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International institutions are prevalent in world politics. More than a thousand multilateral treaties are in place just to protect the environment alone, and there are many more. And yet, it is also clear that these institutions do not operate in a void but are enmeshed in larger, highly complex webs of governance arrangements. This compelling book conceptualizes these broader structures as the “architectures” of global governance. Here, over 40 international relations scholars offer an authoritative synthesis of a decade of research on global governance architectures with an empirical focus on protecting the environment and vital earth systems. They investigate the structural intricacies of earth system governance and explain how global architectures enable or hinder individual institutions and their overall effectiveness. The book offers much-needed conceptual clarity about key building blocks and structures of complex governance architectures, charts detailed directions for new research, and provides analytical groundwork for policy reform.
Post-traumatic stress disorder (PTSD) is a serious mental disorder that develops in some individuals following exposure to severe psychological stressors. In this chapter, we provide an overview of the conceptual issues, specific methods, and practical considerations in evidence-based assessment of PTSD. First, we outline the conceptual issues and practical components of a comprehensive assessment of PTSD. Second, we provide an overview of the most widely used self-rated and clinician-rated measures of trauma exposure and PTSD, comorbid disorders, and response bias. Third, we discuss cultural considerations in assessing PTSD. Fourth, we offer practical guidelines for conducting a clinically sensitive assessment of PTSD, highlighting some of the unique considerations in engaging trauma survivors in the assessment process and optimizing the information obtained. Last, we briefly summarize conceptual considerations and specific measures for other trauma- and stressor-related disorders.
Anaesthesia is possibly the most pharmacology oriented of all clinical medical specialties. What we do every day is, effectively, applied pharmacology. Yet with all this practical experience, some aspects, particularly pharmacokinetics, can appear dauntingly complex. Indeed, mathematical modelling and developing target-controlled infusions is difficult as is the design of modern vaporisers for inhalational drugs but, as an analogy, we don’t need to be able to design a car in order to know how to drive it. However, there are certain basic PK features that will enhance your understanding and improve your ability to use these drugs appropriately.
Periodic lattice materials have been studied extensively in numerous science and engineering fields. Despite the vast knowledge that has emerged, the activities have been stove-piped within individual research communities, often in isolation from those in related fields. To bring this work into a holistic framework, the present article considers the elements needed to integrate the study of lattice materials into the processing–structure–properties paradigm that underpins materials science as an academic discipline. The emphasis is on concepts of structure involving topology, morphology, and defects of lattice materials, with illustrations of structure–property relations in the context of lattice strength.
Distinguishing between hypertrophic cardiomyopathy and other causes ofleft ventricular hypertrophy can be difficult in children. We hypothesised that cardiac MRI T1 mapping could improve diagnosis of paediatric hypertrophic cardiomyopathy and that measures of myocardial function would correlate with T1 times and extracellular volume fraction.
Thirty patients with hypertrophic cardiomyopathy completed MRI with tissue tagging, T1-mapping, and late gadolinium enhancement. Left ventricular circumferential strain was calculated from tagged images. T1, partition coefficient, and synthetic extracellular volume were measured at base, mid, apex, and thickest area of myocardial hypertrophy. MRI measures compared to cohort of 19 healthy children and young adults. Mann–Whitney U, Spearman’s rho, and multivariable logistic regression were used for statistical analysis.
Hypertrophic cardiomyopathy patients had increased left ventricular ejection fraction and indexed mass. Hypertrophic cardiomyopathy patients had decreased global strain and increased native T1 (−14.3% interquartile range [−16.0, −12.1] versus −17.3% [−19.0, −15.7], p < 0.001 and 1015 ms [991, 1026] versus 990 ms [972, 1001], p = 0.019). Partition coefficient and synthetic extracellular volume were not increased in hypertrophic cardiomyopathy. Global native T1 correlated inversely with ejection fraction (ρ = −0.63, p = 0.002) and directly with global strain (ρ = 0.51, p = 0.019). A logistic regression model using ejection fraction and native T1 distinguished between hypertrophic cardiomyopathy and control with an area under the receiver operating characteristic curve of 0.91.
In this cohort of paediatric hypertrophic cardiomyopathy, strain was decreased and native T1 was increased compared with controls. Native T1 correlated with both ejection fraction and strain, and a model using native T1 and ejection fraction differentiated patients with and without hypertrophic cardiomyopathy.
This chapter provides an ethical framework to guide decision making about periviable birth.
Viability in professional ethics in obstetrics and gynecology is a function of both fetal physiology and available resuscitation and life-sustaining treatment. Viability is therefore the biological capacity of a live-born infant to survive even if full technological support is needed. This is the concept of viability used by the United States Supreme Court in its landmark ruling, Roe v. Wade, in 1973.
This chapter provides an ethical framework for decision making about initiation of pregnancy.
Obstetrician-gynecologists play two important roles in the initiation of pregnancy. The first is the medically assisted initiation of pregnancy, usually to manage infertility in the female patient or her partner or both. The second is preconception counseling to anticipate and prevent ethical challenges in assisted initiation of pregnancy.
This chapter provides guidance on deliberative clinical judgment and decision making about preventing pregnancy in professional ethics in gynecology.
The biologic concept of sex is an essential component of the biologic concept of fertility. It is used to categorize human beings according to reproductive role: only the capacity to produce gametes, or the capacity to produce gametes and initiate a pregnancy. Sex was once thought to be dimorphic, but modern genomics of chromosomes has abandoned dimorphism for a concept of biologic sex as ranging along a continuum between these two productive roles. In other words, like all other human traits, biologic sex displays variation.
This chapter provides an introduction to professional ethics in obstetrics and gynecology based on the ethical concept of medicine as a profession and the ethical concepts of the female patient, pregnant patient, and fetal patient. There is also an introduction to professional ethics in perinatal medicine.
This chapter provides an ethical framework for offering, recommending, performing, and referring for induced abortion and feticide.
Counseling pregnant women about induced abortion and feticide presents the obstetrician with a distinct set of challenges., The American Medical Association and the American College of Obstetricians and Gynecologists have provided general guidance. Based on the ethical principles of beneficence and respect for autonomy in professional ethics in obstetrics and gynecology (see Chapter 2), this chapter provides practical, clinically comprehensive ethical guidance on when to offer, recommend, perform, and refer for abortion and feticide.
This chapter provides an ethical framework to guide decision making about fetal analysis.
The ethical principle of respect for autonomy in professional ethics in obstetrics creates the obstetrician’s prima facie ethical obligation to empower the pregnant patient to make informed and voluntary decisions about obstetric management. This ethical obligation has two components. The first is providing her with clinical information about options for fetal analysis using nomenclature that is precise.
This chapter provides an ethical framework for setting justified limits on life-sustaining treatment.
Sometimes a patient’s condition has deteriorated to such a degree that in deliberative clinical judgment the prediction of imminent death becomes reliable. When death is imminent patients are transferred to a critical care unit in which they receive life-sustaining treatment. Life-sustaining treatment deploys a range of interventions, including physical intervention such as cardiopulmonary resuscitation; intravenous administration of drugs, fluids, and nutrition; and mechanical devices such as circulation devices, extracorporeal membrane oxygenation, dialysis, and ventilators. These interventions are designed to support or replace organ functions in the absence of which the risk of mortality will rapidly approach 100%.
This chapter provides an ethical framework to guide decision making about intrapartum management.
Most women deliver their babies vaginally. Vaginal delivery is clearly safer for the pregnant patient because no invasive clinical management is involved, even when fetal monitoring takes place. This clinical reality makes assisting vaginal delivery the default in clinical judgment, placing the burden of proof on justifying cesarean delivery. As a consequence, in traditional obstetric thinking, cesarean delivery is either indicated – the burden of proof is met – or nonindicated – the burden of proof is not met. When cesarean delivery is indicated, it should be recommended. When cesarean delivery is not indicated, it should not be offered, much less recommended.
This chapter provides an ethical framework for the identification and responsible management of conflicts of interest and conflicts of commitment.
The professionally responsible management of conflicts of interest and conflicts of commitment is essential for sustaining the three commitments of the ethical concept of medicine as a profession (see Chapter 1) and therefore for professional integrity.