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In this 1996 book Roger Spegele argues that in the past international theorists have failed to recognise that there is not one conception of international relations, subdivided into different theories and approaches, but at least three wholly different conceptions of the subject. Though scholars are increasingly prepared to accept this, there is still no consensus about what to call these conceptions, how to describe them, and why they should be studied. This book attempts to fill this gap. The author first examines two conceptions of IR - positivism-empiricism and emancipatory international relations - which challenge political realism. He then defends a revised version of realism, called 'evaluative political realism', from challenges arising from its rivals, with the aim of defining a conception of political realism which is coherent, viable, and attractive

AbstractIn a variety of investment arbitration cases, respondent States have argued that measures impugned by investors were mandated by that State's human rights obligations. Tribunals have generally been reluctant to engage with such arguments and to interpret the relationship between investment law and human rights in a straightforward manner. This article discusses two other possibilities: harmonious interpretation and prioritization. Harmonious interpretation seeks to read provisions from investment treaties and human rights treaties together, whereas prioritization gives normative superiority to one provision over another. We conclude that harmonious interpretation is facilitated by the discretionary character of common treaty standards in both human rights and investment law, but that the final result is unlikely to be very different from prioritization, because even harmonious interpretation requires that one provision is read in the light of, and thereby subjugated to, the other.

This paper deals with the recent normative modifications introduced in the European Union by the Directive 2011/83/EU (aimed to realise a full harmonisation of member states' rules in some aspects of consumer and contractual law), and consequently in Italy, through the Legislative Decree No. 21/2014 (which transposed the supranational source). As it is known, the principal legal instruments used in the last years by the EU to protect the weak parties are the 'information duties' and the 'right of withdrawal'. The new rules try to strengthen them, but the implementation of the European Directive in Italy gives rise to many arguable points and perplexities.

A thesis submitted to the University of Bedfordshire, in partial fulfilment of the requirements for the degree of doctor of Philosophy. ; Healthcare self-referral leads to patients receiving care at an inappropriate level and for an unnecessarily higher cost. The patients who most require specialist services are unable to access them in an appropriate manner and the utilisation of Primary Health Care (PHC) services are undermined. In addition, healthcare providers at the referral level regarding care are overwhelmed with minor cases that would have been easily managed at the primary care level. Despite the implications of healthcare self-referral and the large proportion (60-90%) of patients self-referring in the Nigerian healthcare system, there is a dearth of information on the factors that influence healthcare self-referral from the Nigerian context. Therefore, exploratory sequential mixed method approach was employed to address the objectives of this research which were: 1) identify the factors that influence service users' self-referral to secondary healthcare facilities by exploring the perceptions and experiences of the service users and healthcare providers (qualitative approach); and 2) examine the relationships between the identified factors that influence the decision to self-refer among the self-referred service users (quantitative approach). Andersen's initial behavioural model was adopted as the theoretical model for this study. This model posits that individual's use of healthcare services is linked to their predisposing, enabling and need factors for care. Thus, the Andersen's components helped to structure and assist with the understanding of the factors linked with healthcare self-referral. The interviews (qualitative) with the service users (n=24) and healthcare providers (n=18) were analysed using the five stages of framework analysis namely familiarisation with data, identification of thematic framework, indexing, charting, mapping and interpretation of data. This generated several themes associated with service users bypassing their primary healthcare facilities to the secondary level of care. The findings reflected perceptions regarding healthcare providers, equipment, expectations of service users, and advice from friends, relatives and others. Additional factors identified included government regulations on the utilisation of healthcare facilities, medical symptoms and the perception of severity of symptoms service users present with, in addition to an understanding of the healthcare delivery system among the service users. The inferential findings of the quantitative analysis (n=449) ascertained significant differences between levels of education and understanding of healthcare delivery. Significant differences were also established between levels of education and the perceptions of healthcare providers. Further hypotheses that demonstrated significant differences comprised the relationship between employment status and ability to access the secondary level of care. The relationship between age and reported medical symptoms among the self-referred service users was also discovered to be associated with healthcare self-referral. Additionally, the descriptive analysis also disclosed diverse levels of agreement with each of the sub-scale items on the questionnaire. Overall, the quantitative findings were observed to corroborate with large parts of the qualitative findings. The findings of this research suggest the need for a multifacet approach in addressing healthcare self-referral in the Nigerian context. This include ensuring the availability of the services of doctors within the PHC facilities, ensuring equitable distribution of equipped and operational PHC facilities. In addition, there is need to educate the populace on the appropriate utilisation of the different levels of healthcare facilities. In conclusion, an original approach to healthcare self-referral was demonstrated by adopting the exploratory sequential mixed method and Andersen's model to understand healthcare self-referral. The findings also contribute to this field by examining the relationships between the factors identified to predict healthcare self-referrals and consequently, offer recommendations, as it applies to the healthcare system in Nigeria.

The paper will attempt to show that there are many factors associated with a small domestic market that have a bearing on competition law and policy, and therefore competition regime of a small state should take these factors into account. Special reference will be made to Malta, where competition legislation is modelled on EU competition law. The thrust of the arguments put forward in this paper is not that competition rules should be discarded in small states or that abuse should be tolerated. The basic contention is that exceptions, normally based on considerations such as improved efficiency, distribution, and overall consumer benefit, are more likely to be relevant in small states in certain circumstances. ; peer-reviewed

"The book addresses questions about the roles of law and politics and the challenge of legitimacy in constitutional adjudication in the Supreme Court. With all sophisticated observers recognizing that the Justices' political outlooks influence their decision making, many political scientists, some of the public, and a few prominent judges have become Cynical Realists. In their view Justices vote based on their policy preferences, and legal reasoning is mere window-dressing. This book rejects Cynical Realism, but without denying many Realist insights. It explains the limits of language and history in resolving contentious constitutional issues. To rescue the notion that the Constitution is law that binds the Justices, the book provides an original account of what law is and means in the Supreme Court. It also offers a theory of legitimacy in Supreme Court adjudication. Given the nature of law in the Supreme Court, we need to accept and learn to respect reasonable disagreement about many constitutional issues. If so, the legitimacy question becomes: how would the Justices need to decide cases so that even those who disagree with the outcomes ought to respect the Justices' processes of decision? The book gives a fresh and counterintuitive answer to that vital question. Adapting a methodology made famous by John Rawls, it argues that the Justices should strive to achieve a "reflective equilibrium" between their interpretive principles, framed to identify the Constitution's enduring meaning, and their judgments about appropriate outcomes in particular cases, evaluated as prescriptions for the nation to live by in the future. The book blends the perspectives of law, philosophy, and political science to answer theoretical and practical questions of pressing national importance"--

Observers of international courts (ICs) note that several ICs carry out a broad range of non-judicial activities, ranging from legal training workshops and public seminars to visits with public officials. Despite the growing prominence of these activities, they have received little attention from scholars. Seeking to fill this gap, this article examines these activities as a form of 'judicial diplomacy', asking how and why ICs employ judicial diplomacy. The article argues that ICs use judicial diplomacy as a means of legitimation. They seek to boost institutional legitimacy through their judicial diplomacy by targeting the public and communicating norm-referential narratives about their processes and outcomes. This argument bears out in case studies on the judicial diplomacy of the African Court of Human and Peoples' Rights and the Caribbean Court of Justice. Both courts are shown to have judicial diplomacy that is public-oriented and people-centred. This argument has important implications for literature on international courts and the legitimacy of international institutions.

BackgroundA combination of increased life expectancy and improvements in childhood survival rates has resulted in a persistent increase in the population at risk of chronic conditions and multimorbidity (WHO, 2016). Relatively little is known about levels of multi-morbidity, combinations of multi-morbid disorders or risk factors among the Northern Ireland (NI) population.
ObjectivesThis study aims to estimate rates of multi-morbidity among adults aged 25 and over in the NI population and examine the association of multi-morbidity and combinations of multimorbid conditions with a range of social determinants.
MethodsAnalyses are based on 1,123,604 individuals enumerated in the 2011 NI census, aged 25-64 and 65 plus. Descriptive statistics report prevalence rates and logistic regression examined the association between social determinants and multi-morbidity.
ResultsOverall, 40.08% reported at least one health condition, while 19.23% reported multi-morbidity. Results confirm a clear social gradient and association between age and multi-morbidity. Multi-morbidity was more likely among females aged 25- 64 (OR=1.09), but less likely among females aged 65 plus (OR=0.93). Marriage was protective among those aged 25- 64, while those who were never married had lower risk among those aged 65 plus (OR=0.64). Further analyses exploring social determinants of morbidity profiles present a complex array of associations. Among 25-64 year olds, while females were more likely to report single mental and less likely to report single physical problems, they were less likely to report multiple mental conditions and more likely to report combined physical/mental conditions.
ConclusionsResults suggest that multi-morbidity is common among the NI adult population and is a public health issue across the lifespan. While studies assessing the validity of self-reported health conditions within census are required, findings provide tentative evidence of the complex nature of associations between social determinants and multi-morbidity and how these vary among younger and older adults.