That is in line with the general trend of Mr Putin's federalism, which has been to put more of the burden for services on to the regions while concentrating more power and supervision at the federal level.

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Russia's nuclear power equipment and service export monopoly, Atomstroiexport, is building the plant under supervision of the International Atomic Energy Agency (IAEA), the United Nations' nuclear watchdog agency.

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Already there are substantial state-to-state differences in what nurses are allowed to do without the supervision of doctors, differences that tend to reflect the entrenched political power of doctors rather than any sound public policy research.

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