In Favor of “Leader Proofing”

Although it is widely assumed that successful polities require strong leaders, something like the opposite is probably the case. A successful political system may well be one that has no need of strong leaders and may even eschew them. Strong leaders may occasionally be desirable in any polity, but those occasions are–or should be–rare. As often as not (possibly more often than not) strong leaders pose substantial risks. They are liable to do as much damage as good, possibly more. There is a lot to be said for any polity's political culture and institutions having built into them a fair amount of “leader proofing.” </jats:p

A Methodology for the Examination of the Effectiveness of Secure Erasure Tools Running On Windows XP - Research in Progress

Currently, there appears to be a lack of academic research in the area of testing the efficacy of secure erasure applications and utilities in regard to the activities of an average user in a home or small business context. This research in progress aims to develop a testing methodology that will provide a forensically sound base for which to analyse these tools. It involves the installation of various Internet related applications (for example browsers, instant messaging software and download clients), and the use of these applications for typical Internet activities (e.g. internet banking, instant messaging, web browsing and other activities that would be conducted by an average user). Following the creation of the simulated history, this paper discusses a practical testing methodology that includes the creation of image files, the allocation of these image files, and the use of forensic tools to examine disk contents before and after the execution of the secure erasure applications on the simulated user history. Additionally, a reporting mechanism has been formulated that will allow test results to be efficiently compiled and compared to form valid conclusions about the effectiveness of each erasure utility on internet history

Altered Narratives: Female Eighteenth-Century French Authors Reinterpreted

Vol. I of the Eighteenth-Century French World Centre-The University of Western Ontario, edited by Servanne Woodward, Anthony Purdy, Minnette Gaudet, and Peter R. Saìzhttps://ir.lib.uwo.ca/frenchebooks/1000/thumbnail.jp

Eating and drinking interventions for people at risk of lacking decision-making capacity: who decides and how?

Abstract Background Some people with progressive neurological diseases find they need additional support with eating and drinking at mealtimes, and may require artificial nutrition and hydration. Decisions concerning artificial nutrition and hydration at the end of life are ethically complex, particularly if the individual lacks decision-making capacity. Decisions may concern issues of life and death: weighing the potential for increasing morbidity and prolonging suffering, with potentially shortening life. When individuals lack decision-making capacity, the standard processes of obtaining informed consent for medical interventions are disrupted. Increasingly multi-professional groups are being utilised to make difficult ethical decisions within healthcare. This paper reports upon a service evaluation which examined decision-making within a UK hospital Feeding Issues Multi-Professional Team. Methods A three month observation of a hospital-based multi-professional team concerning feeding issues, and a one year examination of their records. The key research questions are: a) How are decisions made concerning artificial nutrition for individuals at risk of lacking decision-making capacity? b) What are the key decision-making factors that are balanced? c) Who is involved in the decision-making process? Results Decision-making was not a singular decision, but rather involved many different steps. Discussions involving relatives and other clinicians, often took place outside of meetings. Topics of discussion varied but the outcome relied upon balancing the information along four interdependent axes: (1) Risks, burdens and benefits; (2) Treatment goals; (3) Normative ethical values; (4) Interested parties. Conclusions Decision-making was a dynamic ongoing process with many people involved. The multiple points of decision-making, and the number of people involved with the decision-making process, mean the question of ‘who decides’ cannot be fully answered. There is a potential for anonymity of multiple decision-makers to arise. Decisions in real world clinical practice may not fit precisely into a model of decision-making. The findings from this service evaluation illustrate that within multi-professional team decision-making; decisions may contain elements of both substituted and supported decision-making, and may be better represented as existing upon a continuum

Nuclear burning and mixing in the first stars: entrainment at a convective boundary using the PPB advection scheme

The evolution of the first generations of stars at zero or extremly low metallicity, and especially some crucial properties like the primary N14 production, is charactarized by convective-reactive mixing events that are mostly absent from similar evolution phases at solar-like metallicity. These episodes occur when unprocessed H-rich material is mixed accross a convective boundary into C12 rich He-burning material, as for example in He-shell flashes of extremely-low metallicity AGB stars. In this paper we describe the astrophysical context of such convective-reactive events, including the difficulty of current one-dimensional stellar evolution models to correctly simulate these evolutionary phases. We then describe the requirements and current state of modeling convective-reactive processes in the first stars environment. We demonstrate some of the new concepts that we are applying to this problem, i.e. the highly accurate PPB advection scheme in the framework of PPM hydrodynamic simulations of mixing accross a very stiff convective boundary. We show initial results of such simulations that address the first non-reactive step of this problem, which is the entrainment of H at the top boundary of the He-shell flash convection zone.Comment: Proceedings paper of First Stars III, 2006, Santa Fe, contributions by Falk Herwig and Paul Woodward, to appear in AIP Conf. Ser., ed. T. Abel, A. Heger and B. O'She

Enhancing COVID-19 public health communication for culturally and linguistically diverse communities: An Australian interview study with community representatives

Background: Public health crises present challenges for providing accessible, timely, and accurate health information to culturally and linguistically diverse (CALD) communities. Aim: The aim of this qualitative project was to explore strategies used by CALD community organizations to improve communication about COVID-19 for their communities; we also aimed to identify gaps and challenges. Methods: We interviewed 16 representatives from Greek, Italian, and Chinese CALD organizations in Melbourne, Australia. The interviews were analyzed thematically. Results: Community leaders played a significant role in engaging their community members with accurate key health information. There were differences between language communities about preferred channels for receiving information. As the pandemic intensified, there was a shift from written communication to more interactive exchanges between authorities and community leaders. Discussion: The findings suggest effective public health communication is enhanced by the mediation and outreach strategies adopted by CALD community organizations; further, stakeholders need to be cognizant of heterogeneity of needs and preferences. This may optimize information dissemination to meet specific needs. Conclusions:The CALD organizations have developed communication strategies involving different kinds of mediation to reach specific sub-groups, especially the most vulnerable. These strategies can inform future public health engagement

What outpatient models have proven efficacy for assessment and management of pelvic radiotherapy late effects?

Pelvic radiotherapy has an essential role in the curative treatment plan of several cancers, but is associated with late adverse effects which may persist for years and have significant impact on social functioning and quality of life. These late effects include gastrointestinal symptoms, urinary symptoms and psychosexual symptoms amongst others. These symptoms often go unreported by patients, with the focus in busy clinical oncology settings often on disease control. However there is evidence that many gastroenterology symptoms can be managed by addressing the physiological and functional changes induced by radiotherapy, and opportunities may also exist for improving urological and sexual function. The purpose of this rapid review is to identify models of care which accurately identify patients with late toxicity following pelvic radiotherapy, and effectively manage that symptom burden. The purpose is to inform the development of local services which can most efficiently address these currently unmet needs

What are the attitudes and perceptions of patients with pulmonary fibrosis and their carers towards use of oxygen therapy? A rapid review

Idiopathic Pulmonary Fibrosis (IPF) is a common interstitial lung disease of unknown aetiology, usually occurring between 50-70 years of age. It is a progressive and ultimately fatal disease with a mean survival of less than 3 years from diagnosis. The majority of patients die from respiratory failure and have a high symptom burden. There are no curative treatments and so best supportive care and symptom palliation are mainstays of treatment for all patients. As the disease advances, breathlessness becomes a major determinant of quality of life, and oxygen (O2) desat-uration contributes to exertional intolerance. However, there is limited data on the benefits of O2 use in this patient group and anecdotal evidence suggests some patients are reluctant to instigate it. This can be a barrier to providing high quality supportive care. Given the incidence of IPF of 20-30/100,000 per year, better understanding of patient and carer perceptions of O2 use in this context will have important implications for multidisciplinary practice in Wales in support of a sizable patient population. The purpose of this rapid review is therefore to understand key facilitators and barriers to the use of O2 therapy from the perspective of patients with IPF and their carers

What is the impact and effectiveness of the 7-day CNS service on palliative care patients and their families? A rapid review

Palliative care clinical nurse specialists (CNSs) across care settings work within a multi-professional specialist palliative care service to offer support and symptom control to patients with life-threatening illness, and their families. Traditionally this CNS service had been available during working hours 5 days a week. In 2004, NICE Guidance on supportive and palliative care in cancer recommended the extension of this service to 7 days a week, acknowledging the likely need for ongoing face to face patient reviews across weekends. However, the extent of that need was not defined, nor did it take account of the increasing non-cancer workload of these services. In subsequent years specialist teams across the UK have responded to the guidance by introducing 7 day - 09.00-17.00 - CNS working, acknowledging the significant challenges of addressing uncertain need, scarcity of resource and potential impact on other parts of service delivery. The purpose of this rapid review is to examine how these challenges have been met, and whether there is evidence that particular models of 7 day CNS working best address the specific needs of patients and families within the context of overall care provision at weekends. The review has been requested as part of a local service evaluation to support and inform 7 day CNS working within Wales