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The important and no longer novel insight from ecology that ecosystems are dynamic and ever-changing along immensely complex causal pathways prompts the further insight that environmental protection regimes should promote not a particular ecosystemic end state, but rather ecosystem resilience, or the capacity to absorb and adapt to stress without compromising essential function. For law to embrace resilience as an objective, it is argued, it must itself be dynamic and flexible, capable of learning and adaptation. This poses potentially serious challenges to law’s resilience: to what extent are flexibility and adaptability at odds with what Niklas Luhmann argues is an essential feature of normative systems, namely, resistance to learning in the face of disappointment? The potentially rapid rate of change expected of a law oriented to ecosystem resilience could overwhelm law’s capacity to provide the measure of order, stability, and predictability that are core to its contribution, or prestation, to society. This paper takes this challenge seriously, but also explores another possible implication of law in the pursuit of ecosystem resilience: if environmental law is no longer conceived of in primarily instrumental terms, as a means to bring about a specific set of ecosystem objectives, there may be some possibility for its own resilience to be enhanced.
We examined the association between a history of smallpox vaccination and immune activation (IA) in a population of antiretroviral therapy-naïve people living with HIV (PLHIV). A cross-sectional study was conducted in Senegal from July 2015 to March 2017. Smallpox vaccination was ascertained by the presence of smallpox vaccine scar and IA by the plasma level of β-2-microglobulin (β2m). The association was analysed using logistic regression and linear regression models. The study population comprised 101 PLHIV born before 1980 with a median age of 47 years (interquartile range (IQR) = 42–55); 57·4% were women. Smallpox vaccine scar was present in 65·3% and the median β2m level was 2·59 mg/l (IQR = 2·06–3·86). After adjustment, the presence of smallpox vaccine scar was not associated with a β2m level ⩾2·59 mg/l (adjusted odds ratio 0·94; 95% confidence interval 0·32–2·77). This result was confirmed by the linear regression model. Our study does not find any association between the presence of smallpox vaccine scar and the β2m level and does not support any association between a previous smallpox vaccination and HIV disease progression. In this study, IA is not a significant determinant of the reported non-targeted effect of smallpox vaccination in PLHIV.
We present the first ultrasound analysis of the secondary palatalization contrast in Irish, analyzing data from five speakers from the Connemara dialect group. Word-initial /pʲ(bʲ) pˠ(bˠ) tʲ tˠ kʲ kˠ fʲ fˠ sʲ sˠ xʲ xˠ/ are analyzed in the context of /iː uː/. We find, first, that tongue body position robustly distinguishes palatalized from velarized consonants, across place of articulation, manner, and vowel place contexts, with palatalized consonants having fronter and/or higher tongue body realizations than their velarized counterparts. This conclusion holds equally for labial consonants, contrary to some previous descriptive claims. Second, the nature and degree of palatalization and velarization depend in systematic ways on consonant place and manner. In coronal consonants, for example, velarization is weaker or absent. Third, the Irish consonants examined resist coarticulation in backness with a following vowel. In all of these respects Irish palatalization is remarkably similar to that of Russian. Our results also support an independent role for pharyngeal cavity expansion/retraction in the production of the palatalization contrast. Finally, we discuss preliminary findings on the dynamics of the secondary articulation gestures. Our use of principal component analysis (PCA) in reaching these findings is also of interest, since PCA has not been employed a great deal in analyses of tongue body movement.
International studies have shown that patients want their spiritual needs attended to at the end of life. The present authors developed a project to investigate people's understanding of spirituality and spiritual care practices in New Zealand (NZ) hospices.
A mixed-methods approach included 52 semistructured interviews and a survey of 642 patients, family members, and staff from 25 (78%) of NZ's hospices. We employed a generic qualitative design and analysis to capture the experiences and understandings of participants' spirituality and spiritual care, while a cross-sectional survey yielded population level information.
Our findings suggest that spirituality is broadly understood and considered important for all three of the populations studied. The patient and family populations had high spiritual needs that included a search for (1) meaning, (2) peace of mind, and (3) a degree of certainty in an uncertain world. The healthcare professionals in the hospices surveyed seldom explicitly met the needs of patients and families. Staff had spiritual needs, but organizational support was sometimes lacking in attending to these needs.
Significance of results:
As a result of our study, which was the first nationwide study in NZ to examine spirituality in hospice care, Hospice New Zealand has developed a spirituality professional development program. Given that spirituality was found to be important to the majority of our participants, it is hoped that the adoption of such an approach will impact on spiritual care for patients and families in NZ hospices.
In situ temperature-resolved Near-edge X-ray Absorption Fine Structure (NEXAFS) measurements were performed on thermo-active ethylene-vinyl acetate (EVA) – multiwall carbon nanotube (MWCNT) composites 12 months following synthesis, and compared with spectra acquired shortly after synthesis to examine aging effects on non-covalent interactions. Room temperature spectra revealed no difference between unstrained and strained composites, suggesting relaxation. Further, energy shifts in π* C=C resonances indicated a change in π–π interactions between MWCNT walls and chemical dispersant, supported also by AFM phase imaging. Temperature-resolved NEXAFS analysis showed a lack of interaction between nanotubes and polymeric chains, suggesting the chemical dispersant unlatched from MWCNT walls. The extent of this effect is finally quantified through a comparative study of spectral trends.
Many languages have restrictions on word-final segments, such as a requirement
that any word-final obstruent be voiceless. There is a phonetic basis for such
restrictions at the ends of utterances, but not the ends of words. Historical
linguists have long noted this mismatch, and have attributed it to an analogical
generalisation of such restrictions from utterance-final to word-final position.
To test whether language learners actually generalise in this way, two
artificial language learning experiments were conducted. Participants heard
nonsense utterances in which there was a restriction on utterance-final
obstruents, but in which no information was available about word-final
utterance-medial obstruents. They were then tested on utterances that included
obstruents in both positions. They learned the pattern and generalised it to
word-final utterance-medial position, confirming that learners are biased toward
word-based distributional patterns.
Now widely recognized as one of the most effective methods for training future surgeons, simulation has become an integral part of the multidimensional landscape that makes up a surgical education curriculum. This book provides an overview of the current status of simulation-based training in various surgical disciplines and explains the science of surgical education, from developing a simulation programme to properly assess surgeons-in-training, to transferring the skills acquired through simulation into real-life settings. As such, the book can be used as a guide for understanding the basics of surgical education.
Surgery, perhaps more than any other branch of medicine, has been defined by the technical skills of its clinicians, and this has meant that the acquisition of these skills has taken primacy over other training requirements. However, the practice of surgery contains far more than high-quality technical skills. These other skills are termed non-technical skills (NTS) and include cognitive and social skills such as decision making, situation awareness, professionalism, teamwork and communication.
There is increasing evidence that deficiencies in NTS exist in surgical teams and that this can significantly affect team performance and patient safety. Clearly current models of surgical training do not adequately ensure the development of these skills and healthcare still ‘lags unacceptably behind other safety-critical industries such as aviation’ (House of Commons Health Committee, 2009).
These NTS are not innate personality traits but can be taught and developed through training. Several authors and government bodies have called for improved training to address this skills gap and simulation has emerged as a powerful training tool to help achieve this (1, 2).
This chapter will first discuss the importance of NTS in healthcare and assuring patient safety and also highlight deficiencies of NTS in surgical practice. Secondly, training methods to improve NTS will be discussed with an emphasis on high-fidelity simulation-based training, which is being increasingly used as a tool to develop and assess these skills in healthcare.
Palatalization contrasts are subject to certain asymmetries across languages (Takatori 1997, Kochetov 2002). For example, they are preferred at the beginning of words or syllables rather than at the end, and they are preferred in coronals rather than labials. Kochetov (2002, 2004) argues that these asymmetries are perceptually motivated, and he provides supporting evidence from Russian. We report on results of an acoustic and perceptual study of palatalization in Connemara Irish. Our acoustic analysis documents a range of properties distinguishing palatalized from non-palatalized consonants in Irish, though our acoustic data come from only one speaker. Based on a speeded AX discrimination task, our perceptual results in some ways parallel Kochetov's for Russian (listeners show degraded performance for the coda contrast compared to the onset contrast), and in some ways do not (they do not perform better on coronals than on labials).
Matthias and I clearly agree on a great deal: a voluntarist approach to defining public international law is unsatisfactory; any rule of recognition in international law must provide a basis for a link between legality and legitimacy; one of the central contributions that law can make to international society is procedural in nature. However, our respective positions on the utility of a binary distinction between law and not-law have significant impacts on our approaches. We are both concerned, I think, with preserving the autonomy of politics – with ensuring that politics (or, more specifically, international public authority) do not come to be invaded by law. My own concern with preserving the autonomy of law leads me to two conclusions with which Matthias would take issue: that international public authority must be constituted by law; and that the rules which those authorities administer must be treated differently, depending on whether or not they meet a set of formal criteria that legal rules must satisfy. I will also address Matthias's discussion of Lon L. Fuller's internal morality of law and Benedict Kingsbury's concept of publicness in international law. I believe that both sets of concepts may be useful to Matthias's argument and deserve further attention. First, however, I would like to explore what it means, or could mean, to cut off the head of the king.
Teck v. Pakootas revisits the infamous Trail smelter, which made history in public international law. This more recent case should be set to make history as well, due to the manner in which the issue of extraterritorial exercise of jurisdiction was handled. The substantive result reached in the courts seems fair, reasonable, and appropriate: a notorious polluter, Teck Cominco Metals Inc., is called to account by the United States Environmental Protection Agency and required to study the feasibility of cleaning up a site it contaminated by dumping effluents in a transboundary river over the course of several decades. Yet, both courts that examined this case on the merits failed to understand the ramifications of this extension of the Environmental Protection Agency's jurisdiction across the Canada–United States border. This article begins with a doctrinal analysis of jurisdictional rules in private and public international law, and then proceeds to evaluate those rules with the help of insights from scholarship on global administrative law and international public authority.
Soft law is often seen as a way to overcome certain problems of legitimacy in international law, notably the weaknesses of a voluntaristic conception of international law's validity. Other perceived benefits of soft law include flexibility, speed of adoption and modification, and even effectiveness. Yet, soft law is seen by others as a threat to law, because it effaces the border between law and politics. This paper explores different approaches to the boundary between law and not-law that seek both to maintain this boundary and to reconceptualize it in a way that better anchors the validity of international legal rules.