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A novel inpatient vocational counseling service (named “In-Voc”) was developed and evaluated in three Australian spinal cord injury (SCI) rehabilitation hospitals, aiming to improve vocational outcomes after SCI. The program provided a trained Vocational Counseling Coordinator who worked alongside the allied health team, medical, and nursing staff at each hospital. The Coordinators were interviewed to examine the role expectations and role behaviors associated with the introduction of their novel, vocationally focused, occupational role. The Coordinators’ descriptions of their role behavior were very similar to those defined by rehabilitation counselors in North America. They reported the novel role to be a productive and satisfying one. Encouragingly, the In-Voc program was associated with significantly higher post-injury employment outcomes.
Background: Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease resulting in muscle weakness, dysarthria and dysphagia, and ultimately respiratory failure leading to death. Half of the ALS patients survive less than 3 years, and 80% of the patients survive less than 5 years. Riluzole is the only approved medication in Canada with randomized controlled clinical trial evidence to slow the progression of ALS, albeit only to a modest degree. The Canadian Neuromuscular Disease Registry (CNDR) collects data on over 140 different neuromuscular diseases including ALS across ten academic institutions and 28 clinics including ten multidisciplinary ALS clinics. Methods: In this study, CNDR registry data were analyzed to examine potential differences in ALS care among provinces in time to diagnosis, riluzole and feeding tube use. Results: Significant differences were found among provinces, in time to diagnosis from symptom onset, in the use of riluzole and in feeding tube use. Conclusions: Future investigations should be undertaken to identify factors contributing to such differences, and to propose potential interventions to address the provincial differences reported.
Canadian hospitals were made aware of the risk of Mycobacterium chimaera infection associated with heater-cooler units (HCUs) through alerts issued by the US food and Drug Administration (FDA) and the US Centers for Disease Control and Prevention (CDC). In response, most hospitals conducted retrospective reviews for infections, informed exposed patients, and initiated a requirement for informed consent with HCU use.
Monica Hakimi's article probes the legal significance of an interesting phenomenon: the UN Security Council condoning the use of force, as opposed to authorizing it. She offers an innovative perspective on this little-studied dimension of how the Council contributes to the development of jus ad bellum. While I applaud much in the article, I question her characterization of what the Council is condoning in the cases she reviews. She claims these are “fact-specific decisions,” whereas I argue that the Council is endorsing controversial interpretations of the law on the use of force. This disagreement does not detract from Hakimi's observations about the policy implications of the practice, or about the Council's role as a site for deliberation and argumentation about the content of international law. But it does cast doubt on her conceptual claim that there are two distinct “regulatory forms,” which together provide the content of jus ad bellum, one particularistic and procedural, the other general and substantive. All legal claims and justifications entail the application of general standards to particular facts, either explicitly or implicitly. Most of her case studies can be explained in those terms. Thus, while the Council's practice of condoning the use of force is important to understand, the “conventional account” she derides provides a more persuasive and parsimonious explanation of that phenomenon.
Hip and knee arthroplasty infections are associated with considerable healthcare costs. The merits of reducing the postoperative surveillance period from 1 year to 90 days have been debated.
To report the first pan-Canadian hip and knee periprosthetic joint infection (PJI) rates and to describe the implications of a shorter (90-day) postoperative surveillance period.
Prospective surveillance for infection following hip and knee arthroplasty was conducted by hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) using standard surveillance definitions.
Overall hip and knee PJI rates were 1.64 and 1.52 per 100 procedures, respectively. Deep incisional and organ-space hip and knee PJI rates were 0.96 and 0.71, respectively. In total, 93% of hip PJIs and 92% of knee PJIs were identified within 90 days, with a median time to detection of 21 days. However, 11%–16% of deep incisional and organ-space infections were not detected within 90 days. This rate was reduced to 3%–4% at 180 days post procedure. Anaerobic and polymicrobial infections had the shortest median time from procedure to detection (17 and 18 days, respectively) compared with infections due to other microorganisms, including Staphylococcus aureus.
PJI rates were similar to those reported elsewhere, although differences in national surveillance systems limit direct comparisons. Our results suggest that a postoperative surveillance period of 90 days will detect the majority of PJIs; however, up to 16% of deep incisional and organ-space infections may be missed. Extending the surveillance period to 180 days could allow for a better estimate of disease burden.
Patient registries represent an important method of organizing “real world” patient information for clinical and research purposes. Registries can facilitate clinical trial planning and recruitment and are particularly useful in this regard for uncommon and rare diseases. Neuromuscular diseases (NMDs) are individually rare but in aggregate have a significant prevalence. In Canada, information on NMDs is lacking. Barriers to performing Canadian multicentre NMD research exist which can be overcome by a comprehensive and collaborative NMD registry.
We describe the objectives, design, feasibility and initial recruitment results for the Canadian Neuromuscular Disease Registry (CNDR).
The CNDR is a clinic-based registry which launched nationally in June 2011, incorporates paediatric and adult neuromuscular clinics in British Columbia, Alberta, Ontario, Quebec, New Brunswick and Nova Scotia and, as of December 2012, has recruited 1161 patients from 12 provinces and territories. Complete medical datasets have been captured on 460 “index disease” patients. Another 618 “non-index” patients have been recruited with capture of physician-confirmed diagnosis and contact information. We have demonstrated the feasibility of blended clinic and central office-based recruitment. “Index disease” patients recruited at the time of writing include 253 with Duchenne and Becker muscular dystrophy, 161 with myotonic dystrophy, and 71 with ALS.
The CNDR is a new nationwide registry of patients with NMDs that represents an important advance in Canadian neuromuscular disease research capacity. It provides an innovative platform for organizing patient information to facilitate clinical research and to expedite translation of recent laboratory findings into human studies.
EMU is a wide-field radio continuum survey planned for the new Australian Square Kilometre Array Pathfinder (ASKAP) telescope. The primary goal of EMU is to make a deep (rms ∼ 10 μJy/beam) radio continuum survey of the entire Southern sky at 1.3 GHz, extending as far North as +30° declination, with a resolution of 10 arcsec. EMU is expected to detect and catalogue about 70 million galaxies, including typical star-forming galaxies up to z ∼ 1, powerful starbursts to even greater redshifts, and active galactic nuclei to the edge of the visible Universe. It will undoubtedly discover new classes of object. This paper defines the science goals and parameters of the survey, and describes the development of techniques necessary to maximise the science return from EMU.
This chapter is about law-making by international organizations (IOs), or what I call “delegated law-making” for short. It is a complex phenomenon, not least because the scope of matters covered by both “law-making” and “delegation” is contested. Although some intergovernmental organizations have been empowered to make law explicitly, the relationship between states and the organizations they create is often more complicated than the term delegation connotes. Various strands of international law (IL) and international relations (IR) theory shed light on this relationship, and, as such, delegated law-making is a good laboratory for exploring the value of cross-disciplinary theorizing.
The chapter begins with the concept of delegation, arguing that it comes in three forms when applied to IOs: explicit, implied, and attenuated. The second section, “Law in Its Infinite Variety” is devoted to law-making. I present a pluralistic conception of law that includes five distinct types of IO acts or instruments: treaty law, legislation and regulation, executive decisions, soft law, and judge-made law. I provide examples to illustrate the extent to which delegation tends to be implied and attenuated, as well as explicit.
We investigated postprandial changes in transcript abundance following a single satiating meal in juvenile Atlantic salmon (Salmo salar L.) (about 70 g body mass) following fasting for 1 week at 12°C. The expression of twenty-three growth-related genes was determined in fast myotomal muscle using quantitative real-time PCR at the following postprandial time points: − 12, 0, 1, 3, 6, 12, 24, 48 and 96 h. The gut was fullest 1–6 h after feeding and emptied within 48–96 h. IGF-I, MyoD1c, MRF4 and myf5 transcripts were sharply up-regulated within 1 h of refeeding and are promising candidate genes involved in a fast-response signalling system that regulates fish myotomal muscle growth. These genes clustered together with MyoD1b and suggest a coordinated regulation to favour resumption of myogenesis as an early response to feeding. Insulin-like growth factor (IGF)-II and the ubiquitin ligase MAFbx/atrogin-1 were initially down-regulated but restored to initial values after 12 h. It is also suggested that local production of IGF-I within the muscle might suppress catabolic pathways depressing MAFbx/atrogin-1.
Questions about the legitimacy of international decision making have arisen in proportion to the growing autonomy of international organizations. If these organizations are able to wield influence not directly traceable to the consent of member governments, what is the source of their legitimacy? In the context of the European Union (EU), the concern is typically framed in terms of the democratic deficit, characterized by the increasing remoteness of those who make decisions from those who are affected by them. Proposals on how to bring down that deficit bump up against a larger question: Can democracy be transposed beyond the level of the nation-state? This chapter explores that question by drawing on the theory of deliberative democracy. My central claim is that voting arrangements are not the only gauge of legitimacy in international organizations; one must also look at the quality of deliberations that precede and follow decisions taken. I support that claim first by identifying a core principle of the theory of deliberative democracy: any decision must be backed by good arguments. What counts as a “good argument” varies from setting to setting, depending on the normative framework within which the deliberation occurs. I then consider whether, as a matter of theory, there are grounds for applying the deliberative principle at the transnational level. I argue that particular conventions of argument and discourse operate in any deliberative enterprise, the parameters of which are set by an interpretive community associated with the enterprise.
The operational activities of international organizations do not occur in a normative vacuum. They are shaped by the normative climate in which they occur, and they in turn shape that climate. This chapter elucidates that proposition by tracing three especially important normative developments over the last fifteen years: the emerging “Responsibility to Protect (R2P),” the growing consensus on the value of democratic governance, and the centrality of counterterrorism to global security policy. I will test the impact of norms by reviewing operational activities that have been most deeply affected, primarily in the field of peace operations, but also humanitarian action, development assistance, and nonproliferation.
These developments have occurred through a dynamic process that involves influential member states, key figures within international institutions, and nongovernmental entities. States are still the primary actors – especially the United States – but because the process has become more fluid, normative evolution at the United Nations (UN) is not driven entirely by the executive branches of government and their diplomatic representatives in New York and Geneva. The UN is both a venue for interaction among states and an “organizational platform” where actors other than states wield influence.
The chapter proceeds as follows. The next section presents a theoretical account of how and why norms matter in international politics and considers the role of the United States in promoting norms.
Critiques of decision making in international organizations are often framed in terms of the democratic deficit. Leveled against the United Nations Security Council, the charge has become more pointed in light of recent quasi-legislative and quasi-judicial acts—most notably the adoption of Resolutions 1373 and 1540 on the financing of terrorism and the spread of weapons of mass destruction, respectively, and the Resolution 1267 sanctions regime, which targets individuals suspected of involvement in terrorism. With the first two resolutions, the Security Council imposed general obligations on all states for an indefinite period; with the third, it set up a sanctions committee that has courtlike powers to identify and freeze the assets of individuals, groups, and corporations. Despite broad sympathy among the UN membership for collective counterterrorist action in the aftermath of the attacks of September 11, 2001, a degree of skepticism accompanied these initiatives from the start and grew with the diplomatic debacle surrounding the war in Iraq. Some critics asked whether an “imperial” Security Council had become an instrument for the imposition of “hegemonic international law.” The Council has moved to address these concerns, but they remain serious enough that the regimes established under Resolutions 1267, 1373, and 1540 are at risk of collapsing.