Government intervention in a dynamic economy

From the late 1970s onwards, the view that government intervention could provide a means of overcoming market failure in advanced was increasingly questioned. For some, intervention was to be discouraged because it interfered with individual liberty. For others, what was problematic was the welfare economist's assumption of an autonomous state acting in the public interest. Finally, there was the issue of the state's ability to achieve what it set out to do. Government failure it was argued was just as pervasive as market failure and no antidote to it. This paper critically evaluates such arguments in relation to competition, industrial change, innovation, and competitive advantage in production.

Home is Where the Human is?:Ethics, Intervention and Hospitality in Kosovo

The human is frequently made central to the way international ethics is thought and practiced. Yet, frequently, the human can be used to close down ethical options rather than open them up. This article examines the case of British foreign policy in Kosovo. It argues that the human in this context was placed at the centre of ethical action, but was discursively constructed as a silent, biopolitial mass which could only be saved close to its territorially qualified home. It could not be protected by being brought to the UK. To remain human, the subject of ethical concern, the Kosovan refugee, had to remain near Kosovo. This construction of the human-home relationship meant that military humanitarian intervention became the only ethical policy available; hospitality, a welcoming of the Kosovan refugee into the British home, was ruled out. This article questions such a construction of the human, listening to the voices of Kosovan refugees to open up the relationship between the human and its home. The complexity that results shows that a more nuanced view of the human would not allow itself to be co-opted so easily to a simplistic logic of intervention. Rather, it could enable the possibility of hospitality as another way of practicing international ethics.

Culture and the Irish Border:Spaces for Conflict Transformation

The Irish border has been described as a ‘natural’ cultural divide between the island's two dominant indigenous ethno-national communities. However, an examination of key resources of ethno-national group culture - religion, sport and language - provides evidence to challenge this representation. Moreover, in the post-1994 period of conflict transformation, evidence is also presented to support the proposition that the Irish border region has developed into a cultural space in which Irish nationalist and Ulster unionist ethno-national communities can explore cultural differences and commonalities through cross-border, cross-community contact and communication in small group encounters. This space underpins the reconfiguration of the border from barrier to political bridge between North and South. European Union (EU) Peace programmes for Ireland, beginning in 1995, provided the support for a cross-border approach to escaping the cage of ethno-national conflict in Northern Ireland. However, post-2004 EU enlargement signalled the beginning of the end for EU Peace funding and severe economic recession has undermined the expectation of British-Irish intergovernmental intervention to support cross-border partnerships and their work. Therefore, the outlook for the sustainability of this cross-border cultural space is gloomy with potentially deleterious consequences for the continued reconfiguration of the border from barrier to bridge.

Hanging Flower Baskets, Blowing in the Wind? Third Sector Groups, Cross-Border Partnerships and the EU Peace Programmes in Ireland

The EU’s Peace programmes in Ireland have promoted the cross-border activity of Third sector groups. Potentially, such activity gives substantive meaning to regional cross-border governance and helps to ameliorate ethno-national conflict by providing positive sum outcomes for ‘post-conflict’ communities. The paper mobilizes focused research conducted by the authors to explore this potential. It finds that while regional cross-border governance has indeed developed under the Peace programmes, the sustainability of the social partnerships underpinning this governance is uncertain and its significance for conflict resolution is qualified by difficulties in forming a stable power-sharing arrangement at the political elite level.

Effect of a pharmacist-led multicomponent intervention focussing on the medication monitoring phase to prevent potential adverse drug events in nursing homes

OBJECTIVES: To determine the extent to which the use of a clinical informatics tool that implements prospective monitoring plans reduces the incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality.

DESIGN: Randomized cluster trial.

SETTING: Twenty-five nursing homes serviced by two long-term care pharmacies.

PARTICIPANTS: Residents living in nursing homes during 2003 (1,711 in 12 intervention; 1,491 in 13 usual care) and 2004 (1,769 in 12 intervention; 1,552 in 13 usual care).

INTERVENTION: The pharmacy automatically generated Geriatric Risk Assessment MedGuide (GRAM) reports and automated monitoring plans for falls and delirium within 24 hours of admission or as part of the normal time frame of federally mandated drug regimen review.

MEASUREMENTS: Incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality.

RESULTS: GRAM triggered monitoring plans for 491 residents. Newly admitted residents in the intervention homes experienced a lower rate of potential delirium onset than those in usual care homes (adjusted hazard ratio (HR)=0.42, 95% confidence interval (CI)=0.35–0.52), overall hospitalization (adjusted HR=0.89, 95% CI=0.72–1.09), and mortality (adjusted HR=0.88, 95% CI=0.66–1.16). In longer stay residents, the effects of the intervention were attenuated, and all estimates included unity.

CONCLUSION: Using health information technology in long-term care pharmacies to identify residents who might benefit from the implementation of prospective medication monitoring care plans when complex medication regimens carry potential risks for falls and delirium may reduce adverse effects associated with appropriate medication use.

Optimal glycaemic control, pre-eclampsia and gestational hypertension in women with type 1 diabetes in the Diabetes and Pre-Eclampsia Intervention Trial

OBJECTIVE
To assess the relationship between glycemic control, pre-eclampsia, and gestational hypertension in women with type 1 diabetes.

RESEARCH DESIGN AND METHODS
Pregnancy outcome (pre-eclampsia or gestational hypertension) was assessed prospectively in 749 women from the randomized controlled Diabetes and Pre-eclampsia Intervention Trial (DAPIT). HbA1c (A1C) values were available up to 6 months before pregnancy (n = 542), at the first antenatal visit (median 9 weeks) (n = 721), at 26 weeks’ gestation (n = 592), and at 34 weeks’ gestation (n = 519) and were categorized as optimal (<6.1%: referent), good (6.1–6.9%), moderate (7.0–7.9%), and poor (=8.0%) glycemic control, respectively.

RESULTS
Pre-eclampsia and gestational hypertension developed in 17 and 11% of pregnancies, respectively. Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy compared with women who did not develop pre-eclampsia (P < 0.05, respectively). In early pregnancy, A1C =8.0% was associated with a significantly increased risk of pre-eclampsia (odds ratio 3.68 [95% CI 1.17–11.6]) compared with optimal control. At 26 weeks’ gestation, A1C values =6.1% (good: 2.09 [1.03–4.21]; moderate: 3.20 [1.47–7.00]; and poor: 3.81 [1.30–11.1]) and at 34 weeks’ gestation A1C values =7.0% (moderate: 3.27 [1.31–8.20] and poor: 8.01 [2.04–31.5]) significantly increased the risk of pre-eclampsia compared with optimal control. The adjusted odds ratios for pre-eclampsia for each 1% decrement in A1C before pregnancy, at the first antenatal visit, at 26 weeks’ gestation, and at 34 weeks’ gestation were 0.88 (0.75–1.03), 0.75 (0.64–0.88), 0.57 (0.42–0.78), and 0.47 (0.31–0.70), respectively. Glycemic control was not significantly associated with gestational hypertension.

CONCLUSIONS
Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy. These data suggest that optimal glycemic control both early and throughout pregnancy may reduce the risk of pre-eclampsia in women with type 1 diabetes.