given the high attrition rates within of some graduate programs (e.g., an estimated 68% of doctoral student never complete their programs in urban universities; Lovitts, 2001). A sequential mixed methods design was used to answer the research questions in two phases. The quantitative phase used student data files to analyze the relationship of two success variables (graduation rate and graduate GPA) to the GRE scores as well as other academic and demographic graduate student characteristics. The qualitative phase served to complement the first phase by describing a wider range of characteristics from the 11 graduate students who were interviewed. Both proximal and distal moderators influence student behaviors and success in graduate school. In the first phase of the study, the GRE was the distal facilitator under analysis. Findings suggested that both the GRE Quantitative and the GRE Verbal were predictors of success for master’s students, but the GRE Quantitative was not predictive of success for doctoral students. Other student characteristics such as demographic variables and disciplinary area were also predictors of success for the population of students studied. In the second phase of the study, it was inconclusive whether the GRE was predictive of graduate student success; though it did influence access to graduate programs. Furthermore, proximal moderators such as student involvement, faculty/peer interactions, motivational factors, and program structure were perceived to be facilitators and/or detractors for success.

Parents Acquiring Learning Strategies (PALS): How Empowering Hispanic Parents Increases Parental Involvement and Student Achievement

Some Hispanic parents in Miami-Dade County show limited involvement in the educational process of their children. Currently, Miami-Dade County Public schools consists of an increasingly high number of language minority students who come from homes where parents are limited in their English proficiency. Consequently, these parents have difficulty assisting their children with schoolwork and often feel they lack adequate skills to involve themselves in school curricula. The lack of parental involvement by this population has a negative impact on students’ learning and their academic achievement. The purpose of this study is to impact the level of participation of these families and to study its ultimate effect on students’ academic achievement.

The Transitioning Economic Dynamics of the Military in Communist Regimes: A Comparison of Cuba, China and Vietnam [Student's Paper Series]

Several factors can increase or decrease military-economic involvement in communist regimes. This anomalous form of military behavior, labeled as the Military Business Complex (MBC), emerged in various communist regimes in the 1980s. However, in early 2000s, the communist governments of China and Vietnam began to decrease the number of military-managed industries, while similar industries increased in Cuba. This paper explains why military industries in Cuba have increased over the last two decades, while they decreased in the Chinese and Vietnamese examples. This question is answered by comparatively testing two hypotheses: the Communist Party and the Bureaucratic-Authoritarian (BA) Hypotheses. The Communist Party hypotheses helps explain how the historical and current structures of Party oversight of the military have been lacking in strength and reliability in Cuba, while they traditionally have been more robust in China and Vietnam. The BA hypotheses helps explain how, due to the lack of a strong civilian institutional oversight, the Cuban military has grown into a bureaucratic entity with many political officers holding autonomous positions of power, an outcome that is not prevalent in the Chinese and Vietnamese examples. Thus, with the establishment of a bureaucratic military government and with the absence of a strong party oversight, the Cuban military has been able to protect its economic endeavors while the Chinese and Vietnamese MBC regimes have contracted.

Does U.S counter-drug policy affect nationalism in the Anglophone Caribbean? A comparative study on the impact of counter-drug policy on nationalism in Jamaica and Trinidad and Tobago

This dissertation examined the effect of United States counter-drug policy on nationalism in small states, focusing on Jamaica and Trinidad and Tobago. The states were selected for their roles and geostrategic importance in the illegal drug trade; Jamaica being the largest drug producing country in the Anglophone Caribbean and having strong links to the trade of Colombian cocaine, and Trinidad being a mere seven miles from the South American coast. Since U.S. counterdrug policies have frequently been viewed in the region as imperialistic, this dovetails into ideas on the perceptions of smallness and powerlessness of Caribbean nations. Hence, U.S. drug policies affect every vulnerability faced by the Caribbean, individually and collectively. Thus, U.S. drug policy was deemed the most appropriate independent variable, with nationalism as the dependent variable. In both countries four Focus Groups and one Delphi Study were conducted resulting in a total of 60 participants. Focus Group participants, recruited from the general population, were asked about their perception of the illegal drug trade in the country and the policies their government had created. They were also asked their perception on how deeply involved the U.S. was in the creation of these policies and their opinions on whether this involvement was positive or negative. The Delphi Study participants were experts in the field of local drug policies and also gave their interpretations of the role the U.S. played in local policy creation. Coupled with this data, content analysis was conducted on various newspaper articles, press releases, and speeches made regarding the topic. In comparing both countries, it was found that there is a disconnect between government actions and the knowledge and perceptions of the general public. In Trinidad and Tobago this disconnect was more apparent given the lack of awareness of local drug policies and the utter lack of faith in government solutions. The emerging conclusion was that the impact of U.S. drug policy on nationalism was more visible in Trinidad and Tobago where there was a weaker civil society-government relationship, while the impact on nationalism was more obscure in Jamaica, which had a stronger civil-society government relationship.