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Background: Although antiretroviral treatment is expanding in sub-Saharan Africa, the World Health Organization advocates for integration of palliative care with HAART because pain, other distressing symptoms and complex psychosocial challenges persist throughout the HIV trajectory. Palliative care improves the outcome for patients with HIV and may complement antiretroviral treatment by increasing adherence through better management of side effects from the treatment, providing patient and family-centred holistic care, and giving end-of-life care when necessary. However, integrating what have become two disciplines is challenging. Aim: To study the implications for palliative care provision in the context of changing policy to universal access to HAART for people living with advanced AIDS (PLWA) in Uganda. Research questions addressed in the study included: 1. How do patients with advanced AIDS (stage 1Il and IV) and with palliative care needs and their families experience care delivery and receipt over a period of 8 weeks? 2. How is the morphine roll-out programme among advanced AIDS patients operationalized in Uganda? 3. What are the challenges faced by health care workers involved in delivery and implementation of integrated palliative care for patients with advanced AIDS? 4. What are the views of key opinion leaders on development of palliative care policies in Uganda? Methods: A mixed methods approach was employed. The study comprised of three phases. In phase one, a consecutive sample of 30 newly enrolled patients advanced AIDS (stage III & IV) and their carers were recruited at Hospice Africa Uganda and followed up for 8 weeks. Qualitative interviews were conducted with patients and their carers at one time point and an outcome measure using African Palliative Care Association-Palliative Outcome Scale (APeA-POS) was used to assess changes in their experiences over 8 weeks, following access to palliative care. In phase two, 10 palliative care staff members participated in individual interviews and one focus group to explore the challenges they faced in delivering services to patients. Phase three explored, by the use of interviews with 7 key stakeholders, the broader context of palliative care policy development and opinions about key priorities for the future. Findings: Out of 30 patients, 14 were male and 16 were female. They ranged in age from 18-60 years. The majority of patients were bed-ridden and experienced distressing symptoms related to advanced AIDS and AIDS-defining cancers which necessitated timely palliative care intervention. The key findings of the study relate to the range of physical symptoms experienced by patients and the psychosocial challenges of disclosure and stigma encountered by patients and their families against u backdrop of profound poverty. Palliative care staff indicated two categories which broadly covered the challenges of palliative care delivery to PLWA in Uganda: service-linked and provider-linked challenges. Palliative health care staff and key stakeholders identified strategies to respond to palliative care needs for PL W A across four dimensions: a) partnerships or networking together with stakeholders; b) improving palliative care education; c) raising awareness of palliative care among communities and health care workers; d) advocacy and policies which support and strengthen initiation and expansion of palliative care services to PL W A, including the availability of morphine. Conclusion: The study shows the paramount importance of drawing on patients' and carers' experiences and concerns to shape models of African palliative care. Both palliative care staff and key informants' perspectives highlight successes, barriers and important lessons for palliative care service delivery in Uganda. These lessons have several implications across the dimensions of practice, education, policy and research. Palliative care staff need to work with several key players or stakeholders to address the many psychosocial issues affecting PL W A including support during treatment. The study indicates the need to translate government policies on palliative care into action. - See more at: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.555603#sthash.xCqlrNoD.dpuf

"The question at hand seems relatively simple and straightforward: whether and to what extent the protection and promotion of human rights is necessary for efforts to address conflict and build peace. The issue has been much debated over time. The 1948 Universal Declaration of Human Rights forcefully associated the protection of human rights with the prevention of violent conflict, stating that 'it is essential, if man is not to be compelled to have recourse, as a last resort, to rebellion against tyranny and oppression, that human rights should be protected by the rule of law' (UN 1948, preamble). Yet in 1996, an anonymous author in Human Rights Quarterly accused the international human rights movement of prolonging the war in Bosnia Herzegovina. There, human rights activists had rejected pragmatic deals that could have ended the violence and, from hindsight, were no worse than the eventual agreement in rewarding ethnic cleansing and aggression. In that author's view, it made 'today's living the dead of tomorrow' by pursuing a perfectly just and moral peace that would bring 'justice for yesterday's victims of atrocities' (Anonymous 1996, 259). Since then, the idea that the normative nature of human rights standards may complicate the practical demands of peacemaking has been a recurrent theme in discussions on the relationship between human rights and efforts to address violent conflict. This is especially the case when the latter is conceived of in terms of conflict settlement or resolution. Questions of definitions and objectives are thus key. Also relevant are the time frame, context and level of intervention one focuses on, though few authors on the subject make this explicit. In addition, narrow perceptions and generalizations abound in this debate as people working on human rights, peace and conflict have been grouped into categories of 'human rights activists' and 'conflict resolvers' as if these were homogenous and coherent clusters of actors. In this chapter, the authoress argues that considering human rights and conflict transformation in conjunction deepens one's analysis of what is involved in moving from violence to sustainable peace. It is informed by the idea that the two fill 'gaps' in one another, in that each contributes to a better understanding of the other by highlighting elements that are relatively under-explored in the theory and practice of each separate field. For conflict transformation, which will be the main focus here, the perspective of human rights forces a greater emphasis on structural conditions, especially the role of the state, systems of governance and issues of power in generating, escalating and transforming violent conflict. Considering human rights in relation to conflict transformation, moreover, highlights the need to employ a holistic, multidimensional understanding of human rights that does not reduce them to their legal foundations. This chapter suggests that conflict transformation, because of its explicit grounding in social justice, and hence inherently normative foundation, may provide a more nuanced and fruitful conceptual space for thinking about human rights, conflict and peace than conflict resolution and conflict management. Placing constructive social change at its core, conflict transformation acknowledges the need for addressing power imbalances and recognizes a role for advocacy and the importance of voices that challenge the status quo. Its concern with direct, structural and cultural violence is thus also highly relevant from a rights perspective. In order to place these ideas in context, the chapter will briefly comment on literature that has been published on human rights and approaches for addressing conflict and building peace (section 2). Section 3 proposes a framework for understanding the relationship between human rights and conflict transformation, using the metaphor of an iceberg, with its graphic image of things visible connected to matters unseen. It also introduces four dimensions of human rights that need to be taken into account in processes to build a just and sustainable peace. Section 4 discusses some of the practical implications of adopting a human rights perspective on conflict transformation. Nepal, South Africa, and other countries where the authoress has worked over the past 15 years, are used as illustrative examples throughout sections 3 and 4. Finally, section 5 concludes and points to some areas for further research." (excerpt)

David Pocock's previously unpublished Inaugural Lecture on 'The point of death' marked his promotion to a Personal Chair at the University of Sussex and was delivered on 3rd May 1977. Pocock generously gave Parry a copy of his text while the latter was writing up material on death in Banares, and as far as we know, this is the only hard copy that has survived (though an audio recording of the lecture itself is listed in the Sussex University Library catalogue). It was written for verbal presentation and, at points, has a somewhat elliptical quality (though that is also true of much that Pocock published). The main text has been edited as lightly as possible and only with a view to occasionally clarifying its meaning. The comments and references in the footnotes have all been added by us. We are grateful to David Pocock's executors, Paul and Susan Yates, for permission to include his lecture alongside our own appreciation of him. The justification for doing so is its enduring interest—both as a still highly suggestive contribution to the comparative study of mortuary practices and of ideas about death, and as an historical document that evokes a number of Pocock's intellectual preoccupations and something of his intellectual style. As our own contribution to this issue of the journal has suggested, death was a topic on which he had long reflected; and here, he addresses it with characteristic erudition and an impressively catholic range of reference to literary and historical sources. But the resonances with his other writings go much further than that. These include: his continuing concern with the way in which uncontrollable biological occurrences and the effects of duration are subordinated to society (showing here that 'the point of death is not the point of death'); and his related concern with the way in which unrepeatable historical events that unfold in linear time are accommodated to a theory of endlessly repeated cyclical time. Thus, the classical Hindu theory of the kaliyug is invoked to argue that the 'good death' of the householder is not really so 'good' after all. It is merely a kind of ersatz kaliyug version of the ideal, which supposes that by the time of his death, the householder will have taken sanyas. This fudge, Pocock intriguingly suggests, is associated with the fuzziness and contradictoriness of the eschatology. And that's another of his recurring themes—the vague and tentative nature of religious belief. But perhaps, the most important message of his lecture has to do with the contrast it sets up between the 'traditional complex', with which the first part of the article is concerned and for which Hindu India stands, and the 'modern complex' exemplified by the contemporary and significantly secularised West, where the values of individualism are associated with 'a maximal denial of death'—and indeed, of society itself. The contrast looks, on the face of it, highly Dumontian; but on closer reading, it is distinctly ambiguous. Though the 'imperative insistence' of Christian doctrine on the survival of the individual soul precludes the assimilation of the individual personality into a general category in a way that no other culture has done, and though the individual's death is represented as being as unique as his birth and subsequent life, elements of the 'traditional complex' nevertheless persist. Rumours about mixing up bones and ashes in the crematorium recur, the standardised depersonalised coffin comes to stand for the deceased and Lily Pincus's advocacy of a renewed intimacy with death and the dying is welcomed as a modern transformation of the older complex. It is the open-endedness and his sense of the complex ambiguity of social and intellectual life that makes Pocock both so frustratingly elusive and so attractive as a thinker. Editorial note by Jonathan Parry and Edward Simpson

When facing the challenge of finding ways to reduce GHG emission to mitigate climate change, besides the actions by government at all levels, planners also need to consider how local communities, which are important actors in the implementation of climate protection plans, react and participate in the process. Through a case study of climate change and community sustainability initiatives in the City of Davis, California, this thesis explores the community participation process and evaluates its effectiveness. I conducted this research by observing the Davis Climate Action Team (CAT) meetings and related public forums, interviewing related participants, participating in the Low Carbon Diet Pilot Program (LCDPP) and its meetings, and surveying the participants of LCDPP. From the analysis of two community programs, I have found that the City of Davis' planned community participation plays an important role in helping the City staff develop the local action plan and motivate participants to change their energy consumption behaviors. Through organization of the CAT and its operation, the community started a process of community engagement. These processes not only increased public awareness of climate action issues but also provided a platform for people to learn from each other and build consensus on future climate actions. The LCDPP further motivated people to change their energy consumption behaviors to reduce their carbon footprints by efficient tools and group support. The results of the two programs show that mixed planning methods are useful in facing the challenge of climate change. The planner used not only traditional comprehensive planning to develop its cost-effectiveness analysis but also advocacy and communicative planning to further iii promote the importance of climate protection and understand what the community wants and therefore enhance the feasibility of future implementations. The results of LCDPP survey also show that changing people's behaviors is not a one-off event but a process. It requires not only giving tools to people but providing the enabling environment and incentives. However, some challenges still exist. Inconstant involvement of some CAT members, limited communication among the CAT, the city departments, and the general public, the uncertain final decision of the plan, and insufficient human resources in developing and implementing the necessary work to keep adequate communication and meet the specific time frame in the CAT process all hinder the effectiveness of participation. For the LCDPP, many self-selected participants have already engaged in low carbon activities before. The fact that the housing energy-use focus in the workbook ignored other strategies and renters' situations also decreased people's willingness to participate. Moreover, the relatively small GHG reduction seems not to meet the City goal of GHG reduction. The lack of a follow up check mechanism also makes the real GHG savings uncertain. In order to achieve broader and more substantial community participation, I propose an ideal community participation process in climate planning and provide specific recommendations for cities to achieve the process. Cities could (a) assign specific GHG reduction goals to varied programs to achieve the overall reduction requirement; (b) develop multiple outreach and participation methods to reach different social groups in their communities; (c) use alternative methods to keep the participation process transparent and open to the public; (d) develop various methods to ensure as iv much as possible that all participants have accurate information and equal access to make decisions and that suggestions from every participant will be equally considered; (e) add sufficient resources for community participation to improve communication and accelerate the process; (f) provide specific incentives and information to attract more participants; (g) work with existing social organizations to approach people more naturally and to keep the network more cohesive; and (h) set up a monitoring and evaluation mechanism to monitor and verify the effectiveness. I also suggest that more research is needed in order to understand ways that community participation can be more effectively implemented and its effectiveness within varied social contexts. Comparison studies are also recommended to understand the overall effectiveness of community participation in climate protection planning.

Objetivo. Presentar los primeros datos de un estudio de base poblacional sobre sordera y deficiencia auditiva en Brasil. Métodos. Se realizó una encuesta transversal de hogares en 2003 en la que participaron 2 427 personas de 4 años de edad o más. La población de estudio estuvo compuesta por 1 040 hogares escogidos de manera sistemática en 40 sectores censales (conglomerados de viviendas) escogidos al azar en la ciudad de Canoas, estado de Rio Grande do Sul, en el sur de Brasil. Se evaluó la función auditiva de los participantes mediante audiometría tonal liminar y examen físico, según el Protocolo para el Estudio de Trastornos Óticos y Auditivos y las definiciones de niveles auditivos, ambos de la Organización Mundial de la Salud. Entre los datos socioeconómicos colectados estaban los años de escolaridad de las personas estudiadas y los ingresos del jefe del hogar. Resultados. Se encontró que 26,1% de la población estudiada mostró algún grado de deficiencia auditiva y 6,8% (intervalo de confianza de 95% [IC95%]: 5,5% a 8,1%) se clasificó en el grupo con deficiencia auditiva incapacitante. La prevalencia de pérdida auditiva moderada fue de 5,4% (IC95%: 4,4% a 6,4%); de pérdida auditiva grave, 1,2% (IC95%: 0,7% a 1,7%); y de pérdida auditiva profunda, 0,2% (IC95%: 0,03% a 0,33%). Los grupos en mayor riesgo de pérdida auditiva fueron los hombres (razón de posibilidades [odds ratio, OR] = 1,54; IC95%: 1,06 a 2,23); los participantes de 60 años de edad o más (OR = 12,55; IC95%: 8,38 a 18,79); los que tenían menos años de escolaridad formal (OR = 3,92; IC95%: 2,14 a 7,16); y los que tenían menores ingresos (OR = 1,56; IC95%: 1,06 a 2,27). Conclusiones. Estos resultados respaldan las recomendaciones de los planificadores de políticas sanitarias y de los proveedores de servicios de salud sobre la prevención de la sordera y la deficiencia auditiva. Además, pueden contribuir a aumentar el nivel de conciencia de la comunidad, las universidades y las agencias gubernamentales acerca de las necesidades de atención sanitaria que generan los problemas auditivos. ; Objective. To provide the first population-based data on deafness and hearing impairment in Brazil. Methods. In 2003, a cross-sectional household survey was conducted of 2 427 persons 4 years old and over. The study population was composed of 1 040 systematically chosen households in 40 randomly selected census tracts (dwelling clusters) in the city of Canoas, which is in the state of Rio Grande do Sul, in southern Brazil. Hearing function was evaluated in all subjects by both pure-tone audiometry and physical examination, using the World Health Organization Ear and Hearing Disorders Survey Protocol and definitions of hearing levels. The socioeconomic data that were gathered included the amount of schooling of all individuals tested and the income of the head of the household. Results. It was found that 26.1% of the population studied showed some level of hearing impairment, and 6.8% (95% confidence interval (CI) = 5.5%–8.1%) were classified in the disabling hearing impairment group. The prevalence of moderate hearing loss was 5.4% (95% CI = 4.4%–6.4%); for severe hearing loss, 1.2% (95% CI = 0.7%–1.7%); and for profound hearing loss, 0.2% (95% CI = 0.03%–0.33%). The groups at higher risk for hearing loss were men (odds ratio (OR) = 1.54; 95% CI = 1.06–2.23); participants 60 years of age and over (OR = 12.55; 95% CI = 8.38–18.79); those with fewer years of formal schooling (OR = 3.92; 95% CI = 2.14–7.16); and those with lower income (OR = 1.56; 95% CI = 1.06–2.27). Conclusions. These results support advocacy by health policy planners and care providers for the prevention of deafness and hearing impairment. The findings could help build awareness in the community, in universities, and in government agencies of the health care needs that hearing problems create.

Objetivo. Presentar los primeros datos de un estudio de base poblacional sobre sordera y deficiencia auditiva en Brasil. Métodos. Se realizó una encuesta transversal de hogares en 2003 en la que participaron 2 427 personas de 4 años de edad o más. La población de estudio estuvo compuesta por 1 040 hogares escogidos de manera sistemática en 40 sectores censales (conglomerados de viviendas) escogidos al azar en la ciudad de Canoas, estado de Rio Grande do Sul, en el sur de Brasil. Se evaluó la función auditiva de los participantes mediante audiometría tonal liminar y examen físico, según el Protocolo para el Estudio de Trastornos Óticos y Auditivos y las definiciones de niveles auditivos, ambos de la Organización Mundial de la Salud. Entre los datos socioeconómicos colectados estaban los años de escolaridad de las personas estudiadas y los ingresos del jefe del hogar. Resultados. Se encontró que 26,1% de la población estudiada mostró algún grado de deficiencia auditiva y 6,8% (intervalo de confianza de 95% [IC95%]: 5,5% a 8,1%) se clasificó en el grupo con deficiencia auditiva incapacitante. La prevalencia de pérdida auditiva moderada fue de 5,4% (IC95%: 4,4% a 6,4%); de pérdida auditiva grave, 1,2% (IC95%: 0,7% a 1,7%); y de pérdida auditiva profunda, 0,2% (IC95%: 0,03% a 0,33%). Los grupos en mayor riesgo de pérdida auditiva fueron los hombres (razón de posibilidades [odds ratio, OR] = 1,54; IC95%: 1,06 a 2,23); los participantes de 60 años de edad o más (OR = 12,55; IC95%: 8,38 a 18,79); los que tenían menos años de escolaridad formal (OR = 3,92; IC95%: 2,14 a 7,16); y los que tenían menores ingresos (OR = 1,56; IC95%: 1,06 a 2,27). Conclusiones. Estos resultados respaldan las recomendaciones de los planificadores de políticas sanitarias y de los proveedores de servicios de salud sobre la prevención de la sordera y la deficiencia auditiva. Además, pueden contribuir a aumentar el nivel de conciencia de la comunidad, las universidades y las agencias gubernamentales acerca de las necesidades de atención sanitaria que generan los problemas auditivos. ; Objective. To provide the first population-based data on deafness and hearing impairment in Brazil. Methods. In 2003, a cross-sectional household survey was conducted of 2 427 persons 4 years old and over. The study population was composed of 1 040 systematically chosen households in 40 randomly selected census tracts (dwelling clusters) in the city of Canoas, which is in the state of Rio Grande do Sul, in southern Brazil. Hearing function was evaluated in all subjects by both pure-tone audiometry and physical examination, using the World Health Organization Ear and Hearing Disorders Survey Protocol and definitions of hearing levels. The socioeconomic data that were gathered included the amount of schooling of all individuals tested and the income of the head of the household. Results. It was found that 26.1% of the population studied showed some level of hearing impairment, and 6.8% (95% confidence interval (CI) = 5.5%–8.1%) were classified in the disabling hearing impairment group. The prevalence of moderate hearing loss was 5.4% (95% CI = 4.4%–6.4%); for severe hearing loss, 1.2% (95% CI = 0.7%–1.7%); and for profound hearing loss, 0.2% (95% CI = 0.03%–0.33%). The groups at higher risk for hearing loss were men (odds ratio (OR) = 1.54; 95% CI = 1.06–2.23); participants 60 years of age and over (OR = 12.55; 95% CI = 8.38–18.79); those with fewer years of formal schooling (OR = 3.92; 95% CI = 2.14–7.16); and those with lower income (OR = 1.56; 95% CI = 1.06–2.27). Conclusions. These results support advocacy by health policy planners and care providers for the prevention of deafness and hearing impairment. The findings could help build awareness in the community, in universities, and in government agencies of the health care needs that hearing problems create.

This report looks at the efforts of nonprofit data intermediaries to provide the institutions and individuals working in low-income urban neighborhoods with access to neighborhood-level data resources and the ability to use them to effect positive social change. The rise of data intermediaries has been propelled by the rise and diffusion of advanced information and computing technologies, including the Internet and Geographic Information Systems (GIS). In the decade or so since data intermediaries first arose on the scene, they have overwhelmingly adopted the Internet as their primary means for disseminating data resources, creating online "neighborhood information systems" that can be freely accessed by the broad public. In this study, the author investigates the development of data intermediaries within the community development and community building fields and looks at how they are harnessing the Internet and GIS toward these ends. The work of data intermediaries fits within the broader action frameworks of community capacity building and community technology. Operating at the intersection of these agendas, the activities of data intermediaries primarily address what has been called the "organizational divide," or the gap between community organizations' potential use for digital technologies and their ability to access and use these technologies. As community groups have taken on greater responsibilities in providing services and public goods to urban constituencies, they have become more professionalized and have demanded access to data and data analysis tools such as GIS. Despite the utility of these resources for community groups, they are resource-poor and often lack both access to these tools and the capacity required to apply them to their planning, service delivery and advocacy activities. The ability of data intermediaries to "democratize data"—defined as enabling community actors to access data and to use it to build community capacity to effect social change—is influenced by the availability of financial resources, the local political context and the local organizational culture. One of the challenges faced by data intermediaries is the attitude toward data on the part of the communities they seek to serve. These are often the same communities that data has historically been used against through practices such as redlining. Because of this challenge, the author hypothesizes that trust is an important bridging factor that allows data intermediaries to attain their goal of democratizing data. Through a comparative case study analysis of data intermediaries in Oakland and New Orleans, the author looks at the practice of democratizing data and the constraints and opportunities faced by data intermediaries. In doing so, she pays particular attention to the ways in which each organization perceives the variable of trust and acts to foster trust between itself, its online data resources and its target audiences. She finds that the process of democratizing data via the Internet is underwritten by trust-building efforts on the part of data intermediaries. In each case, trust-building is an important component of the data intermediary's work. Each organization, however, has developed different methods of incorporating trust-building into their programs, methods which resonate with its overall organizing logic. Each provides a sort of model by which data intermediaries shape information and information technologies in ways that make them useful for the communities they seek to serve. In describing these models, the author characterizes the New Orleans group as design-based and the Oakland group as partnership-based. These cases illustrate a palette of methods by which data intermediaries can build trust and show the diversity of forms of practice within the field. Activities engaged in by data intermediaries to build trust include collaborative program development, outreach and networking, iterative site design and user testing, culturally-relevant and community-specific site content, and online and in-person training modules. Through these methods, data intermediaries mitigate the negative unintended consequences involved in bringing expert spatial data technologies to marginalized communities and remake information technologies into community technologies.

Since 1995, the James Irvine Foundation has invested more than $11 million to support the growth and development of Collaborative Regional Initiatives (CRIs) throughout the state -- nonprofit organizations that engage key players from business, environmental, and a variety of other advocacy groups with players from local governments and public agencies to create improvements in their regions. CRIs work on issues ranging across transportation, land use, housing, and economic development. They work in a variety of ways from developing legislation to media campaigns to practical work on particular projects. All are directed at building civic capacity and filling in gaps where government does not or cannot act. Some CRIs have been in place for years; others are more recently formed. They represent experiments in regional governance. The Irvine Foundation tapped a team of Berkeley faculty to perform an assessment of the CRIs so the foundation can target its resources in order to make them effective and sustainable over time and assist them in producing valuable outcomes for their regions. Together the team published case studies of four major CRIs -- the Bay Area Alliance for Sustainable Communities, Joint Venture: Silicon Valley, the San Diego Dialogue and the Sierra Business Council -- as well as an analysis of regional workforce development collaboratives in California. The study of regional workforce development collaboratives in California looks at a new approach to the problem of linking economic and workforce development -- in particular, a theory of change proposed by a group of stakeholders from a variety of sectors (government, foundations, and the workforce development system) in the late 1990s. To meet the multiple goals of increasing economic opportunity, decreasing poverty, and increasing regional economic competitiveness, these experts advocated a new workforce development system that was collaborative in scope, regional in scale, career-oriented in focus, and data-intensive in strategy. This study examines five cases that broadly follow this model of regional collaboration in order to determine how effective they are at problem-solving. The California Center for Regional Leadership (CCRL), the James Irvine Foundation (JIF), and the California Employment Development Department (EDD) worked with organizations to produce proposals that developed career progressions and identified partners and funding. Four organizations -- three Collaborative Regional Initiatives (CRIs) and one community college that was formerly part of a CRI -- were selected in March 2001. Of the CRIs, Fresno Area CRI was to train in occupations related to its water technology cluster; Gateway Cities Partnership (GCP) was to train in logistics; and Orange County Business Council (OCBC) was to train in information technology. Cabrillo College -- formerly part of a CRI called the Santa Cruz Clusters Project -- created the Watsonville Digital Bridge Academy (WDBA) also to train in information technology. This study compares these four workforce demonstration projects with another regional workforce development collaborative, the San Francisco Information Technology Consortium (SFITC). SFITC, which is funded in part by the James Irvine Foundation, consists of a network of community-based organizations and community colleges offering entry-level computer training, job placement, upgrade training, and needed social support to current and prospective IT workers. Based on 40 interviews with collaborative leaders and key informants, as well as review of related documents, this study asks whether the CRIs organize problem-solving around workforce development more effectively than do other collaboratives. It finds that regional collaboration is not well suited to addressing both workforce and economic development goals; however, it can make workforce development programs more effective if partners from both inside and outside the current system are engaged in a networked structure with clear roles and responsibilities, as opposed to a collaboration on paper. The report looks first at how organization structure (origin, mission, and organization), economic development focus, program design, and collaborative style shape program and other outcomes such as adaptiveness, ability to mobilize resources, and system change. A final section addresses the potential for sustainability of these workforce development innovations and the policy implications that emerge from the comparison of collaboratives.

Access to antiretroviral medicines (ARVs) for AIDS treatment creates a field binding local and global governance. Local modalities of AIDS treatment are governed by the context of global trade through the implementation of patents on medicines in the World Trade Organisation (WTO), and within the context of global aid through development assistance. While industrialized countries, on the one hand, set aside donations to fight AIDS in developing countries, on the other hand, the same countries use the WTO to prevent developing countries from accessing cheap medicines. Uganda's success in reducing HIV prevalence is unique among African states, and it is considered the most promising candidate for effectively "scaling up" ARV treatment on the basis of its history of dealing with the pandemic. Yet, despite the many interventions addressing HIV/AIDS and dramatic price reductions of ARVs, only a minority of the infected population is currently receiving treatment, and promises of universal coverage for all who need it seem unrealistic. Our paper examines how the disconnect between international and national priorities on the one hand, and between aid and trade on the other, are currently affecting access to ARVs in Uganda. In spite of the political discourse of equality in treatment, the realities of funding suggest the difficult choices will be made from the level of policy to that of individual. Thus, global governance of trade and of aid will both shape and rely on individuals in charge of "implementation" which must be examined outside the sanitizing context of development discourse. We introduce our use of governance in this paper, and then discuss the global governance of aid to AIDS and global governance of trade and AIDS. The second half of the paper examines the Ugandan case study beginning with a political background and examination of aids policy, followed by the history of ARV provision and advocacy for ARVs, a discussion of the national health system and then aid initiatives and trade of ARVs in Uganda. Finally, we draw preliminary conclusions from our case on the conflicts between global and local governance of trade and aid to AIDS. ; Adgang til Anti-retroviral (ARV) medicin til behandling af AIDS i udviklingslandene skaber nye koblinger mellem lokal og global regulering. Lokale tilgange til behandling af AIDS er reguleret dels inden for de retningslinier for patenter på medicin, der gælder i den globale regulering af handel i verdenshandelsorganisationen (WTO), og dels de reguleringsformer der eksisterer inden for international udviklingsbistand. Mens industrialiserede lande på den ene side donerer penge til bekæmpelse af AIDS i udviklingslande, sætter de samme lande begrænsninger for adgang til billig medicin gennem WTOs handelsregime. Ugandas succes i forhold til bekæmpelse af AIDS er unik blandt afrikanske stater. På basis af landets historiske tilgang til epidemien, bliver Uganda set som et godt land for opgradering af programmer til AIDS behandling. På trods af dette, de mange tiltag på AIDS området og reduktioner i prisen på AIDS medicin, er det kun en minoritet af den smittede del af befolkningen, der har adgang til AIDS medicin i dag. I dette working paper undersøger vi, hvilke konflikter der er mellem internationale og nationale prioriteter på den ene side, og mellem udviklingsbistand og international handelsregulering på den anden side, samt hvordan disse konflikter påvirker adgangen til ARV medicin i Uganda. I modsætning til den politiske diskurs om lige adgang til behandling, er international bistand forbundet med svære prioriteringer på nationalt og individuelt niveau. Derfor bliver global regulering af både handel og bistand påvirket og skabt af de individer der implementerer reguleringen nationalt. Først introducerer vi vores brug af begrebet 'governance' (regulering), som bliver brugt i forbindelse med global regulering af udviklingsbistand og handel i relation til AIDS. I den anden halvdel af working paperet ser vi på Uganda som case: den politiske baggrund og udviklingen i Ugandas AIDS-politik, Ugandas programmer og tiltag for adgang til ARV medicin, en diskussion af det nationale sundhedssystem og endelig ARVs set i sammenhæng med handel. I konklusionen præsenterer vi ud fra casen, hvilke konflikter der kan ses i mellem globale og lokale reguleringsformer for adgang til AIDS medicin og hhv. handel og bistand til AIDS

Since 1995, the James Irvine Foundation has invested more than $11 million to support the growth and development of Collaborative Regional Initiatives (CRIs) throughout the state—nonprofit organizations that engage key players from business, environmental, and a variety of other advocacy groups with players from local governments and public agencies to create improvements in their regions. CRIs work on issues ranging across transportation, land use, housing, and economic development. They work in a variety of ways from developing legislation to media campaigns to practical work on particular projects. All are directed at building civic capacity and filling in gaps where government does not or cannot act. Some CRIs have been in place for years; others are more recently formed. They represent experiments in regional governance. Recently, the Irvine Foundation tapped a team of Berkeley faculty to perform an assessment of the CRIs so the foundation can target its resources in order to make them effective and sustainable over time and assist them in producing valuable outcomes for their regions. City planning professor Judith Innes, who led the complex evaluation, teamed with city planning professors AnnaLee Saxenian, Karen Christensen, Karen Chapple and political science professor Judith Gruber to focus on the projects and programs that a sample of CRIs engage in, asking which are most successful and why. In particular, the researchers examined how variables like leadership, resources, diversity of participation, processes of dialogue and collaboration, and the ways problems have been framed contribute to the degree of success in each program. The work is designed to assist the CRIs with strategies to select and build the successes of their programs and to help them overcome obstacles and identify opportunities for effective work. Together the researchers published case studies of four major CRIs -- the Bay Area Alliance for Sustainable Communities, Joint Venture: Silicon Valley, the San Diego Dialogue and the Sierra Business Council -- as well as an analysis of regional workforce development collaboratives in California. The Bay Area Alliance for Sustainable Communities was formed to change the patterns and practices of land use in the San Francisco Bay Area to achieve a more compact, transit-friendly form of growth. The diverse group has worked toward this goal by creating a regional Compact or vision outlining the actions needed for a sustainable Bay Area, a Smart Growth Strategy/Regional Livability Footprint used to influence the regional population projections, and a regional indicators report. The group's one action project has been to bring investment into disadvantaged neighborhoods through their Community Capital Investment Initiative. The idea is that disadvantaged neighborhoods offer an untapped business opportunity if investors and developers can be assisted by knowledgeable community players; at the same time, such investments can be designed to provide community benefit. However, business's need for speed and secrecy in making investments and the community's need for transparency and thorough dialogue have created conflict. Both business and community players are learning to work together and are committed to making the effort productive and sustainable, but it remains a work in progress. Overall the Alliance's main outcomes, in addition to some building projects, have been to advance a regional discourse about smart growth and to help regional civic leaders representing the three E's (environment, economy and equity) to understand how each other's interests can be jointly met. According to Professor Innes, the primary reason the Bay Area Alliance has not achieved more lies in its choice of a large scale and complex problem—changing the region's institutions and land use patterns and ultimately making it sustainable. "This is what planners call a 'wicked' problem—where parameters are poorly defined, features are contradictory and changing, there are many players with differing goals and there exists no simple generic solution," she says. "The scope and complexity of BAASC's mission makes achieving their ambitions difficult."

Environmental justice is an increasingly important element of policy making in transportation. It is not specific to any mode of transportation, particular community, or single policy issue. It is fundamentally about fairness toward the disadvantaged and often addresses the exclusion of racial and ethnic minorities from decision making. The federal government has identified environmental justice as an important goal in transportation, and local and regional governments must incorporate environmental justice into transportation programs. Because ideas about justice differ between communities, local and regional governments have flexibility in how they change their policies to reflect environmental justice. Communities and local governments struggle to balance competing interests and interpretations of environmental justice. To parents living in a neighborhood with a lot of bus service, environmental justice might mean converting buses from diesel to natural gas, reducing their children's exposure to air pollution. A security guard working the night shift might feel that environmental justice has been served if the bus she takes deviates from its regular route to drop her off closer to home. Environmental justice to a non-English speaking neighborhood might mean having bilingual staff and community leaders running a public meeting. To low-income workers relying on bus service in a large downtown, environmental justice might mean that a city increases the frequency of buses instead of building a new light rail line that would serve upper-income commuters. In short, there is no single definition of environmental justice: its meaning depends on context, perspective and timeframe. Environmental justice issues arise most frequently when: Some communities get the benefits of improved accessibility, faster trips, and congestion relief, while others experience fewer benefits; Some communities suffer disproportionately from transportation programs' negative impacts, like air pollution; Some communities have to pay higher transportation taxes or higher fares than others in relation to the services that they receive; or Some communities are less represented than others when policy-making bodies debate and decide what should be done with transportation resources. Racial and ethnic minority groups, low-income people, the elderly, and people with disabilities have all been the victims of environmental injustices in transportation. Sometimes an affected community is primarily geographic, consisting of those living in a particular corridor or in a neighborhood near a certain transportation facility. Or those affected might share similar racial, ethnic, or economic characteristics. These groups are often referred to as "environmental justice communities." But because power and needs change over time and space, the term "environmental justice communities" is problematic. Environmental justice is used to protect the needs of the powerless, whomever they might be, and as they change. Many community members are becoming involved with transportation decisions that impact their mobility needs, health, and overall quality of life. A member of the public concerned with environmental justice might be involved with making transportation decisions as: A citizen appointed to an environ-mental justice task force or committee; A member of a disempowered group, representing the group's interests to an advisory committee for the purpose of discussing and influencing transportation policy choices; A member of an advocacy group active in transportation issues; An employee of a non-profit agency that wants to be involved because of the effect that transportation policies have on its constituents; or A resident or business owner affected by a transportation decision. Although there is no substitute for the knowledge that can be gained over time through experience, this handbook will help those who are new to transportation decision processes influence how environmental justice is incorporated into decisions about transportation policy and projects. Various approaches to environmental justice are discussed, along with steps in the planning process when citizen involvement is particularly effective, suggestions for how environmental justice can be incorporated into a project, and legal requirements for environmental justice.

"An estimated one third of the world's population is infected with Mycobacterium tuberculosis, and nearly 9 million persons develop disease caused by M. tuberculosis each year. Although tuberculosis (TB) occurs predominantly in resource-limited countries, it also occurs in the United States. During 1985-1992, the United States was confronted with an unprecedented TB resurgence. This resurgence was accompanied by a rise in multidrug-resistant TB (MDR TB), which is defined as TB that is resistant to the two most effective first-line therapeutic drugs, isoniazid and rifampin. In addition, virtually untreatable strains of M. tuberculosis are emerging globally. Extensively drug-resistant (XDR) TB is defined as MDR TB that also is resistant to the most effective second-line therapeutic drugs used commonly to treat MDR TB: fluoroquinolones and at least one of three injectable second-line drugs used to treat TB (amikacin, kanamycin, or capreomycin). XDR TB has been identified in all regions of the world, including the United States. In the United States, the cost of hospitalization for one XDR TB patient is estimated to average $483,000, approximately twice the cost for MDR TB patients. Because of the limited responsiveness of XDR TB to available antibiotics, mortality rates among patients with XDR TB are similar to those of TB patients in the preantibiotic era. In January 1992, CDC convened a Federal TB Task Force to draft an action plan to improve prevention and control of drug-resistant TB in the United States (CDC. National action plan to combat multidrug-resistant tuberculosis. MMWR 1992;41([No. RR-11]). In November 2006, CDC reconvened the Task Force to draft an updated action plan to address the issue of MDR TB and XDR TB. Task Force members were divided into nine response areas and charged with articulating the most pressing problems, identifying barriers to improvement, and recommending specific action steps to improve prevention and control of XDR TB within their respective areas. Although the first priority of the Federal TB Task Force convened in 2006 was to delineate objectives and action steps to address MDR TB and XDR TB domestically, members recognized the necessity for TB experts in the United States to work with the international community to help strengthen TB control efforts globally. TB represents a substantial public health problem in low- and middle-income countries, many of which might benefit from assistance by the United States. In addition, the global TB epidemic directly affects the United States because the majority of all cases of TB and 80% of cases of MDR TB reported in the United States occur among foreign-born persons. For these reasons, the Action Plan also outlines potential steps that U.S. government agencies can take to help solve global XDR TB problems. Unless the fundamental causes of MDR TB and XDR TB are addressed in the United States and internationally, the United States is likely to experience a growing number of cases of MDR TB and XDR TB that will be difficult, if not impossible, to treat or prevent. The recommendations provided in this report include specific action steps and new activities that will require additional funding and a renewed commitment by government and nongovernment organizations involved in domestic and international TB control efforts to be implemented effectively. The Federal TB Task Force will coordinate activities of various federal agencies and partner with state and local health departments, nonprofit and TB advocacy organizations in implementing this plan to control and prevent XDR TB in the United States and to contribute to global efforts in the fight against this emerging public health crisis." - p. 1 ; Introduction -- Recommendations to combat extensively drug-resistant tuberculosis -- Action plan to combat extensively drug-resistant tuberculosis -- Conclusion -- References -- Appendix ; reported by Philip LoBue, Christine Sizemore, Kenneth G. Castro ; "February, 2009." ; "The material in this report originated in the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Kevin Fenton, MD, PhD, Director, and the Division of Tuberculosis Elimination, Kenneth G. Castro, MD, Director." - p. 1 ; Also available via the World Wide Web. ; Includes bibliographical references (p. 40).

"For nearly all infants, breastfeeding is the best source of infant nutrition and immunologic protection, and it provides remarkable health benefits to mothers as well. Babies who are breastfed are less likely to become overweight and obese. Many mothers in the United States want to breastfeed, and most try. And yet within only three months after giving birth, more than two-thirds of breastfeeding mothers have already begun using formula. By six months postpartum, more than half of mothers have given up on breastfeeding, and mothers who breastfeed one-yearolds or toddlers are a rarity in our society. October 2010 marked the 10th anniversary of the release of the HHS Blueprint for Action on Breastfeeding, in which former Surgeon General David Satcher, M.D., Ph.D., reiterated the commitment of previous Surgeons General to support breastfeeding as a public health goal. This was the first comprehensive framework for national action on breastfeeding. It was created through collaboration among representatives from medical, business, women's health, and advocacy groups as well as academic communities. The Blueprint provided specific action steps for the health care system, researchers, employers, and communities to better protect, promote, and support breastfeeding. I have issued this Call to Action because the time has come to set forth the important roles and responsibilities of clinicians, employers, communities, researchers, and government leaders and to urge us all to take on a commitment to enable mothers to meet their personal goals for breastfeeding. Mothers are acutely aware of and devoted to their responsibilities when it comes to feeding their children, but the responsibilities of others must be identified so that all mothers can obtain the information, help, and support they deserve when they breastfeed their infants. Identifying the support systems that are needed to help mothers meet their personal breastfeeding goals will allow them to stop feeling guilty and alone when problems with breastfeeding arise. All too often, mothers who wish to breastfeed encounter daunting challenges in moving through the health care system. Furthermore, there is often an incompatibility between employment and breastfeeding, but with help this is not impossible to overcome. Even so, because the barriers can seem insurmountable at times, many mothers stop breastfeeding. In addition, families are often unable to find the support they need in their communities to make breastfeeding work for them. From a societal perspective, many research questions related to breastfeeding remain unanswered, and for too long, breastfeeding has received insufficient national attention as a public health issue. This Call to Action describes in detail how different people and organizations can contribute to the health of mothers and their children. Rarely are we given the chance to make such a profound and lasting difference in the lives of so many. I am confident that this Call to Action will spark countless imaginative, effective, and mutually supportive endeavors that improve support for breastfeeding mothers and children in our nation." - p. v ; The Importance of breastfeeding -- Rates of breastfeeding -- Barriers to breastfeeding in the United States -- Breastfeeding from the public health perspective -- A Call to action -- References -- Acknowledgments -- Appendix 1. Actions to improve breastfeeding -- Appendix 2. Excess health risks associated with not breastfeeding -- Appendix 3. Development of the call to action -- Appendix 4. Abbreviations and acronyms ; "The Surgeon General's Call to Action to Support Breastfeeding was prepared by the Centers for Disease Control and Prevention and the Office on Women's Health under the direction of the Office of the Surgeon General. These three agencies are part of the U.S. Department of Health and Human Services, which published the Call to Action." -p. 69 ; "CS213420" ; Also available via the World Wide Web.as an Acrobat .pdf file (903.73 KB, 100 p.). ; Includes bibliographical references (p. 59-68). ; U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011.

Abstract The given article offers a political and legal analysis of the constitutions of the members of the Commonwealth of Independent States that began constructing their independent statehood after the collapse of the USSR. The authors conducted a comparative analysis of such institutions in the CIS as the parliament, presidency, courts and found out that the studied institutional features could be described as "modern traditionalism." At the same time prevalence is given to informal political practices (clans, interest groups, and political networks) that facilitate the political process in these countries. By opposing the traditional constitutional institutions, these informal mechanisms and structures could be able to "seize the government" and cause the emergence of neopatrimonialism. The paper describes various models of the neopatrimonialism regimes which allows to depart from a simplified description of these regimes as being "authoritarian" and find new "hybrid" institutions, that accumulate both formal and informal power.