501 research outputs found
A comparative framework: how broadly applicable is a 'rigorous' critical junctures framework?
The paper tests Hogan and Doyle's (2007, 2008) framework for examining critical junctures. This framework sought to incorporate the concept of ideational change in understanding critical junctures. Until its development, frameworks utilized in identifying critical junctures were subjective, seeking only to identify crisis, and subsequent policy changes, arguing that one invariably led to the other, as both occurred around the same time. Hogan and Doyle (2007, 2008) hypothesized ideational change as an intermediating variable in their framework, determining if, and when, a crisis leads to radical policy change. Here we test this framework on cases similar to, but different from, those employed in developing the exemplar. This will enable us determine whether the framework's relegation of ideational change to a condition of crisis holds, or, if ideational change has more importance than is ascribed to it by this framework. This will also enable us determined if the framework itself is robust, and fit for the purposes it was designed to perform â identifying the nature of policy change
Climate as a risk factor for armed conflict
This is the author accepted manuscriptResearch findings on the relationship between climate and conflict are diverse and contested. Here we assess the current understanding of the relationship between climate and conflict, based on the structured judgments of experts from diverse disciplines. These experts agree that climate has affected organized armed conflict within countries. However, other drivers, such as low socioeconomic development and low capabilities of the state, are judged to be substantially more influential, and the mechanisms of climateâconflict linkages remain a key uncertainty. Intensifying climate change is estimated to increase future risks of conflict.European Research Counci
ĐĐ”ŃĐ°ŃОзОŃĐ”ŃĐșĐŸĐ” Đ·ĐœĐ°ŃĐ”ĐœĐžĐ” ĐșĐ°ŃĐ”ĐłĐŸŃĐžĐč ĐżŃĐ”ĐŽĐŒĐ”ŃĐ° Đž ĐœĐ”ĐżŃĐ”ĐŽĐŒĐ”ŃĐ° ĐČ Đ»ĐŸĐłĐžĐșĐ”, ĐżĐŸŃŃĐœŃĐ”ĐŒĐŸĐ” ĐżŃĐžĐŒĐ”ŃĐ°ĐŒĐž ŃĐ”ŃĐ”ĐœĐžŃ Đ°ĐœŃĐžĐœĐŸĐŒĐžĐž Đ Đ°ŃŃДла ĐČ ŃĐ”ĐŸŃОО ŃĐžĐżĐŸĐČ Đž Đ°ĐșŃĐžĐŸĐŒĐ°ŃĐžŃĐ”ŃĐșĐŸĐč ŃĐžŃŃĐ”ĐŒĐ” NBG
ĐĐ”ŃĐ°ŃОзОŃĐ”ŃĐșĐŸĐ” Đ·ĐœĐ°ŃĐ”ĐœĐžĐ” ĐșĐ°ŃĐ”ĐłĐŸŃĐžĐč ĐżŃĐ”ĐŽĐŒĐ”ŃĐ° Đž ĐœĐ”ĐżŃĐ”ĐŽĐŒĐ”ŃĐ° ĐČ Đ»ĐŸĐłĐžĐșĐ”, ĐżĐŸŃŃĐœŃĐ”ĐŒĐŸĐ” ĐżŃĐžĐŒĐ”ŃĐ°ĐŒĐž ŃĐ”ŃĐ”ĐœĐžŃ Đ°ĐœŃĐžĐœĐŸĐŒĐžĐž Đ Đ°ŃŃДла ĐČ ŃĐ”ĐŸŃОО ŃĐžĐżĐŸĐČ Đž Đ°ĐșŃĐžĐŸĐŒĐ°ŃĐžŃĐ”ŃĐșĐŸĐč ŃĐžŃŃĐ”ĐŒĐ” NB
Health care professionalsâ experience, understanding and perception of need of advanced cancer patients with cachexia and their families: The benefits of a dedicated clinic.
BACKGROUND: Cachexia is defined as the on-going loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support. It is found in up to 80% of patients with advanced cancer and has profound psycho-social consequences for patients and their families. Previous studies demonstrate that many healthcare professionals receive little formal education in cachexia management leading them to feel that they have limited understanding of the syndrome and cannot intervene effectively. This study aims to examine the value of a dedicated cachexia clinic and its influence on staff understanding and practice. METHODS: An exploratory qualitative study was conducted. The study employed semi-structured interviews with a range of healthcare professionals responsible for designing and delivering cancer care in a large teaching hospital in Australia. This hospital had a dedicated cachexia clinic. RESULTS: In-depth interviews were conducted with 8 healthcare professionals and senior managers. Four themes were identified: formal and informal education; knowledge and understanding; truth telling in cachexia and palliative care; and, a multi-disciplinary approach. Findings show that improved knowledge and understanding across a staff body can lead to enhanced staff confidence and a willingness to address cancer cachexia and its consequences with patients and their families. CONCLUSION: Comparisons with similar previous research demonstrate the advantages of providing a structure for staff to gain knowledge about cachexia and how this can contribute to feelings of improved understanding and confidence necessary to respond to the challenge of cachexia
The correlation and level of agreement between end-tidal and blood gas pCO2 in children with respiratory distress: a retrospective analysis
<p>Abstract</p> <p>Background</p> <p>To investigate the correlation and level of agreement between end-tidal carbon dioxide (EtCO<sub>2</sub>) and blood gas pCO<sub>2 </sub>in non-intubated children with moderate to severe respiratory distress.</p> <p>Methods</p> <p>Retrospective study of patients admitted to an intermediate care unit (InCU) at a tertiary care center over a 20-month period with moderate to severe respiratory distress secondary to asthma, bronchiolitis, or pneumonia. Patients with venous pCO<sub>2 </sub>(vpCO<sub>2</sub>) and EtCO<sub>2 </sub>measurements within 10 minutes of each other were eligible for inclusion. Patients with cardiac disease, chronic pulmonary disease, poor tissue perfusion, or metabolic abnormalities were excluded.</p> <p>Results</p> <p>Eighty EtCO<sub>2</sub>-vpCO<sub>2 </sub>paired values were available from 62 patients. The mean ± <smcaps>SD</smcaps> for EtCO<sub>2 </sub>and vpCO<sub>2 </sub>was 35.7 ± 10.1 mmHg and 39.4 ± 10.9 mmHg respectively. EtCO<sub>2 </sub>and vpCO<sub>2 </sub>values were highly correlated (r = 0.90, p < 0.0001). The correlations for asthma, bronchiolitis and pneumonia were 0.74 (p < 0.0001), 0.83 (p = 0.0002) and 0.98 (p < 0.0001) respectively. The mean bias ± <smcaps>SD</smcaps> between EtCO<sub>2 </sub>and vpCO<sub>2 </sub>was -3.68 ± 4.70 mmHg. The 95% level of agreement ranged from -12.88 to +5.53 mmHg. EtCO<sub>2 </sub>was found to be more accurate when vpCO<sub>2 </sub>was 35 mmHg or lower.</p> <p>Conclusion</p> <p>EtCO<sub>2 </sub>is correlated highly with vpCO<sub>2 </sub>in non-intubated pediatric patients with moderate to severe respiratory distress across respiratory illnesses. Although the level of agreement between the two methods precludes the overall replacement of blood gas evaluation, EtCO<sub>2 </sub>monitoring remains a useful, continuous, non-invasive measure in the management of non-intubated children with moderate to severe respiratory distress.</p
Staphylococcal protein Ecb impairs complement receptor-1 mediated recognition of opsonized bacteria
Staphyloccus aureus is a major human pathogen leading frequently to sepsis and soft tissue infections with abscesses. Multiple virulence factors including several immune modulating molecules contribute to its survival in the host. When S. aureus invades the human body, one of the first line defenses is the complement system, which opsonizes the bacteria with C3b and attract neutrophils by release of chemotactic peptides. Neutrophils express Complement receptor-1 [CR1, CD35) that interacts with the C3b-opsonized particles and thereby plays an important role in pathogen recognition by phagocytic cells. In this study we observed that a fraction of S. aureus culture supernatant prevented binding of C3b to neutrophils. This fraction consisted of S. aureus leukocidins and Efb. The C-terminus of Efb is known to bind C3b and shares significant sequence homology to the extracellular complement binding protein [Ecb). Here we show that S. aureus Ecb displays various mechanisms to block bacterial recognition by neutrophils. The presence of Ecb blocked direct interaction between soluble CR1 and C3b and reduced the cofactor activity of CR1 in proteolytic inactivation of C3b. Furthermore, Ecb could dose-dependently prevent recognition of C3b by cell-bound CR1 that lead to impaired phagocytosis of NHS-opsonized S. aureus. Phagocytosis was furthermore reduced in the presence of soluble CR1 [sCR1). These data indicate that the staphylococcal protein Ecb prevents recognition of C3b opsonized bacteria by neutrophil CR1 leading to impaired killing by phagocytosis and thereby contribute to immune evasion of S. aureus.Peer reviewe
Introduction: Rethinking the Impact of the Inter-American Human Rights System
This chapter introduces the central themes of the book and argues that the Inter-American Human Rights System (IAHRS) is activated by political actors and institutions in ways that transcend traditional compliance perspectives and that have the potential to meaningfully alter politics and provoke positive domestic human rights change. The chapter identifies key gaps in existing human rights scholarship, particularly in relation to the IAHRS, and outlines three core perspectives on the Systemâs impact on human rights. It offers a synthesis of the key findings of the volume, and provides reflections on the future prospects of the System by locating it in its broader global context
Optimism and commitment: An elementary theory of bargaining and war
We propose an elementary theory of wars fought by fully rational contenders.
Two parties play a Markov game that combines stages of bargaining with stages
where one side has the ability to impose surrender on the other. Under uncertainty
and incomplete information, in the unique equilibrium of the game, long
confrontations occur: war arises when reality disappoints initial (rational) optimism,
and it persist longer when both agents are optimists but reality proves
both wrong. Bargaining proposals that are rejected initially might eventually
be accepted after several periods of confrontation. We provide an explicit computation
of the equilibrium, evaluating the probability of war, and its expected
losses as a function of i) the costs of confrontation, ii) the asymmetry of the
split imposed under surrender, and iii) the strengths of contenders at attack
and defense. Changes in these parameters display non-monotonic effects
Global energy governance : a review and research agenda
Over the past few years, global energy governance (GEG) has emerged as a major new field of enquiry in international studies. Scholars engaged in this field seek to understand how the energy sector is governed at the global level, by whom and with what consequences. By focusing on governance, they broaden and enrich the geopolitical and hard-nosed security perspectives that have long been, and still are, the dominant perspectives through which energy is analysed. Though still a nascent field, the literature on GEG is thriving and continues to attract the attention of a growing number of researchers. This article reviews the GEG literature as it has developed over the past 10 years. Our aim is to highlight both the progress and limitations of the field, and to identify some opportunities for future research. The article proceeds as follows. First, it traces the origins of the GEG literature (section âOrigins and roots of GEG researchâ). The subsequent sections deal with the two topics that have received the most attention in the GEG literature: Why does energy need global governance (section âThe goals and rationale of global energy governanceâ)? And, who governs energy (section âMapping the global energy architectureâ)? We then address a third question that has received far less attention: How well or poor is energy governed (section âEvaluating global energy governanceâ)? In our conclusions (section âConclusions and outlookâ), we reflect on the current state of GEG, review recent trends and innovations, and identify some questions that warrant future consideration by scholars. This article is published as part of a thematic collection on global governance
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