"The Refugee Crisis: British and Canadian Responses" International Symposium Report

January 4-7, 1989 marked the third international symposium to be co-sponsored by the Refugee Studies Programme at the University of Oxford, and the Centre for Refugee Studies (formerly the Refugee Documentation Project) at York University, Canada. The symposium title reflects the framework for British participants to address current refugees issues from the perspective of Britain's Race Relations Act, and Canadians from the perspective of the recent Multicultural Act

Current legal and institutional issues in the commercialization of phosphoric acid fuel cells

Legal and institutional factors affecting the development and commercial diffusion of phosphoric acid fuel cells are assessed. Issues for future research and action are suggested. Perceived barriers and potential opportunities for fuel cells in central and dispersed utility operations and on-site applications are reviewed, as well as the general concept of commercialization as applied to emerging energy technologies

Evaluation and Screening of Remedial Technologies for Uranium at the 300-FF-5 Operable Unit, Hanford Site, Washington

Pacific Northwest National Laboratory (PNNL) is presently conducting a re-evaluation of remedies addressing persistent dissolved uranium concentrations in the upper aquifer under the 300 Area of the Hanford Site in southeastern Washington State. This work is being conducted as a Phase III feasibility study for the 300-FF-5 Operable Unit on behalf of the U.S. Department of Energy. As part of the feasibility study process, a comprehensive inventory of candidate remedial technologies was conducted by PNNL. This report documents the identification and screening of candidate technologies. The screening evaluation was conducted in accordance with guidance and processes specified by U.S. Environmental Protection Agency regulations associated with implementation of the Comprehensive Environmental Response, Compensation, and Liability Act process

Orthostatic Hypotension and Antiparkinsonian Drugs: A Systematic Review and Meta-analysis

BACKGROUND: Orthostatic hypotension (OH) is multifactorial in Parkinson's disease (PD). Antiparkinsonian medication can contribute to OH, leading to increased risk of falls, weakness and fatigue. METHODS: We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of antiparkinsonian drugs associated with OH as an adverse effect, compared to placebo. We searched EMBASE, MEDLINE and Web of Science databases until November 2020. Analysis used fixed-effects models and the GRADE tool to rate quality of evidence. Meta-analysis was performed if 3 or more studies of a drug group were available. RESULTS: Twenty-one RCTs including 3783 patients were included comparing 6 PD drug groups to placebo (MAO-B inhibitors, dopamine agonists, levodopa, COMT inhibitors, levodopa and adenosine receptor antagonists). OH was recorded as an adverse event or measurement of vital signs, without further specification on how this was defined or operationalised. Meta-analysis was performed for MAO-B inhibitors and dopamine agonists, as there were 3 or more studies for these drug groups. In this analysis, compared with placebo, neither MAO-B inhibitors or dopamine agonists were associated with increased risk of OH, (OR 2.28 [95% CI:0.81-6.46]), (OR 1.39 [95% CI:0.97-1.98]). CONCLUSIONS: Most studies did not specifically report OH, or reporting of OH was limited, including how and when it was measured. Furthermore, studies specifically reporting OH included participants that were younger than typical PD populations without multimorbidity. Future trials should address this, for example,, by including individuals over the age of 75, to improve estimations of how antiparkinsonian medications affect risk of OH

Experiences of advance care planning in Parkinson’s disease and atypical Parkinsonian disorders: a mixed methods systematic review

Background and purpose: Advance care planning allows people to plan for their future care needs and can include medical, psychological and social aspects. However, little is known on the use, experience of and attitudes towards advance care planning in patients with parkinsonian disorders, their family carers and healthcare professionals. Methods: A systematic search of online databases was conducted in April 2019 using a narrative synthesis approach with thematic analysis and tabulation to synthesize the findings. Results: In all, 507 articles were identified and 27 were included. There were five overarching themes: (i) what is involved in advance care planning discussions, (ii) when and how advance care planning discussions are initiated, (iii) barriers to advance care planning, (iv) the role of healthcare professionals and (v) the role of the family carer. This evidence was used to highlight eight effective components to support optimal advance care planning in parkinsonian disorders: advance care planning discussions should be individualized in content, timing and approach; patients should be invited to discuss advance care planning early and regularly; palliative care services should be introduced early; a skilled professional should deliver advance care planning; support to family carers should be offered in the advance care planning process; healthcare professionals should be educated on parkinsonian disorders and palliative care; advance care planning should be clearly documented and shared with relevant services; and healthcare professionals should be enabled to conduct effective advance care planning. Conclusions: These components can inform best practice in advance care planning in patients with parkinsonian disorders

Medical student mentoring programs: current insights

Medical school mentoring programs incorporate a wide range of objectives. Clinical mentoring programs help to develop students' clinical skills and can increase interest in under-subscribed specialties. Those that focus on teaching professionalism are integrated into medical school curriculums in order to overcome the "hidden curriculum". Positive mentoring plays a part in reversing the decline of academic medicine, by sparking interest through early research experiences. It also has an important role in encouraging recruitment of under-represented minority groups into the medical profession through widening access programs. The aim of our review of the literature, is to analyze current trends in medical student mentoring programs, taking into account their objectives, execution, and evaluation. We outline the challenges encountered, potential benefits, and key future implications for mentees, mentors, and institutions