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How can businesses operate profitably and sustainably while ensuring that they are applying human rights? It is possible to apply human rights while at the same time decreasing cost and making human rights contribute to profits. Yet business efforts alone are insufficient, and states must possess sufficient regulatory power to work together with businesses and investors – not only to improve human rights but also to foster development more broadly. This textbook, the first of its kind, explores all aspects of the links between business operations and human rights. Its twenty-five chapters guide readers systematically through all the particular features of this intersection, integrating legal and business approaches. Thematic sections cover conceptual and regulatory frameworks, remedies and dispute resolution, and practical enforcement tools. Ideal for courses in business, law, policy and international development, the book is also essential reading for managers in large corporations.
Developing an original theoretical approach to understanding the roots of regional conflict and cooperation, International Relations in the Middle East explores domestic and international foreign policy dynamics for an accessible insight into how and why Middle Eastern regional order has changed over time. Highlighting interactions between foreign policy trajectories in a range of states including Egypt, Iran, Iraq, Israel, Saudi Arabia, Syria and Turkey, Ewan Stein identifies two main drivers of foreign policy and alignments: competitive support-seeking and ideological externalisation. Clearly linking political, ideological and foreign policy dynamics, Stein demonstrates how the sources of regional antagonisms and solidarities are to be found not in the geopolitical chessboard, but in the hegemonic strategies of the region's pivotal powers. Making the case for historical sociology - in particular the work of Antonio Gramsci and Louis Althusser - as the most powerful lens through which to understand regional politics in the Middle East, with wider implications for the study of regional order elsewhere.
As major global challenges intensify in the twenty-first century, which domestic institutions will best enable countries to take decisive and positive action? This article explores this question in the realm of environmental policy. Scholars and practitioners have long argued that ‘democracy’ yields the best environmental outcomes, but others now maintain that ‘eco-authoritarianism’ may be the best way forward. The author unpacks the theoretical mechanisms behind these debates, and adds important nuance in making three arguments. First, the link between elections and eco-policy depends on what citizens want. Secondly, the relationship between civil liberties protections and environmentalism depends on which actors within society hold power. Finally, political constraints make environmental policy change – be it environmentally friendly or damaging – more difficult. The study empirically tests these arguments and finds strong support for the expectations regarding elections and civil liberties. There is only limited evidence that constraints stymie eco-policy change.
High-protein meals and foods are promoted for their beneficial effects on satiety, weight loss and glucose homeostasis. However, the mechanisms involved and the long-term benefits of such diets are still debated. We here review how the characterisation of intestinal gluconeogenesis (IGN) sheds new light on the mechanisms by which protein diets exert their beneficial effects on health. The small intestine is the third organ (in addition to the liver and kidney) contributing to endogenous glucose production via gluconeogenesis. The particularity of glucose produced by the intestine is that it is detected in the portal vein and initiates a nervous signal to the hypothalamic nuclei regulating energy homeostasis. In this context, we demonstrated that protein diets initiate their satiety effects indirectly via IGN and portal glucose sensing. This induction results in the activation of brain areas involved in the regulation of food intake. The μ-opioid-antagonistic properties of protein digests, exerted in the portal vein, are a key link between IGN induction and protein-enriched diet in the control of satiety. From our results, IGN can be proposed as a mandatory link between nutrient sensing and the regulation of whole-body homeostasis. The use of specific mouse models targeting IGN should allow us to identify several metabolic functions that could be controlled by protein diets. This will lead to the characterisation of the mechanisms by which protein diets improve whole-body homeostasis. These data could be the basis of novel nutritional strategies targeting the serious metabolic consequences of both obesity and diabetes.
According to the World Health Organization, smoking is the most important risk factor for adverse pregnancy outcomes in industrialized nations. We aimed to establish how fetal gender and smoking interact with regard to perinatal outcomes, especially preterm delivery. Data from 220,339 singleton pregnancies, obtained from the German Perinatal Survey in Schleswig-Holstein and registered between 2004 and 2017 were analyzed in regard to smoking behavior, fetal gender, and preterm delivery. The rate of preterm births was directly proportional to the women’s consumption of nicotine. The rate of preterm deliveries was 6.8% among nonsmokers, and 13.2% in women who were very heavy smokers (≥22 cigarettes/day). Very heavy smoking (≥22 cigarettes/day) had a marked impact on extremely preterm births (<28 weeks of gestation) and very preterm births (28–31 weeks of gestation). Preterm births increased by 1.2% from heavy smokers to very heavy smokers; the differences between the other groups ranged between 0.1% and 0.4%. Fetal gender also had an impact on preterm birth: male infants were predominant in nearly all groups of women who delivered preterm infants. Smoking during pregnancy and male gender are both risk factors for preterm delivery. Fetal gender should be given greater attention as one of the several risk factors of preterm birth. Due to the high rate of morbidity among preterm infants and enormous costs for the healthcare system, women should be encouraged to cease or at least reduce smoking during pregnancy.
The recommendations of the Association for European Paediatric and Congenital Cardiology for basic training in paediatric and congenital cardiology required to be recognised as a paediatric cardiologist by the Association for European Paediatric and Congenital Cardiology are described below. Those wishing to achieve more advanced training in particular areas of paediatric cardiology should consult the training recommendations of the different Association for European Paediatric and Congenital Cardiology Working Groups available on the Association for European Paediatric and Congenital Cardiology website (www.aepc.org) and the respective publications 1–6. The development of training requirements is the responsibility of the Educational Committee and the Association for European Paediatric and Congenital Cardiology Council in collaboration with the Working Groups of the Association for European Paediatric and Congenital Cardiology. Trainees should be exposed to all aspects of general paediatric and congenital cardiology from fetal life to adolescence and adulthood. Centres performing generalised and specialised work in paediatric and congenital cardiology should be committed to deliver postgraduate training. At each training institute, trainers should be appointed to supervise and act as mentors to the trainees. Association for European Paediatric and Congenital Cardiology will provide basic teaching courses to supplement the training process.
Background: In an effort to reduce inappropriate testing of hospital-onset Clostridioides difficile infection (HO-CDI), we sequentially implemented 2 strategies: an electronic health record-based clinical decision support tool that alerted ordering physicians about potentially inappropriate testing without a hard stop (intervention period 1), replaced by mandatory infectious diseases attending physician approval for any HO-CDI test order (intervention period 2). We analyzed appropriate HO-CDI testing rates of both intervention periods. Methods: We performed a retrospective study of patients 18 years or older who had an HO-CDI test (performed after hospital day 3) during 3 different periods: baseline (no intervention, September 2014–February 2015), intervention 1 (clinical decision support tool only, April 2015–September 2015), and intervention 2 (ID approval only, December 2017–September 2018). From each of the 3 periods, we randomly selected 150 patients who received HO-CDI testing (450 patients total). We restricted the study to the general medicine, bone marrow transplant, medical intensive care, and neurosurgical intensive care units. We assessed each HO-CDI test for appropriateness (see Table 1 for criteria), and we compared rates of appropriateness using the χ2 test or Kruskall-Wallis test, where appropriate. Results: In our cohort of 450 patients, the median age was 61 years, and the median hospital length of stay was 20 days. The median hospital day that HO-CDI testing was performed differed among the 3 groups: 12 days at baseline, 10 days during intervention 1, and 8.5 days during intervention 2 (P < .001). Appropriateness of HO-CDI testing increased from the baseline with both interventions, but mandatory ID approval was associated with the highest rate of testing appropriateness (Fig. 1). Reasons for inappropriate ordering did not differ among the periods, with <3 documented stools being the most common criterion for inappropriateness. During intervention 2, among the 33 inappropriate tests, 8 (24%) occurred where no approval from an ID attending was recorded. HO-CDI test positivity rates during the 3 time periods were 12%, 11%, and 21%, respectively (P = .03). Conclusions: We found that both the clinical decision support tool and mandatory ID attending physician approval interventions improved appropriateness of HO-CDI testing. Mandatory ID attending physician approval leading to the highest appropriateness rate. Even with mandatory ID attending physician approval, some tests continued to be ordered inappropriately per retrospective chart review; we suspect that this is partly explained by underdocumentation of criteria such as stool frequency. In healthcare settings where appropriateness of HO-CDI testing is not optimal, mandatory ID attending physician approval may provide an option beyond clinical decision-support tools.
Increasingly, students with intellectual disabilities (ID) in the United States are overcoming historical barriers to accessing traditionally exclusionary higher education. These gains undoubtedly represent a hard-fought victory for the broader disability rights movement. However, this advance has not come through enforcing the civil rights and non-discrimination statutes that generated disability rights victories in other areas or the disability-specific education laws that promoted access to primary and secondary schooling. Instead, many students with ID are accessing higher education opportunities through specialised programmes, often styled as ‘inclusive’ despite their segregated nature. Such programmes present new arenas for familiar forms of disability-based discrimination to once more manifest — such as suspect admissions criteria, second-class status and biased disciplinary procedures. Thus, despite the proliferation of inclusive post-secondary programmes, there remains an urgent social need to address barriers to full and effective participation in higher education that students with ID continue to face when navigating university and college campuses.
Eighty percent of all patients suffering from major depressive disorder (MDD) relapse at least once in their lifetime. Thus, understanding the neurobiological underpinnings of the course of MDD is of utmost importance. A detrimental course of illness in MDD was most consistently associated with superior longitudinal fasciculus (SLF) fiber integrity. As similar associations were, however, found between SLF fiber integrity and acute symptomatology, this study attempts to disentangle associations attributed to current depression from long-term course of illness.
A total of 531 patients suffering from acute (N = 250) or remitted (N = 281) MDD from the FOR2107-cohort were analyzed in this cross-sectional study using tract-based spatial statistics for diffusion tensor imaging. First, the effects of disease state (acute v. remitted), current symptom severity (BDI-score) and course of illness (number of hospitalizations) on fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity were analyzed separately. Second, disease state and BDI-scores were analyzed in conjunction with the number of hospitalizations to disentangle their effects.
Disease state (pFWE < 0.042) and number of hospitalizations (pFWE< 0.032) were associated with decreased FA and increased MD and RD in the bilateral SLF. A trend was found for the BDI-score (pFWE > 0.067). When analyzed simultaneously only the effect of course of illness remained significant (pFWE < 0.040) mapping to the right SLF.
Decreased FA and increased MD and RD values in the SLF are associated with more hospitalizations when controlling for current psychopathology. SLF fiber integrity could reflect cumulative illness burden at a neurobiological level and should be targeted in future longitudinal analyses.
Expectant parents who live through perinatal loss experience intense grief, which is not always acknowledged or accepted. A screening tool to detect bereaved parents’ grief reactions can guide professionals, including perinatal palliative care teams, to provide follow-up for those in need. This review's goal is to identify and synthesize the international published literature on existent instruments specifically measuring the grieving process after any perinatal loss and to identify factors that could moderate grief reactions.
Systematic review (PROSPERO # CRD42018092555) with critical synthesis. PUBMED, Cochrane, and PsycINFO databases were searched in English language articles using the keywords “perinatal” AND (“grief” OR “bereavement” OR mourning) AND (“scale” OR “questionnaire” OR “measure” OR “assessment”) up to May 2018. Eligibility criteria included every study using a measure to assess perinatal grief after all kinds of perinatal losses, including validations and translations to other languages and interventions designed to alleviate grief symptoms.
A total of 67 papers met inclusion criteria. Seven instruments measuring perinatal grief published between 1984 and 2002 are described. The Perinatal Grief Scale (PGS) was used in 53 of the selected studies. Of those, 39 analyzed factors associated with grief reactions. Six articles used PGS scores to evaluate pre- and post-bereavement interventions. Studies in English language only might have limited the number of articles.
Significance of results
The PGS is the most used standardized measures to assess grief after perinatal loss. All parents living through any kind of perinatal loss should be screened.
Calcium–magnesium–alumino-silicate (CMAS) particulates enter the aero-engine in a sandy environment, melt and infiltrate into 7 wt% yttria-stabilized zirconia (7YSZ) thermal barrier coatings (TBCs), reducing their lifetime. This leads to chemical degradation in 7YSZ accompanied by tetragonal to monoclinic phase transformation upon cooling. In this work, electron-beam physical vapor deposition coatings were infiltrated with a synthetic CMAS. Synchrotron X-ray diffraction measurements show that CMAS infiltration at 1250 °C has about 43% higher monoclinic phase volume fraction (PVF) at the coating surface compared to 1225 °C and remains consistently higher throughout the coating depth. Additionally, the increase in annealing time from 1 to 10 h results in a 31% higher monoclinic phase at the surface. Scanning electron microscopy revealed the presence of globular monoclinic phases corresponding spatially with the above findings. These results resolve the impact of time and temperature on CMAS infiltration kinetics which is important for mitigation.
Behavioural activation (BA) is an evidence-based treatment for depression that has been primarily delivered in individual out-patient treatment. Prior research supports a positive participant experience in individual therapy; however, less is known about the patient experience in group therapy, which is common in acute psychiatric settings.
The present study examined the patient experience of Brief Behavioral Activation Treatment for Depression (BATD) delivered in group acute psychiatric treatment.
We used thematic analysis to extract themes from feedback surveys administered as part of quality improvement practice at a partial hospital program. Survey questions explored what patients learned, liked, disliked and thought could be improved in the BATD groups. Three individuals independently coded survey responses and collaboratively developed categories and themes.
Themes included several helpful content areas (e.g. value-driven activities, increasing motivation, goal setting, activity scheduling, cognitive behavioural model, self-monitoring) and learning methods (e.g. group format, experiential exercises, worksheets). Patients also identified unhelpful content (e.g. specific focus on depression and listing activities by mood). There was mixed feedback regarding the repetition of material and balance of lecture versus group participation.
Overall, these findings suggest a mostly positive patient experience of group-delivered BATD and support the acceptability of group-delivered BATD as a component of short-term intensive treatment.
Schizotypy is a putative risk phenotype for psychosis liability, but the overlap of its genetic architecture with schizophrenia is poorly understood.
We tested the hypothesis that dimensions of schizotypy (assessed with the SPQ-B) are associated with a polygenic risk score (PRS) for schizophrenia in a sample of 623 psychiatrically healthy, non-clinical subjects from the FOR2107 multi-centre study and a second sample of 1133 blood donors.
We did not find correlations of schizophrenia PRS with either overall SPQ or specific dimension scores, nor with adjusted schizotypy scores derived from the SPQ (addressing inter-scale variance). Also, PRS for affective disorders (bipolar disorder and major depression) were not significantly associated with schizotypy.
This important negative finding demonstrates that despite the hypothesised continuum of schizotypy and schizophrenia, schizotypy might share less genetic risk with schizophrenia than previously assumed (and possibly less compared to psychotic-like experiences).
Considerations around the dynamics of medicalization and social suffering are at the heart of working with refugees, as is attention to and advocacy for families’ social and settlement needs. In this chapter, the authors describe one particular form of advocacy: the generation of medico-legal reports to accompany asylum claims. The authors argue that the increasing medicalization of the refugee experience has led to widespread dissemination of this practice, and suggest that leveraging psychiatric language in a medico-legal report is not without risk to children and families. They cite the emergence of a significant culture-bound syndrome in Sweden, Uppgivenhetssyndrom, felt to be partly related to the language applied by advocating physicians. The United States of America’s recent policy of forcibly separating migrant families has also seen physician activists discuss “toxic stress” and warn of future pathology. The authors discuss the complexity of using psychiatric language for advocacy and suggest some ways of mitigating negative impacts on families. They suggest that physicians consider moving beyond the clinical encounter to advocate for refugee rights on a broader scale.
We prove a functional equation for a vector valued real analytic Eisenstein series transforming with the Weil representation of
. By relating such an Eisenstein series with a real analytic Jacobi Eisenstein series of degree
, a functional equation for such an Eisenstein series is proved. Employing a doubling method for Jacobi forms of higher degree established by Arakawa, we transfer the aforementioned functional equation to a zeta function defined by the eigenvalues of a Jacobi eigenform. Finally, we obtain the analytic continuation and a functional equation of the standard
-function attached to a Jacobi eigenform, which was already proved by Murase, however in a different way.
The alternative mitigation program that the Bureau of Land Management (BLM) established in 2008 to address impacts to the archaeological resources in the Permian Basin of southeastern New Mexico, now one of the most active of the nation's oil and gas energy fields, has supported more than $10 million in field research programs and is poised to be able to fund about $1 million in field research annually for the foreseeable future. The financial success of the program is mirrored by the program's outstanding contributions to our understanding of the Permian Basin's long and complex history of human occupation. Surprisingly, although other public lands under the auspices of the BLM are seeing similar rates of energy development, the critical elements of this program have not been picked up elsewhere in the BLM. The Permian Basin program appears doomed to be an example of a “one-off” alternative mitigation solution. The factors barring more widespread adoption include the ebb and flow of energy production activity, complications arising from mixed land status and the ability to work across jurisdictional boundaries, hesitation to change procedures that are working adequately for the time being, and a lack of capacity to institute systemic change.
Playing into the master narrative of the US civil rights movement, John Lewis, Andrew Aydin, and Nate Powell's March trilogy negotiates not only the movement's tactics and achievements, but also its initial mediation through photography and television and its ongoing remediation. Taking the memoir's urge to teach as a starting point, this article assesses its didactic impulses and implications, combining a historiographic approach with an assessment of the narrative's visual construction. The article highlights the trilogy's potentials and shortcomings as an intervention into civil rights memory and outlines a metacritical pedagogy through which March can become potent classroom material.
Subclinical psychotic-like experiences (PLE), resembling key symptoms of psychotic disorders, are common throughout the general population and possibly associated with psychosis risk. There is evidence that such symptoms are also associated with structural brain changes.
In 672 healthy individuals, we assessed PLE and associated distress with the symptom-checklist-90R (SCL-90R) scales ‘schizotypal signs’ (STS) and ‘schizophrenia nuclear symptoms’ (SNS) and analysed associations with voxel- and surfaced-based brain structural parameters derived from structural magnetic resonance imaging at 3 T with CAT12.
For SNS, we found a positive correlation with the volume in the left superior parietal lobule and the precuneus, and a negative correlation with the volume in the right inferior temporal gyrus [p < 0.05 cluster-level Family Wise Error (FWE-corrected]. For STS, we found a negative correlation with the volume of the left and right precentral gyrus (p < 0.05 cluster-level FWE-corrected). Surface-based analyses did not detect any significant clusters with the chosen statistical threshold of p < 0.05. However, in exploratory analyses (p < 0.001, uncorrected), we found a positive correlation of SNS with gyrification in the left insula and rostral middle frontal gyrus and of STS with the left precuneus and insula, as well as a negative correlation of STS with gyrification in the left temporal pole.
Our results show that brain structures in areas implicated in schizophrenia are also related to PLE and its associated distress in healthy individuals. This pattern supports a dimensional model of the neural correlates of symptoms of the psychotic spectrum.
Unit cohesion may protect service member mental health by mitigating effects of combat exposure; however, questions remain about the origins of potential stress-buffering effects. We examined buffering effects associated with two forms of unit cohesion (peer-oriented horizontal cohesion and subordinate-leader vertical cohesion) defined as either individual-level or aggregated unit-level variables.
Longitudinal survey data from US Army soldiers who deployed to Afghanistan in 2012 were analyzed using mixed-effects regression. Models evaluated individual- and unit-level interaction effects of combat exposure and cohesion during deployment on symptoms of post-traumatic stress disorder (PTSD), depression, and suicidal ideation reported at 3 months post-deployment (model n's = 6684 to 6826). Given the small effective sample size (k = 89), the significance of unit-level interactions was evaluated at a 90% confidence level.
At the individual-level, buffering effects of horizontal cohesion were found for PTSD symptoms [B = −0.11, 95% CI (−0.18 to −0.04), p < 0.01] and depressive symptoms [B = −0.06, 95% CI (−0.10 to −0.01), p < 0.05]; while a buffering effect of vertical cohesion was observed for PTSD symptoms only [B = −0.03, 95% CI (−0.06 to −0.0001), p < 0.05]. At the unit-level, buffering effects of horizontal (but not vertical) cohesion were observed for PTSD symptoms [B = −0.91, 90% CI (−1.70 to −0.11), p = 0.06], depressive symptoms [B = −0.83, 90% CI (−1.24 to −0.41), p < 0.01], and suicidal ideation [B = −0.32, 90% CI (−0.62 to −0.01), p = 0.08].
Policies and interventions that enhance horizontal cohesion may protect combat-exposed units against post-deployment mental health problems. Efforts to support individual soldiers who report low levels of horizontal or vertical cohesion may also yield mental health benefits.