The European Union approach to data protection consists of assessing the adequacy of the data protection offered by the laws of a particular jurisdiction against a set of principles that includes purpose limitation, transparency, quality, proportionality, security, access, and rectification. The EU's Data Protection Directive sets conditions on the transfer of data to third countries by prohibiting Member States from transferring to such countries as have been deemed inadequate in terms of the data protection regimes. In theory, each jurisdiction is (...) evaluated similarly and must be found fully compliant with the EU's data protection principles to be considered adequate. In practice, the inconsistency with which these evaluations are made presents a hurdle to international data-sharing and makes difficult the integration of different data-sharing approaches; in the 20 years since the Directive was first adopted, the laws of only five countries from outside of the EU, Economic Area, or the European Free Trade Agreement have been deemed adequate to engage in data transfers without the need for further administrative safeguards. (shrink)

With a population of over 1.3 billion, China is the most populous country in the world. It is facing an acute aging population problem, with a projected 440 million residents over age 60 and 101 million over age 80 by 2050. Furthermore, rapid industrialization and urbanization in China have resulted in serious air pollution and associated public health problems, including an increase in respiratory diseases and cancers. These and other demographic trends have generated concerns about the cost of health care (...) and its impact on population health. In recent years, the Chinese government has invested heavily in the fields of translational research and biobanking with the hope that research in both fields can yield effective solutions to improve the public’s health and quality of life. The establishment of national biobanks was identified as a major initiative needed for the biomedical industry in the 12th Five-Year National Development Plan of Strategic Emerging Industries promulgated by the State Council in 2012. (shrink)

All parties involved in researching, developing, manufacturing, and distributing COVID-19 vaccines need guidance on their ethical obligations. We focus on pharmaceutical companies' obligations because their capacities to research, develop, manufacture, and distribute vaccines make them uniquely placed for stemming the pandemic. We argue that an ethical approach to COVID-19 vaccine production and distribution should satisfy four uncontroversial principles: optimising vaccine production, including development, testing, and manufacturing; fair distribution; sustainability; and accountability. All parties' obligations should be coordinated and mutually consistent. For (...) instance, companies should not be obligated to provide host countries with additional booster shots at the expense of fulfilling bilateral contracts with countries in which there are surges. Finally, any satisfactory approach should include mechanisms for assurance that all parties are honouring their obligations. This assurance enables countries, pharmaceutical companies, global organisations, and others to verify compliance with the chosen approach and protect ethically compliant stakeholders from being unfairly exploited by unethical behaviour of others. (shrink)

We study whether greater social trust is associated with a lower incidence of corporate misconduct. Both social norm and network theory suggest that social trust can affect managerial behavior and reduce the likelihood of misconduct behavior. Consistent with this prediction, we find that social trust is negatively associated with corporate misconduct behavior. Moreover, we show that, when media coverage is higher, the negative relation between social trust and corporate misconduct behavior is more pronounced. Further analyses suggest that social trust can (...) help mitigate both disclosure-related and nondisclosure-related misconduct. (shrink)

Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can (...) meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance. (shrink)

This paper describes an innovative just-in-time health humanities programme to educate and provide support to COVID-19 frontline doctors-in-training. The programme incorporates small-group screening of the Netflix documentary, The Next Pandemic from the Explained series, followed by a one-hour facilitated discussion to explore themes surrounding the current pandemic and its impact on frontline doctors in a tertiary paediatric hospital in Singapore. Themes derived from the film included preparedness, blame, and the impact on healthcare workers and public, which were further discussed to (...) include concerns regarding current local readiness levels given global connectivity, the need for international cooperation, and the effects of blame such as racism and prejudice. The association with culture; the current impact on healthcare workers, physician-patient relationships, and the public including the role of social media, the government and associated public reactions were also explored. These rich discussions demonstrate the pivotal role health humanities has in times of uncertainty such as an emerging infectious disease outbreak by providing timely pandemic education and supporting reflective learning. (shrink)

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public (...) health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This “flu-risk standard” is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: having developed a vaccine, raising taxes to pay for vaccine research and purchase, wanting to eliminate economic and social burdens, and being ineffective in combating COVID-19 through public health interventions. (shrink)

Focusing on episodes of student-generated and -sustained talk during document-based disciplinary history discussions, this study explored what teacher candidates prioritize and value about social studies discussions, and how these priorities align with their actions and goals as facilitators. Using a complex systems-based model, we investigated candidates’ goals as they planned for, facilitated, and reflected upon student sensemaking relative to three common orientations for social studies discussions: disciplinary history, participatory civics, and critical literacy. Findings revealed that candidates employed elements from all (...) three orientations, yet without clear alignment to any particular approach. This misalignment reflected tensions between candidates’ stated goals, beliefs about student engagement, and instructional decisions. We draw implications for teacher education to support candidates in developing coherent practices for discussion facilitation that align with their instructional visions and sociocultural contexts. (shrink)

Many studies have explored the antecedents of corporate social performance, such as institutional forces and stakeholder pressures. However, few studies examine CSP from a socio-cognitive perspective. To address this research void, this study adopts an attention-based approach to examine the relationship between managers' attention to social issues and CSP. More important, this study reports that this relationship will be moderated by governance mechanisms that constrain managerial discretion. Using a sample of Chinese listed firms, this study provides empirical support for these (...) arguments. Therefore, our study adds new insights to the literature addressing CSP from a socio-cognitive perspective and speaks to the structural features, both inside and outside organizations, that guide managers' attention. (shrink)

Five studies examined the extent to which autobiographical memory retrieval is hierarchical, whether a hierarchical search depends on central executive resources, and whether retrieving memories that are “higher” in the hierarchy impairs problem‐solving ability. The first study found that random generation (assessed using a button‐pressing task) was sensitive to changes in memory load (digit span). The second study showed that when participants fail to retrieve a target event, they respond with a memory that is higher up the hierarchy. The third (...) study showed that memory is more generic only when participants use low imageable cues under cognitive load. The final two experiments showed that experimental manipulation of memory specificity affects problem solving (MEPS performance). The data are consistent with Conway and Pleydell‐Pearce's hierarchical retrieval model of autobiographical memory, and suggest that overgeneral memory in nonclinical participants is associated with reduced executive capacity only when retrieval is “top‐down” (generative). (shrink)

We examine the impact of a city’s cultural diversity on a firm’s tax avoidance. Our findings suggest that when a firm is located in a culturally diverse city, it exhibits less TA than a firm located in a less culturally diverse city. The findings are robust to alternative metrics of cultural diversity and TA and after accounting for omitted sample bias and endogeneity. Additional analysis suggests that the negative impact of cultural diversity on a firm’s TA is more salient in (...) a firm with strong managerial incentives or in a city that is characterized by more migration. Furthermore, we document that the negative impact of cultural diversity on TA is more pronounced when firms face strong financial constraints or effective internal and external monitoring. (shrink)

Background: People in both Taiwan and China originally descended from the Han Chinese, but the societies have been separated for approximately 38 years. Due to different political systems, variations exist in healthcare and nursing education systems in Taiwan and China. Objective: The purpose of this study was to examine the professional values of nursing students in Taiwan and China. Design: A cross-sectional design was applied in this study. The Nursing Professional Value Scale–Revised was used to measure the professional values of (...) the students. The questionnaire was distributed to eligible undergraduate students in a classroom setting. Ethical considerations: This study was approved by the Institutional Review Board at the first investigator’s university. Participants were informed that completion and return of the questionnaire was voluntary, and confidentiality was ensured by keeping the responses anonymous. Participants: A convenience sample included 292 Taiwanese students and 654 Chinese students. Findings: A total of 11 individual Nursing Professional Value Scale–Revised items showed significant differences between the two groups. These results reflect the differences in the perceived importance of these items between the groups. There was no significant difference between the two groups in the mean overall scores for the Nursing Professional Value Scale–Revised (p =.766) and three subscales (all p >.05). Conclusion: There are some differences in professional values between nursing students in Taiwan and China. Given the increasingly frequent and close interactions between Taiwan and China and the globalization of nursing, understanding these differences may help nursing educators identify students’ perceptions of their professional values and support the development of strategies to improve weaknesses in professional values. (shrink)

This research is motivated by the criticism levelled at the academic community for its failure to incorporate sufficient ethics education into the accounting curriculum :53–71, 2004; Madison and Schmidt 2006). The inclusion of ethics decision-making frameworks by professional bodies in their codes of conduct or as a standalone tool and the encouragement of their use as a part of ethics education to help students to identify and think through ethical issues in a business context has been subject to very limited (...) research to date. The aim of this study is to provide evidence of the impact of providing a framework on its own and providing a framework as part of a comprehensive integrated ethics education component of a first-year unit of study, on accounting students’ ethical sensitivity and judgment. Results indicate that providing students with a framework only does not increase students’ ethical sensitivity but does support their ethical judgment. In contrast, the integrated ethics component does increase student’s ethical sensitivity, however, an unexpected finding of this study is that increases in students’ ethical judgement are greater if they have not been previously exposed to the framework. Taken together, our findings suggest that it is the framework that has a significant impact on students’ ethical judgment, while an integrated ethics education can expose students to a range of ethical issues and thereby improve their ethical sensitivity, a critical component which initiates the ethical decision-making process. (shrink)

AI and robotic technologies attract much hype, including utopian and dystopian future visions of technologically driven provision in the health and care sectors. Based on 30 interviews with scientists, clinicians and other stakeholders in the UK, Europe, USA, Australia, and New Zealand, this paper interrogates how those engaged in developing and using AI and robotic applications in health and care characterize their future promise, potential and challenges. We explore the ways in which these professionals articulate and navigate a range of (...) high and low expectations, and promissory and cautionary future visions, around AI and robotic technologies. We argue that, through these articulations and navigations, they construct their own perceptions of socially and ethically ‘acceptable futures’ framed by an ‘ethics of expectations.’ This imbues the envisioned futures with a normative character, articulated in relation to the present context. We build on existing work in the sociology of expectations, aiming to contribute towards better understanding of how technoscientific expectations are navigated and managed by professionals. This is particularly timely since the COVID-19 pandemic gave further momentum to these technologies. (shrink)

Purpose This paper aims to analyze the ways socio-economic issues are represented in mainstream news media and how it is consumed, understood and interpreted by Israeli young adults. It examines how mainstream media uses neo-liberal discourse, and the ways YAs internalize this ethic, while simultaneously finding ways to overcome its limitations. Design/methodology/approach This was a mixed methods study. First, it undertook content analysis of the most popular Israeli mainstream news media among YAs: the online news site Ynet and the TV (...) Channel 2 news. Second, the authors undertook semi-structured in-depth interviews with 29 Israeli YAs. The analysis is based on an online survey of 600 young Israelis, aged 18–35 years. Findings Most YAs did not perceive mainstream media as enabling a reliable understanding of the issues important to them. The content analysis revealed that self-representation of YAs is rare, and that their issues were explained, and even resolved, by older adults. Furthermore, most of YAs' problems in mainstream news media were presented using a neo-liberal perspective. Finally, from the interviews, the authors learned that YAs did not find information that could help them deal with their most pressing economic and social issue, in the content offered by mainstream media. For most of them, social media overcomes these shortcomings. Originality/value Contrary to research that has explored YAs’ consumerism of new media outlets, this article explores how YAs in Israel are constructed in the media, as well as the way in which YAs understand mainstream and new social media coverage of the issues most important to them. Using media content analysis and interviews, the authors found that Young Adults tend to be ambivalent toward media coverage. They understand the lack of media information: most of them know that they do not learn enough from the media. This acknowledgment accompanies their tendency to internalize the neo-liberal logic and conservative Israeli national culture, in which class and economic redistribution are largely overlooked. Mainstream news media uses neo-liberal discourse, and young adults internalize this logic, while simultaneously finding ways to overcome the limitations this discourse offers. They do so by turning to social media, mainly Facebook. Consequently, their behavior maintains the logic of the market, while also developing new social relations, enabled by social media. (shrink)

The demand for ethical fashion products has grown in recent years, with consumers caring more about how the product is made. Based on the deontological underpinnings of ethical fashion, the present research provides recommendations to ethical fashion brands by leveraging the emotion of awe through visual representations. This research examines 5362 Instagram posts of five ethical fashion brands and shows that the presence of awe-inspiring visual elements increases consumer engagement on social media for ethical fashion brands. Further, this research identifies (...) the moderating roles of the color green and the size of the visual elements in this context. Two follow-up experiments provide causal evidence for these relationships. Experimental evidence for the role of deontological beliefs as a mediator of the relationship between feelings of awe and social media engagement with ethical fashion brands is also provided. Overall, the findings offer a more nuanced understanding of how ethical fashion brands can develop effective visual advertising campaigns on social media and the underlying process driving the effect, which is consistent with deontological ethics. (shrink)

This study examines the impact of the strength of an accounting firm's ethical environment on the quality of auditor judgment, across different levels of audit expertise. Using a 2 × 2 full factorial 'between subjects' experimental design, with audit managers and audit seniors, the impact of different levels of strength of the ethical environment on auditor judgments was assessed with a realistic audit scenario, requiring participants to make judgments in respect of an inventory writedown. Based on prior research, and as (...) hypothesized, participants possessing greater auditing experience made higher quality technical judgments. While there were no significant differences between the quality of audit judgments made by participants in the stronger ethical environment, over-all results indicate that managers are more sensitive to differences in the strength of the ethical environment than seniors. This is consistent with the hypothesis, and with prior research which suggests that the impact of the code will only be significant if it has been bilaterally internalized by individuals. This has important implications for accounting firms and regulators, given that the International Standard on Quality Control 1, requires the communication and reinforcement of ethical principles as part of firms' quality control processes. It suggests that firms will need to carefully consider the means by which they communicate and reinforce ethical principles, as it is possible to differentially impact auditors of different rank. (shrink)

BackgroundBreast cancer patients are at elevated risk of depression during treatment, thus provoking the chance of poor clinical outcomes. This retrospective cohort study aimed to investigate whether integrating Chinese herbal medicines citation into conventional cancer therapy could decrease the risk of depression in the long-term breast cancer survivors.MethodsA cohort of patients aged 20–70 years and with newly diagnosed breast cancer during 2000–2008 was identified from a nationwide claims database. In this study, we focused solely on survivors of breast cancer at (...) least1 year after diagnosis. After one-to-one matching for age, sex, and baseline comorbidities, breast cancer patients who received and did not receive CHM treatment were enrolled. The incidence rate and hazard ratio citation for depression between the two groups was estimated at the end of 2012. A Cox proportional hazard model was constructed to examine the impact of the CHM use on the risk of depression.ResultsDuring the study period, the incidence rate of depression was significantly lower in the treated cohort than in the untreated cohort [8.57 compared with 11.01 per 1,000 person-years citation], and the adjusted HR remained significant at 0.74 in a Cox proportional hazards regression model. The corresponding risk further decreasing to 43% among those using CHM for more than 1 year.ConclusionFinding from this investigation indicated that the lower risk of depression observed in breast cancer patients treated with CHM, suggesting that CHM treatment should be considered for disease management toward breast cancer. Yet, the optimal administered dose should be determined in further clinical trials. (shrink)

This study examines the relationship between procedural justice and employee job insecurity, and the boundary conditions of this relationship. Drawing upon uncertainty management theory and ethical leadership research, we hypothesized that procedural justice is negatively related to job insecurity, and that this relationship is moderated by ethical leadership. We further predicted that the moderating relationship would be more pronounced among employees with a low power distance orientation. We tested our hypotheses using a sample of 381 workers in Macau and Southern (...) China. The results support all of our hypotheses. The implications of these results for research and practice are discussed. (shrink)

Sustainability, and the related concept of climate change, is an emerging domain within nursing and nurse education. Climate change has been posited as a serious global health threat requiring action by health professionals and action at international level. Anåker & Elf undertook a concept analysis of sustainability in nursing based on Walker and Avant's framework. Their main conclusions seem to be that while defining attributes and cases can be established, there is not enough research into sustainability in the nursing literature. (...) This paper seeks to develop their argument to argue that sustainability in nursing can be better understood by accessing non‐nursing and grey literature and, for example, the literature in the developing web‐based ‘paraversity’. Without this understanding, and application in nursing scholarship, nurses will have a rather narrow understanding of sustainability and its suggested links with social and health inequalities and the dynamics underpinning unsustainable neoliberalist political economy. This understanding is based on the social and political determinants of health approach and the emerging domain of planetary health. However, this is a major challenge as it requires a critical reflection on what counts as nursing knowledge, a reflection which might reject sustainability and political economy as irrelevant to much of nursing practice. (shrink)

Amartya Sen introduces the concept of capabilities, i.e. what people are able to do and to be, as a non-economic measure in the development evaluation. This essay seeks to explore how this concept deals with the issues of values and politics, which in many cases determines people’s identity. The main argument is that the concept of capabilities is built around a certain individualistic view of human beings, whereas identity suggests a more complex picture. As such, Sen’s capability approach cannot properly (...) address the issue of identity and risks losing important insights which may contribute to people’s well being. Keywords: Amartya Sen, capability approach, identity, development, justice. Abstrak: Amartya Sen memperkenalkan konsep kapabilitas, yakni apa yang dapat dilakukan oleh seseorang dan bagaimana ia dapat menjadi dirinya, sebagai tolok ukur non-ekonomik dalam evaluasi pembangunan. Artikel ini berupaya mengkaji bagaimana konsep ini dapat diselaraskan dengan nilai-nilai identitas dan politik, yang dalam banyak hal menentukan apa yang dianggap oleh banyak orang sebagai nilai. Argumen yang dikemukakan dalam artikel ini adalah bahwa konsep mengenai kapabilitas dibangun atas sebuah pandangan individualistik mengenai manusia, sementara identitas menyiratkan sebuah gambaran yang lebih kompleks. Dipahami secara demikian, pendekatan kapabilitas Sen tidak dapat menanggapi permasalahan identitas secara memadai dan beresiko kehilangan insight penting yang justru dapat memberi sumbangan bagi kesejahteraan manusia. Kata-kata kunci: Amartya Sen, pendekatan kapabilitas, identitas, perkembangan, keadilan. (shrink)

In this paper, I discuss substance-induced visions and consider their epistemic status, meaning, and modes of proper interpretation. I focus on the visions induced by ayahuasca, a powerful psychoactive plant-made brew that has had a central status and role in the indigenous tribal cultures of the upper Amazonian region. The brew is especially famous for the visions seen with it. These are often coupled with personal psychological insights, mentations concerning topics of special significance to one, intellectual (notably, philosophical and metaphysical) (...) ideations, as well as powerful religious and spiritual sentiments. Thus, under the intoxication, people often feel that they gain significant knowledge and understanding. The present discussion takes a cognitive-phenomenological perspective coupled with a philosophical analysis of the various epistemological questions at hand. (shrink)

A report suggests that United States’ army officers may engage in dishonest reporting regarding their compliance procedures. Similarly, nurses with espoused high ethical standards sometimes fail to live up to them and may do so while deceiving themselves about such practices. Reasons for lapses are complex. However, multitudinous managerial demands arising within ‘technical and instrumental rationality’ may impact on honest decision‐making. This paper suggests that compliance processes, which operates within the social structural context of the technical and instrumental rationality manifest (...) as ‘managerialism’, contributes to professional ‘dishonesty’ about lapses in care, sometimes through ‘thoughtlessness’. The need to manage risk, measure, account, and control in order to deliver efficiency, effectiveness, and economy (technical rationality) thus has both unintended and dysfunctional consequences. Meeting compliance requirements may be mediated by factors such as the ‘affect heuristic’ and ‘reflexive deliberations’ as part of the ‘structured agency’ of nurses. It is the complexity of ‘structured agency’ which may explain why some nurses fail to respond to such things as sentinel events, a failure to recognize ‘personal troubles’ as ‘public issues’, a failure which to outsiders who expect rational and professional responses may seem inconceivable. There is a need to understand these processes so that nurses can critique the context in which they work and to move beyond either/or explanations of structure or agency for care failures, and professional dishonesty. (shrink)

The emergency department (ED) is a fast-paced, highly stressful environment where clinicians function with little or suboptimal information and where time is measured in minutes and hours. In addition, death and dying are phenomena that are often experienced in the ED. Current end-of-life care models, based on chronic illness trajectories, may be difficult to apply in the ED. A philosophical approach examining end-of-life care may help us understand how core medical and nursing values are embodied as care practices and as (...) ethical comportment. The integration of Aristotle's notions of phronesis and praxis with Merleau-Ponty's ontological notions of intentional arc and maximum grip in the context of the culture and practices of the ED offers a unique view of clinical and ethical practice at the end-of-life in the emergency setting. Caring for people at the end-of-life calls us to act virtuously based on previous experience, meanings and local practices. The maximum grip of the ultimate particulars of the situation combined with one's experiential and theoretical knowledge opens up situated possibilities for the expert clinician. (shrink)

Research about the Olympic Games has primarily focused on preparing athletes for competition. Less attention has been paid to the post-Olympic-phase and athlete well-being during this time. This study explored Australian Olympic athletes’ experiences following the conclusion of the 2016 Rio Olympic Games, including the factors that may have contributed to or challenged their well-being during this time. Eighteen athletes participated in semi-structured interviews and thematic analysis revealed that when Olympic performance appraisal met prior expectations, when athletes planned for a (...) return to work or study, and when support from a variety of sources was readily available, this positively influenced athletes’ well-being during the POP. When these factors were not in place, more challenging post-Games experiences were present, and well-being was compromised. The findings contribute to the broader literature on elite athlete well-being and at an applied level, may be used to inform targeted programs that focus on supporting athletes after an Olympic campaign. (shrink)

We explore the entanglement of the vacuum of a relativistic field by letting a pair of causally disconnected probes interact with the field. We find that, even when the probes are initially non-entangled, they can wind up to a final entangled state. This shows that entanglement persists between disconnected regions in the vacuum. However the probe entanglement, unlike correlations, vanishes once the regions become sufficiently separated. The relation between entropy, correlations and entanglement is discussed.

Henrich et al.'s critical review demonstrating that psychology research is over-reliant on WEIRD samples is an important contribution to the field. Their stronger claim that is less convincing, however. We argue that WEIRD people's apparent distinct weirdness is a methodological side-effect of psychology's over-reliance on WEIRD populations for developing its methods and theoretical constructs.

A significant international literature has shown that political fragmentation the existence of multiple parties in a governing body - affects policy-making. Indeed, an increase in the number of parties increases the number of viewpoints considered, but on the other hand may also lead to a decrease in government flexibility. This paper first of all shows that Flemish municipalities often have fragmented governments as measured by the number of parties represented in the municipal council and the College of Mayor and Alderman. (...) We also show that this fragmentation at the local level affects policy-making, though not necessarily in the same directions found in the international literature. (shrink)