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This Article argues that international investment agreements (IIAs) serve a dual economic function—to discipline host country policies that impose international externalities on foreign investors, and to curtail inefficient risks associated with agency costs, risk aversion, asymmetric information, and time inconsistency problems that uneconomically increase the cost of imported capital in host countries. It draws on the economic analysis to explain central features of IIAs and their evolution over time, and to address various controversial issues in international investment litigation.
The aims of this study were to explore the outcome measures that can be recorded in a radiotherapy IT system and the extract mortality results for a group of patients receiving radical radiotherapy treatment for primary brain cancer.
Treatment mortality outcomes were extracted from a radiotherapy database and were compared to treatment technique used between 1 January 2011 and 31 December 2017. The patients selected received 1 course of radiotherapy of 60 Gray in 30 treatments (n = 270). These patients received either Conformal Radiotherapy (CRT) (n = 127) or Volumetric Modulated Arc Therapy (VMAT) (n = 143). Kaplan–Meier plots were generated for these two groups to assess the survival. The median survival was 20·1 months (95%CI = 16·8−23·4) and 14·0 months (95%CI = 11·1−16·5) for CRT and VMAT, respectively.
Surprisingly, the results of this data extraction demonstrated that CRT gave better survival for this group of patients, than VMAT. The reason for the difference in survival is unclear and more data are needed to explain the result.
This demonstrates that not only that a radiotherapy database can be used to extract outcome measures but that it must be done to explore where a change in treatment delivery has been of benefit to the patients or not.
Introduction: Transportation of patients better served at an alternative destinations (diversion) is part of a proposed solution to emergency department (ED) overcrowding. We evaluated the pilot implementation of the “Mental Health and Addiction Triage and Transport Protocol”. This is the first Canadian diversion protocol that allows paramedics to transport intoxicated or mental health patients to an alternative facility, bypassing the ED. Our aim was to implement a safe diversion protocol to allow patients to access more appropriate service without transportation to the emergency department. Methods: A retrospective analysis was conducted on patients presenting to EMS with intoxication or psychiatric issues. Study outcomes were protocol compliance, determined through missed protocol opportunities, noncompliance, and protocol failure (presentation to ED within 48 hours of appropriate diversion); and protocol safety, determined through patient morbidity (hospital admission within 48 hours of diversion) and mortality. Data was abstracted from EMS reports, hospital records, and discharge forms from alternative facilities. Data was analyzed qualitatively and quantitatively. Results: From June 1st, 2015 to May 31st, 2016 Greater Sudbury Paramedic Services responded to 1376 calls for mental health or intoxicated patients. 241 (17.5%) met diversion criteria, 158 (12.9%) patients were diverted and 83 (4.6%) met diversion criteria but were transported to the ED. Of the diverted patients 9 (5.6%) represented to the ED <48rs later and were admitted. Of the 158 diversions, 113 (72%) were transported to Withdrawal Management Services (WMS) and 45 (28%) were taken to Crisis Intervention (CI). There was protocol noncompliance in 77 cases, 69 (89.6%) were due to incomplete recording of vital signs; 6 (10.3%) were direct protocol violations of being transferred with vital sings outside the acceptable range. Conclusion: The Mental Health and Addiction Triage and Transport Protocol has the potential to safely divert 1 in 6 mental health or addiction patients to an alternative facility.
Animal studies have suggested that exposure of the middle ear to topical local anaesthesia may be ototoxic. This study aimed to report sensorineural hearing outcomes and patients’ satisfaction in those who underwent myringotomy and ventilation tube insertion using topical local anaesthesia.
Twenty-nine patients (32 ears) were operated on. Pre- and post-operative audiology findings were compared. A Likert-type questionnaire on treatment satisfaction was completed at the end of the procedure.
Median patient age was 55 years (range, 27–88 years). Pre- and post-operative bone conduction pure tone averages were 26.76 dB and 25.26 dB respectively (mean reduction of −1.22 dB, 95 per cent confidence interval of −5.91 to 8.13 dB; p = 0.7538). One ear (3 per cent) had a reduction in pure tone average of 10 dB.
The results suggest that sensorineural hearing loss is not a complication of ear exposure to topical local anaesthesia during myringotomy and ventilation tube insertion. The procedure was well perceived.
In recent years, digital technologies have expanded the possibilities for human interactions in ways that were never before imagined, further complicating the teaching and learning of languages (Taguchi & Sykes, 2013; Thorne, Sauro, & Smith, 2015). Despite this complexity, when approached as meaningful, high-stakes practices, discourses in digital contexts can be highly useful for language learning and teaching. This article synthesizes work related to two digital discourse contexts, specifically hashtags and digital games. Moving away from technology as the vehicle to deliver “important content,” the analysis to follow examines digital discourses as both the content and context to be examined as part of learners’ multilingual experiences. The article begins by situating the discussion focused on digital discourses, reviewing relevant work addressing interactional patterns in each context, and then applying findings to second language teaching and learning. Drawing on empirical work, the article then describes a framework with specific examples for learner exploration of digital discourses as part of their language learning experience. The article concludes with implications for future research and teaching.
Within IAPT (Improving Access to Psychological Therapies), cognitive behavioural therapy (CBT) is offered to all clients regardless of gender, religion, culture and language. Hence, the demand for working with interpreters to facilitate communication during therapy in IAPT has increased. This study explored the experience of therapists working with interpreters to facilitate communication in psychological therapies with clients with mild to moderate anxiety and depression including those with co-morbid physical health problems. Thirteen participants, including six CBT therapists and seven Psychological Wellbeing Practitioners (PWPs) working in an NHS IAPT service, were interviewed. A qualitative approach, using semi-structured interviews and thematic analysis (Braun and Clarke, 2006), was implemented. The following four major themes were identified from the participants’ accounts: negotiating a three-way communication, difficulties in expressing empathy, a lack of shared understanding and working creatively with interpreters. During this collaborative working new understandings of engaging emerged leading participants to view this work as possible.
Highly degradable protein diets creating high ammonia and/or urea concentrations in blood or reproductive fluids may affect reproductive performance by their toxicity to embryos (Hammon et al. 2005). Pastures in NZ during spring have high CP (170 to 273 g/kg DM) and cows on these pastures have high blood urea (36 mg/dl; Moller et al. 1993). Few studies (Ordonez et al. 2007) have evaluated association between high blood urea and reproduction of individual cows. The present study examined individual cow reproductive performance and blood urea concentration during grazing of spring pasture.
Evans Ice Stream, West Antarctica, has five tributaries and a complex grounding zone. The grounding zone of Evans Ice Stream, between the landward and seaward limits of tidal flexing, was mapped using SAR interferometry. The width of the mapped grounding zone was compared with that derived from an elastic beam model, and the tidal height changes derived from interferometry were compared with the results of a tidal model. Results show that in 1994 and 1996 the Evans grounding zone was located up to 100 km upstream of its location in the BEDMAP dataset. The grounding line of Evans Ice Stream is subjected to 5 m vertical tidal forcing, which would clearly affect ice-stream flow.
Determining whether increasing temperature or precipitation will dominate the cryospheric response to climate change is key to forecasting future sea-level rise. The volume of ice contained in the ice caps and glaciers of the Arctic archipelago of Svalbard is small compared with that of the Greenland or Antarctic ice sheets, but is likely to be affected much more rapidly in the short term by climate change. This study investigates the mass balance of Austfonna, Svalbard’s largest ice cap. Equilibrium-line fluxes for the whole ice cap, and for individual drainage basins, were estimated by combining surface velocities measured using satellite radar interferometry with ice thicknesses derived from radio-echo sounding. These fluxes were compared with balance fluxes to reveal that during the 1990s the total mass balance of the accumulation zone was (5.6±2.0)×108m3 a–1. Three basins in the quiescent phase of their surge cycles contributed 75% of this accumulation. The remaining volume may be attributable either to as yet unidentified surge-type glaciers, or to increased precipitation. This result emphasizes the importance of considering the surge dynamics of glaciers when attempting to draw any conclusions on climate change based on snapshot observations of the cryosphere.
WHILE rarely the focus of critical attention, the angel has long since hovered beside the solitary in the history of anchoritic spirituality. According to the conceptualisation of the religious life known as the vita angelica, men and women who devoted themselves to contemplation of God and renounced the world lived in imitation of, and even association with, the angels of heaven. As Jean Leclercq states in his chapter on the angelic life in La Vie parfaite:
The more a person is shut off from the world, the more he is open to heaven. The more he abandons the world, the more he enters again into the state which preceded sin, when man lived in familiarity with the angels.
[plus on se ferme au monde et plus on s'ouvre au ciel; plus on quitte le siècle et plus on rentre dans l’état qui a précédé le péché, alors que l'homme vivait dans la familiarité des anges.]
Does it follow, therefore, that the most physically isolated of all religious people – anchorites – had the closest relationship of all to the celestial beings they emulated? Leclercq certainly suggests that this was the case. Later in his discussion, he provides the following extract from Nicholas of Clairvaux's sermon, On the dedication of a church:
[Hermits] hide themselves […] in the mountain caves and in the hollows of the valleys, in order to associate with the angelic spirits. They are enraptured in the contemplation of the riches of glory…
[Ils se cachent […] dans les cavernes des montagnes et les creux des vallées, pour s'associer aux esprits angéliques: ils sont ravis dans la contemplation des richesses de la gloire …]
Here, we seem to have evidence for the idea that worshippers retreated to far-flung places with the intention of seeking out celestial beings. Yet the phrase ‘in order to associate with angelic spirits’ [‘pour s'associer aux esprits angéliques’] distorts the meaning of the Latin, which implies not that hermits deliberately sought out angels, but that their highly contemplative mode of existence united them with angels, whose very function is to contemplate God.
Introduction: Prehospital transport of patients to an alternative destination (diversion) has been proposed as part of a solution to overcrowding in emergency departments (ED). We evaluated compliance and safety of an EMS bypass protocol allowing paramedics to transport intoxicated patients directly to an alternate facility [Withdrawal Management Services (WMS)], bypassing the ED. Patients were eligible for diversion if they were ≥18 years old, classified as CTAS level III-IV, scored <4 on the Prehospital Early Warning (PHEW) score, and did not have any vital sign parameters in a danger zone (as per PHEW score criteria). Methods: A retrospective analysis was conducted on intoxicated patients presenting to Sudbury EMS. Data was abstracted from EMS reports, hospital medical records, and discharge forms from WMS. Protocol compliance was measured using missed protocol opportunities (patients eligible for diversion but taken directly to the ED) and protocol noncompliance rates; protocol safety was measured using protocol failure (presentation to ED within 48 hours of appropriate diversion) and patient morbidity rates (hospital admission within 48 hours of diversion). Data was analysed qualitatively and quantitatively using proportions. Results: EMS responded to 681 calls for intoxication. Of the 568 taken directly to the ED, 65 met diversion criteria; these were missed protocol opportunities (11%). 113 patients were diverted. There was protocol noncompliance in 41 cases (36%), but 35 were due to incomplete recording of vital signs. There were direct protocol violations in only 6 cases (5%). There was protocol failure in 16 cases (22%), and patient morbidity in 1 case (1%). No patients died within 48 hours of diversion. Conclusion: EMS providers were fairly compliant with the protocol when transporting patients directly to the ED. There was some protocol non-compliance with patients diverted to WMS, though this is largely attributed to incomplete recording of vital signs; direct protocol violations were low. The protocol provides high levels of safety for patients diverted to WMS. Broader implementation of the protocol could reduce the volume of intoxicated patients seen in the ED, and improve quality of care received by this population.
Introduction: Prehospital transport of patients to an alternative destination (diversion) has been proposed as part of a solution to overcrowding in emergency departments (ED). We evaluated compliance and safety of an EMS protocol allowing paramedics to transport medically stable patients with psychiatric issues directly to an alternate facility [Crisis Intervention (CI)], bypassing the ED. Patients were eligible for diversion if they were ≥18 years old, classified as CTAS III-IV, scored <4 on the Prehospital Early Warning (PHEW) score, and did not have any vital sign parameters in a danger zone (as per PHEW score criteria). Methods: A retrospective analysis was conducted on patients presenting to Sudbury EMS with behavioural or psychiatric issues. Data was abstracted from EMS reports, hospital medical records, and discharge forms from CI. Protocol compliance was measured using missed protocol opportunities (patients eligible for diversion but taken directly to the ED) and protocol noncompliance rates; protocol safety was measured using protocol failure (presentation to ED within 48 hours of appropriate diversion) and patient morbidity rates (hospital admission within 48 hours of diversion). Data was analysed qualitatively and quantitatively using proportions. Results: EMS responded to 695 calls with psychiatric complaints. Of the 650 taken directly to the ED, 18 met diversion criteria; these were missed protocol opportunities (3%). 45 patients were diverted. There was protocol noncompliance in 36 cases (80%), but 34 were due to incomplete recording of vital signs. There were direct protocol violations in only 2 cases (4%). There was protocol failure in 3 cases (33%), and patient morbidity in 8 cases (18%). No patients died within 48 hours of diversion. Conclusion: EMS providers were highly compliant with the protocol when transporting patients directly to the ED. There were high levels of protocol non-compliance in diverting patients to CI, though this is largely attributed to incomplete recording of vital signs; direct protocol violations were low. The protocol provides moderate levels of safety in diverted patients. Broader implementation of a diversion protocol could reduce the volume of mental health patients seen in the ED, and improve quality of care received by this patient population.
This paper asks whether archaeologists might profitably re-engage with the pre-Enlightenment doctrines of elemental philosophy and humoral theory as paradigms more relevant for archaeological interpretation in certain contexts than much of current theoretical discourse. These ancient cosmologies are here reconceptualized to suggest ways in which archaeologists might provide fairer representations of past cultures, through the readoption of ideas that they understood rather than through the imposition of more recent and thus anachronistic frames of analytical reference. In four brief case studies, the paper seeks to show how the foregrounding of elemental and humoral theories might lead to new ways of thinking about the study and interpretation of the landscape, material culture, consumption and the senses. Through them, the paper looks to encourage reflection on whether elemental and humoral theories represent the intellectual paradigms that archaeologists have been striving to invent since the discipline's creation.
In this chapter we present an overview of NASA's Planetary Data System project with emphasis on the Small Bodies Node (SBN) and describe a separate relational database project, the Steward Observatory Asteroid Relational Database (SOARD). We summarize the datasets that are currently available through SBN and SOARD as well as those planned to be ingested in the future. Procedures for accessing data from the SBN and SOARD via Internet are included.
Find it in London is the first pilot project of its kind in London. Using ten partner institutions across the archive, library and museum domains, it tests the concept of searching in one single step across these sectors for relevant collections. The pilot database, though currently small, allows an information seeker to choose a subject and find out which archives, libraries and museums in the pilot have collections which may be of interest. The next step will be to seek further substantial funding to scale the project up across the full span of London’s information treasure troves and create a world-beating web-based lookup subject tool.
I first came to know John Jackson in his role as a consultant to the international trade group at Arnold & Porter. Fresh out of law school and a novice in the field of international trade law, I quickly learned that John was the leading American expert on legal aspects of both GATT and domestic trade law issues. Only later did I come to realize that his stature in this regard was global. John's advice on GATT issues was sought after by academics and policymakers everywhere.