The law relating to activities of man in space, chapters 5-7 Final report

Legal aspects of satellite communications, liability and space activities, natural resources, and pollution aspects of space exploratio

Aspirations and adaptations : immigrant synagogues of Montreal, 1880s-1945

"Aspirations and Adaptations" traces the development of the Jewish community of Montreal by tracking the growth, location, and movement of its early synagogues focusing on those established by the Eastern European immigrants from the 1880s until 1945. This is a study of material culture, a study of synagogues and the congregations who created and inhabited them. It is a story which considers these buildings as a reflection of the aspirations of the congregations and their adaptation to a new environment both architecturally and socially. Organized chronologically and geographically, the paper focuses on four consecutive and adjacent areas of settlement which formed the areas of greatest concentration of the Jewish community of Montreal during the period under study. As immigration intensified in the first decades of the twentieth century, the number of congregations swelled. The plethora of synagogues served not only the needs of a growing population, but also the varying expressions of communal identity. It was the more veteran immigrant congregations which aspired to obtain larger and more prominent synagogues. As the enterprise of synagogue building in nineteenth century Europe signaled a process of acculturation, so too, the building of larger synagogues by an immigrant community indicated a process of integration. As traditionalists in Europe resisted change and continued to worship in small houses of prayer and study, the more recent immigrants, seeking to remain connected to familiar practices, founded smaller synagogues, which, nevertheless, served not only a religious but also a social function

Anderson-Fabry disease cardiomyopathy: an update on epidemiology, diagnostic approach, management and monitoring strategies

Anderson-Fabry disease (AFD) is an X-linked lysosomal storage disorder caused by deficient activity of the enzyme alpha-galactosidase. While AFD is recognized as a progressive multi-system disorder, infiltrative cardiomyopathy causing a number of cardiovascular manifestations is recognized as an important complication of this disease. AFD affects both men and women, although the clinical presentation typically varies by sex, with men presenting at a younger age with more neurologic and renal phenotype and women developing a later onset variant with more cardiovascular manifestations. AFD is an important cause of increased myocardial wall thickness, and advances in imaging, in particular cardiac magnetic resonance imaging and T1 mapping techniques, have improved the ability to identify this disease non-invasively. Diagnosis is confirmed by the presence of low alpha-galactosidase activity and identification of a mutation in the GLA gene. Enzyme replacement therapy remains the mainstay of disease modifying therapy, with two formulations currently approved. In addition, newer treatments such as oral chaperone therapy are now available for select patients, with a number of other investigational therapies in development. The availability of these therapies has significantly improved outcomes for AFD patients. Improved survival and the availability of multiple agents has presented new clinical dilemmas regarding disease monitoring and surveillance using clinical, imaging and laboratory biomarkers, in addition to improved approaches to managing cardiovascular risk factors and AFD complications. This review will provide an update on clinical recognition and diagnostic approaches including differentiation from other causes of increased ventricular wall thickness, in addition to modern strategies for management and follow-up

Exploring assessment of medical students\u27 competencies in pain medicine - A review

Introduction: Considering the continuing high prevalence and public health burden of pain, it is critical that medical students are equipped with competencies in the field of pain medicine. Robust assessment of student expertise is integral for effective implementation of competency-based medical education. Objective: The aim of this review was to describe the literature regarding methods for assessing pain medicine competencies in medical students. Method: PubMed, Medline, EMBASE, ERIC, and Google Scholar, and BEME data bases were searched for empirical studies primarily focusing on assessment of any domain of pain medicine competencies in medical students published between January 1997 and December 2016. Results: A total of 41 studies met the inclusion criteria. Most assessments were performed for low-stakes summative purposes and did not reflect contemporary theories of assessment. Assessments were predominantly undertaken using written tests or clinical simulation methods. The most common pain medicine education topics assessed were pain pharmacology and the management of cancer and low-back pain. Most studies focussed on assessment of cognitive levels of learning as opposed to more challenging domains of demonstrating skills and attitudes or developing and implementing pain management plans. Conclusion: This review highlights the need for more robust assessment tools that effectively measure the abilities of medical students to integrate pain-related competencies into clinical practice. A Pain Medicine Assessment Framework has been developed to encourage systematic planning of pain medicine assessment at medical schools internationally and to promote continuous multidimensional assessments in a variety of clinical contexts based on well-defined pain medicine competencies

Reinhardi Diterici a Tauben Equit. Misnici De Mediis, sive Neutrius Partis in bellis civilibus Oratio, In illustrissima Saxon. Academia habita publice Wittenbergae, ad d. XXIV. Maii, A. MDCXLVI.

REINHARDI DITERICI A TAUBEN EQUIT. MISNICI DE MEDIIS, SIVE NEUTRIUS PARTIS IN BELLIS CIVILIBUS ORATIO, IN ILLUSTRISSIMA SAXON. ACADEMIA HABITA PUBLICE WITTENBERGAE, AD D. XXIV. MAII, A. MDCXLVI. Reinhardi Diterici a Tauben Equit. Misnici De Mediis, sive Neutrius Partis in bellis civilibus Oratio, In illustrissima Saxon. Academia habita publice Wittenbergae, ad d. XXIV. Maii, A. MDCXLVI. ([1]r) Titelseite ([1]r) Widmung ([2]r) Text ([4]r) Beitrag ([15]r

Predicting Risk of Cardiotoxic Effects in Breast Cancer: Are We There Yet?

People with breast cancer are at increased risk of cardiovascular disease, myocardial injury, and heart failure (HF) due to underlying risk factors, a proinflammatory milieu, and cancer therapy–related cardiovascular toxic effects (CTR-CVT).1 Of the therapies for breast cancer, human epidermal growth factor receptor-2 (ERBB2)–targeted therapies, such as trastuzumab, and anthracyclines, such as doxorubicin, have the most well-described associations with both decline in left ventricular ejection fraction (LVEF), and clinical HF.2,3 Given that cardiotoxic effects are not always reversible and can result in significant morbidity and mortality, current European Society of Cardiology guidelines recommend risk stratification before starting potentially cardiotoxic anticancer therapy in all patients with cancer (Class 1B) to identify patients who are at high risk of developing CTR-CVT.4 Several risk prediction models have been developed to estimate adverse cardiac outcomes among patients with breast cancer. However, the design, performance, and methodological rigor of the risk prediction models have not been assessed systematically