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Dutch constitutional identity is not a fixated entity functioning as a constitutional bulwark to shield the Netherlands from European integration, but is rather characterised by an openness to and embeddedness in international and European law. It includes an emphasis on individual rights and autonomy within a culture of compromise and cooperation, based on the idea of all ultimately being in the same boat together. This idea not only applies to the traditional ability of the Dutch to live together peacefully despite differing views on fundamental issues. It also entails that the Dutch constitutional identity should not exist in opposition towards other constitutional identities within the European Union, but that all should move alongside each other, setting sail in the same direction.
The hypoactive, hyperactive, and mixed subtypes of delirium differently impact patient management and prognosis, yet the evidence remains sparse. Therefore, we examined the outcome of varying management strategies in the subtypes of delirium.
In this observational cohort study, 602 patients were managed for delirium over 20 days with the following strategies: supportive care alone or in combination with psychotropics, single, dual, or triple+ psychotropic regimens. Cox regression models were calculated for time to remission and benefit rates (BRs) of management strategies.
Generally, the mixed subtype of delirium caused more severe and persistent delirium, and the hypoactive subtype was more persistent than the hyperactive subtype. The subtypes of delirium were similarly predictive for mortality (P = 0.697) and transfer to inpatient psychiatric care (P = 0.320). In the mixed subtype, overall, psychotropic drugs were administered more often (P = 0.016), and particularly triple+ regimens were administered more commonly compared to hypoactive delirium (P = 0.007). Patients on supportive care benefited most, whereas those on triple+ regimens did worst in terms of remission in all groups of hypoactive, hyperactive, and mixed subtypes (BR: 4.59, CI 2.01–10.48; BR: 4.59, CI 1.76–31.66; BR: 3.36, CI 1.73–6.52; all P < 0.05).
Significance of results
The mixed subtype was more persistent to management than the hypoactive and hyperactive subtypes. Delirium management remains controversial and, generally, supportive care benefited patients most. Psychopharmacological management for delirium requires careful choosing of and limiting the number of psychotropics.
Both acute and chronic pain can disrupt reward processing. Moreover, prolonged prescription opioid use and depressed mood are common in chronic pain samples. Despite the prevalence of these risk factors for anhedonia, little is known about anhedonia in chronic pain populations.
We conducted a large-scale, systematic study of anhedonia in chronic pain, focusing on its relationship with opioid use/misuse, pain severity, and depression. Chronic pain patients across four distinct samples (N = 488) completed the Snaith–Hamilton Pleasure Scale (SHAPS), measures of opioid use, pain severity and depression, as well as the Current Opioid Misuse Measure (COMM). We used a meta-analytic approach to determine reference levels of anhedonia in healthy samples spanning a variety of countries and diverse age groups, extracting SHAPS scores from 58 published studies totaling 2664 psychiatrically healthy participants.
Compared to healthy samples, chronic pain patients showed higher levels of anhedonia, with ~25% of patients scoring above the standard anhedonia cut-off. This difference was not primarily driven by depression levels, which explained less than 25% of variance in anhedonia scores. Neither opioid use duration, dose, nor pain severity alone was significantly associated with anhedonia. Yet, there was a clear effect of opioid misuse, with opioid misusers (COMM ⩾13) reporting greater anhedonia than non-misusers. Opioid misuse remained a significant predictor of anhedonia even after controlling for pain severity, depression and opioid dose.
Study results suggest that both chronic pain and opioid misuse contribute to anhedonia, which may, in turn, drive further pain and misuse.
Using data collected from a Community Assessment for Public Health Emergency Response (CASPER) conducted in Fairfax Health District, Virginia, in 2016, we sought to assess the relationship between household-level perceived preparedness and self-reported preparedness behaviors.
Weighted population estimates and 95% confidence intervals were reported, and Pearson’s chi-squared test was used to investigate differences by group.
Examining responses to how prepared respondents felt their household was to handle a large-scale emergency or disaster, an estimated 7.4% of respondents (95% CI: 4.3–12.3) reported that their household was “completely prepared,” 37.3% (95% CI: 31.4–43.7) were “moderately prepared,” 38.2% (95% CI: 31.6–45.2) were “somewhat prepared,” and 14.4% (95% CI: 10.2–20.0) were “unprepared.” A greater proportion of respondents who said that their household was “completely” or “moderately” prepared for an emergency reported engaging in several behaviors related to preparedness. However, for several preparedness behaviors, there were gaps between perceived preparedness and self-reported readiness.
Community assessments for public health preparedness can provide valuable data about groups who may be at risk during an emergency due to a lack of planning and practice, despite feeling prepared to handle a large-scale emergency or disaster.
In this chapter, Section 1 discusses the increasing constitutionalization of human right law (HRL) and international economic law (IEL) at national and regional levels of governance and its implications for the settlement of disputes. Section 2 discusses constitutional justice principles as legal basis for impartial third-party adjudication requiring judicial administration of justice and treaty interpretations in conformity with the principles of justice and human rights. Section 3 elaborates in more detail problems of systemic integration and constitutionalist interpretation in IEL (e.g., resulting from fragmentation and forum shopping) and enhance the legitimacy of law and adjudication. Section 4 gives an overview of procedural human rights dimensions in IEL adjudication, like the human right of access to justice and the emerging common law of transnational adjudication. Section 5 discusses procedural and substantive human rights problems in WTO and investment adjudication. Section 6 criticizes trade and investment adjudication for neglecting human rights law and constitutional, distributive, corrective and commutative justice principles.
Since 2017, the United States (US) and other World Trade Organization (WTO) members have been violating their legal duties and democratic mandates given by national parliaments to maintain the WTO Appellate Body (AB) as legally prescribed in Article 17 of the WTO Dispute Understanding (DSU). Article 17 defines the AB as being ‘composed of seven persons’, with vacancies being ‘filled as they arise’. Sections 2 and 3 explain why none of the reasons offered by the US for its blocking of the (re)appointment of AB candidates – on grounds unrelated to the personal qualifications of the candidates – can justify the illegal disruptions of the WTO legal and dispute settlement system. EU trade diplomats must exercise leadership using the existing legal powers and duties of the WTO Ministerial Conference and General Council under Article IX WTO – if necessary, based on ‘a majority of the votes cast’ – to complete the WTO selection procedures for filling AB vacancies and protect the AB as legally defined in Article 17 DSU. Sections 4 and 5 explain why the competition, social policy, and rule-of-law principles underlying European ‘ordo-liberalism’ offer coherent strategies for overcoming the WTO governance crises by limiting hegemonic abuses of both US neo-liberalism and Chinese state-capitalism.
Maybe it is too soon to call it a tradition, but in recent years your colleagues and friends in The Hague have sponsored this closing plenary with much pleasure. In cooperation with the City of The Hague and His Majesty's Embassy, the Asser Institute for International and European Law has organized the panel discussion at the closing plenary. Our subject this year is multilateralism, a topic that is close at heart to many of us. That is certainly the case for us, practitioners and scholars based in The Hague, where international efforts for multilateral agreements and institutions have been part of the fabric of our city since the nineteenth century. Multilateral institutions continue to define the spirit of our city.
Musical history research and ethnomusicology have hitherto usually been treated as separate fields. One of the reasons for this is doubtless the search for a way in which the material to be dealt with should be presented. Historical research has, as we know, to do with a body of musical fact which has been handed down through the medium of notation and therefore exists in a more or less concrete form. Non-European music and European folk music, on the other hand, are exclusively dependent upon oral tradition. To begin with, the latter does not, as Robert Lachmann once very aptly expressed it, exist for us at all. Materials must first be made indirectly tangible for us through special means, that is to say, they must be translated through recording and transcription out of the sphere of oral tradition into that of written notation. This is certainly one of the chief reasons why musical history research and ethnomusicology have hitherto gone different ways, each with its own independent aims, complexes of problems and methods.
One of the most pressing demands of current Hungarian folk music research is to single out those precise elements in the traditions of Hungarian folk music which can be proved to be archaic residues of an early culture of Finno-Ugric origin. Under the inspiration of the labours of Bartók and Kodály this goal was attacked with enthusiasm as much as with methodical reflection. The methods of investigation which have been applied and also the results of the research attained thus far could arouse objection at many points. On the other hand, there can be no doubt about the justification of formulating the question as such.
Following the model of linguistic science, Hungarian folk music research has used above all comparative as well as historical methods. Through close study of recent collections of melodies recorded from Finno-Ugric peoples living far apart from each other, pains have been taken to establish stylistic coincidence or relationships which justify the tracing back of certain melodic structures and style complexes to Finno-Ugric roots.
That folk song found its way into Mahler's music is often stated but never demonstrated. The term 'folk song' must only be taken to cover the kind of song absorbed by him during his youth; later in life he did not concern himself with folk tunes. The songs of his homeland, on the border between Bohemia and Moravia, include (a) Moravian songs with archaic features, (b) Czech and German-Bohemian folk songs with clearly defined stylistic elements from the eighteenth century, and (c) songs of the bordering German lands of Bavaria and Silesia. Analysis has shown that Mahler used formulae from Moravian folk song, including the lydian fourth, and that there is a basic relationship between his music and the folk songs of his homeland. His melodies tend to be rhythmically free and to use repeated notes. Rhythmic features, such as short notes on strong beats, syncopation, and feminine endings, point to Czech folk song. Repetition of short formulae, and chain- or open forms occur, as in Czech and Moravian folk song. His writing for strings aims at producing the characteristic tone of folk fiddles in Iglau, and displays the heterophony between voice and accompaniment characteristic of that region.
A new species of the Paleozoic bryozoan genus Ptilotrypa of the order Cryptostomata is described from the lower part of the Yong Limestone Formation, Katian, Upper Ordovician of the Kumaun Tethys Himalaya: Ptilotrypa bajpaii new species. The presence of the genus Ptilotrypa in the Tethyan Himalaya suggests paleogeographic connections to the Upper Ordovician of North America and, consequently, Upper Ordovician age for the lower part of the Yong Limestone Formation. This species displays a reticulate colony shape, which suggests an efficient filtering capacity in an environment with a high primary production. Morphological peculiarities and systematic assignment of the genus Ptilotrypa are discussed.
Thirteen bryozoan species are described from the Brewer Dock (Hickory Corners) Member of the Reynales Formation (lower Silurian, Aeronian) at the locality Hickory Corners in western New York, USA. Three species are new: trepostomes Homotrypa niagarensis n. sp. and Leioclema adsuetum n. sp. and the rhabdomesine cryptostome Moyerella parva n. sp. Only one species, Hennigopora apta Perry and Hattin, 1960, developed obligatory encrusting colonies whereas the others produced erect ramose colonies of various thicknesses and shapes: cylindrical, branched, and lenticular. Bryozoans display high abundance and richness within the rock. This fauna is characteristic of a moderately agitated environment with a stable substrate. The identified species reveal paleobiogeographic connections to other Silurian localities of New York as well as Ohio and Indiana (USA) and Anticosti (Canada).