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Protocols for Postcapitalist Expression is a book published by members of the Economic Space Agency. Its objective is to frame protocols (social agreements) on which to build the conditions for an economic system that is distributed (no centralised control) and can express network views about what constitutes, and how to measure, ‘value’ (value beyond profit). An insightful review by William Morgan (2024) probes some key dimensions of our project. This reply both reframes some of William’s insights and takes issue with others, especially those which emphasise a Hayekian interpretation.
This chapter focuses on the variety of different EEG patterns that can be seen after hypoxic ischemic brain injury, which often produces some of the most severe encephalopathies. Common post–cardiac arrest findings include discontinuity, burst suppression, background voltage attenuation and suppression, lack of EEG reactivity, seizures, myoclonus, and status epilepticus. The prognostic significance of these findings is discussed. Finally, the topic of using EEG as a confirmatory tool in brain death protocols is introduced.
One of the major pillars of the African Union is the integration of peoples and the ability for them to move freely from one member country to another, with the right to reside and practise their trade or profession. This aspect of integration found full expression in the Protocol to the Treaty Establishing the African Economic Community Relating to the Free Movement of Persons, Right of Residence and Right of Establishment, adopted in 2018. Upon operationalization, it will remove obstacles to the movement of people, capital and resources in the region and give expression to aspiration 2 of the African Union Agenda 2063. However, significant challenges lie on the path of its implementation. This article doctrinally reviews the protocol, looking at its prospects for promoting African integration and development, and anticipates some of the problems that the protocol will face. It concludes with recommendations for achieving its lofty but desirable ends.
The evidence base for racemic ketamine treatment for treatment-resistant major depressive disorder (TRD) continues to expand, but there are major challenges translating this evidence base into routine clinical care.
Aim
To prepare guidelines for ketamine treatment of TRD that are suitable for routine use by publicly funded specialist mental health services.
Method
We consulted with senior leadership, clinical pharmacy, psychiatrists, nursing, service users and Māori mental health workers on issues relating to ketamine treatment. We prepared treatment guidelines taking the evidence base for ketamine treatment and the consultation into account.
Results
Ketamine treatment guidance is reported. This offers two treatment pathways, including a test of ketamine responsiveness with intramuscular ketamine and the dominant use of oral ketamine for a 3-month course to maximise the opportunity for the short-term benefits of ketamine to accumulate.
Conclusions
We have responded to the challenges of translating the evidence base for ketamine treatment into a form suitable for routine care.
Concurrent and distributed systems based on message passing have become important drivers of our technological advancement. Their programming requires the integration of communicating processes, at the heart of which we find the notion of choreography: a document that prescribes the communications that processes should perform in order to reach a common goal. We say that a system has the property of choreography compliance if the interactions that take place among processes follow the agreed-upon choreography.
Edited by
Masum Khwaja, Imperial College of Science, Technology and Medicine, London,Peter Tyrer, Imperial College of Science, Technology and Medicine, London
This chapter discusses information-sharing, including with victims of crime committed by persons with mental disorders. In general, a patient’s treatment is confidential and, unless the patient consents to information being shared, this limits the information that can be disclosed. However, information about a patient can be disclosed to a third party such as a victim if other statutes, such as the Domestic Violence and Mental Health Acts, permit this. Information can also be disclosed if another person is at risk of harm if the information is not disclosed. Furthermore, the victims of specific violent and sexual offences have certain rights to information about the offender. This includes offenders subject to the MHA and detained in hospital or subject to compulsion in the community. Patients can be victims as well as perpetrators of crime, and professionals working in health, social care and the justice system require a robust understanding of when to share confidential information. The first half of the chapter provides information on relevant legislation and guidance to be considered when sharing information about patients in general. The second half is focused on legislation and guidance on information sharing by organisations supporting victims of crimes committed by mentally disordered offenders.
The chapter analyses each element of the definition of a treaty in the Vienna Convention on the Law of Treaties 1969: an international agreement, concluded between states, in written form, governed by international law, either in a single instrument or in two or more related instruments, whatever its particular designation. Agreements in simplified form such as an exchange of notes or an exchange of letters can also be treaties. The chapter examines the criteria which international courts and tribunals have applied in determining whether other instruments such as agreed minutes might constitute treaties. Relevant factors include: form and designation, terminology, subject matter, terms, context, intent, level of negotiator, definite or conditional terms, clarity, subsequent practice, and registration with the UN. Examples of electronic signature are noted, although state practice is sparse. A treaty should be distinguished from a non-legally binding instrument, such as a memorandum of understanding, although some states use the title ‘Memorandum of Understanding’ also for treaties with a certain subject matter. Unilateral declarations are not treaties but may in some circumstances have binding legal effects. Treaties have a wide variety of titles, including Protocol, but the title does not itself determine whether an instrument is a treaty.
Treaties may be amended by agreement between the parties. Bilateral treaties can be amended more easily than multilateral treaties. Bilateral treaties will sometimes include a provision on amendment but, in the absence of that, the parties will often simply proceed to amend the treaty by means of an exchange of notes, with provision concerning the entry into force of the amendment. Multilateral treaties too will often have express provision specifying amendment procedures. The chapter analyses various examples of these, including the use of supplementary treaties or protocols. If there is no such provision, residual rules are provided by Articles 40 and 41 of the Vienna Convention on the Law of Treaties.
This paper describes the development and pilot-testing of a horse welfare assessment protocol (HWAP). The HWAP consists of the collective measurement of numerous factors considered likely to affect a horse's welfare and is thereby designed to provide a holistic score of its welfare status and to identify potential risk factors. The draft protocol contains 47 measures: 15 animal-based, 24 resource-based and eight management-based. It was tested in the autumn at two Swedish riding schools using a total of 37 horses of varying breed, gender and age. Each assessment was repeated after 16-25 days. The results showed that 66% (31/47) of the measures had over 85% repeatability between assessments. Results indicated occurrence of behavioural issues, eg aggression and avoidance, and potential risk factors, such as inadequate management routines and feeding regimes. Using the HWAP, the assessment of up to 22 horses could be carried out in one day. Changes were proposed to the draft protocol which included incorporating an ethogram to assess the human-animal relationship and assessing bit-related injuries. We propose that the protocol might: i) provide a firm basis for the welfare monitoring of horses; ii) identify important potential risk factors; iii) guide welfare improvement and management practices for horse owners and stable managers; and iv) contribute to the development of certification schemes for horse facilities.
The Welfare Quality® (WQ) protocols are increasingly used for assessing welfare of farm animals. These protocols are time consuming (about one day per farm) and, therefore, costly. Our aim was to assess the scope for reduction of on-farm assessment time of the WQ protocol for dairy cattle. Seven trained observers quantified animal-based indicators of the WQ protocol in 181 loose-housed and 13 tied Dutch dairy herds (herd size from 10 to 211 cows). Four assessment methods were used: avoidance distance at the feeding rack (ADF, 44 min); qualitative behaviour assessment (QBA, 25 min); behavioural observations (BO, 150 min); and clinical observations (CO, 132 min). To simulate reduction of on-farm assessment time, a set of WQ indicators belonging to one assessment method was omitted from the protocol. Observed values of omitted indicators were replaced by predictions based on WQ indicators of the remaining three assessment methods, resources checklist, and interview, thus mimicking the performance of the full WQ protocol. Agreement between predicted and observed values of WQ indicators, however, was low for ADF, moderate for QBA, slight to moderate for BO, and poor to moderate for CO. It was concluded that replacing animal-based WQ indicators by predictions based on remaining WQ indicators shows little scope for reduction of on-farm assessment time of the Welfare Quality® protocol for dairy cattle. Other ways to reduce on-farm assessment time of the WQ protocol for dairy cattle, such as the use of additional data or automated monitoring systems, should be investigated.
This study was designed to determine whether feedback from welfare assessments, using the Horse Welfare Assessment Protocol, affected actual horse welfare in 21 stables. After the first assessment, stable managers in the high feedback (HF; n = 10 stables) group were supplied with extensive information and support regarding the welfare measures and relevance of the results. The low feedback (LF; n = 11 stables) group only received the results without additional information. Upon re-assessment, six months later, no significant changes were seen in the stable overall (SO) score in either group. Significant changes occurred in individual measures; in the HF group more fresh-air inlets were open but water drinker function and ocular discharge deteriorated. In the LF group, the feeding troughs were cleaner but mane and tail condition deteriorated. Both groups had cleaner water troughs and less equipment chafing but the sum of relative air humidity (RH) and temperature (T) deteriorated. Significant decreases occurred in the stable welfare issues (SWI) score; the HF group decreased from 93.3 to 72.0 and the LF group from 113.3 to 91.3. There were also nonsignificant changes; in the HF group, 71 measures and five stables improved while 63 measures and five stables (50%) deteriorated. In the LF group, 65 measures and seven stables improved while 62 measures and four stables deteriorated. The observed improvements in both groups suggest that assessment alone (with no detailed feedback) might raise awareness but we cannot yet conclude whether or not the type of feedback affects overall horse welfare.
The confined environment of the dog shelter, particularly over extensive time-periods can impact severely on welfare. Surveillance and assessment are therefore essential components of the welfare protocol. The aim of this study was to generate a descriptive analysis of a sample of Italian long-term shelters and identify potential hazards regarding the welfare of shelter dogs. This was achieved through application of the Shelter Quality Protocol (SQP) to link income/outcome variables and the inclusion of sixty-four long-term shelters in Italy. Descriptive and logistic regression analyses were conducted. Key findings showed feeding regime, type of diet and access to outdoor area to be significantly associated with inadequate body condition score (BCS). The probability of observing skin lesions was shown to be influenced by bedding inadequacy and bedding type. Limiting beds to one per dog and utilising clean bedding materials was significantly associated with a reduced probability of observing dirty/wet dogs. Protection from adverse weather conditions and inadequate bedding were significantly associated with the manifestation of polypnea. Non-existent dog training facilities, outdoor access or leash walking were all found to significantly increase the likelihood of fearful or aggressive attitudes to people. Outdoor access also, in conjunction with feeding regime, was associated with the presence of diarrhoea. The SQP proved useful in identifying welfare hazards, both as regards shelter environment and shelter management. Identification of these hazards creates the opportunity for interventions to be applied, minimising the risks and improving the welfare of long-term shelter dogs.
Tobacco smoking is the most common preventable cause of morbidity and mortality in the world. In an effort to counteract the harmful consequences of smoking, various tobacco control measures have been implemented, including the use of smoking cessation programmes to reduce the number of new smokers as well as helping current smokers to quit smoking. In Thailand, the SMART Quit Clinic Program (FAH-SAI Clinics) was launched in 2010 to provide smoking cessation services by a multidisciplinary team. There are currently 552 FAH-SAI Clinics established across all 77 provinces of Thailand.
Aim:
This protocol describes a study aiming to evaluate the SMART Quit Clinic Program (FAH-SAI Clinics) in terms of programme performance and clinical outcomes. We hope that the results of the study could be used to improve the current service model and the programme’s success.
Method:
A multicentre prospective observational study will be conducted. The study will focus on 24 FAH-SAI Clinics across 21 provinces of Thailand. The primary outcomes are seven-day point prevalence abstinence rate and continuous abstinence rate at three and six months. The outcomes will be measured using a self-reported questionnaire and biochemical validated by exhaled carbon monoxide.
Discussion:
This study will be the first real-world study that reports the effectiveness of the well-established smoking cessation programme in Thailand. Findings from this study can help improve the quality of smoking cessation services provided by multidisciplinary teams and other smoking cessation services, especially those implemented in low- and middle-income countries.
People with mental illness (MI) have a reduced life expectancy compared to the general population, mostly attributable to somatic diseases caused by poor physical health. Modifiable lifestyle factors are increasingly associated with the onset of somatic diseases in people with MI. Despite the increasing evidence for the efficacy of lifestyle interventions there is little change in routine clinical care. This discrepancy is referred to as the implementation gap and has caused a need for effectiveness and implementation research in real-world settings.
Objectives
This study investigates the health outcomes and implementation of a multidisciplinary lifestyle focused approach in treatment of inpatients with mental illness (MULTI+).
Methods
This is an open cohort stepped wedge cluster randomized trial in inpatients psychiatric wards of GGz Centraal. Three clusters are randomly allocated to one of the three pre-defined steps to integrate MULTI+. MULTI+ can be tailored to fit individual psychiatric wards and includes 10 core components aimed at improving lifestyle factors. The primary outcome is to investigate whether there is a greater decrease in the QRISK3 cardiovascular risk score after receiving MULTI+ as compared to treatment as usual. Secondary outcomes include somatic and mental health outcomes, lifestyle factors, and implementation factors.
Results
First results expected in 2022.
Conclusions
To our knowledge, this will be the first large-scale study evaluating the long-term effects of a multidisciplinary, multicomponent approach aimed at improving lifestyle factors. We expect that this approach will increase long-term sustainability and can serve as a potential blueprint for future implementation of lifestyle interventions to improve routine clinical care.
This chapter is written for the researcher who may encounter immunohistochemistry (IHC) in a slightly different context when compared to diagnostic applications. There are many moving parts to IHC assays, and this chapter covers all of the important aspects the researcher needs to consider when employing IHC for their projects. This objective is achieved by employing a request form for IHC services. The questions posed on the form build towards piecing together a protocol that is fit for purpose and can be used in many applications. Practical explanations about epitope retrieval, diluting antibodies from concentrates and the use of detection kits are provided. The need to block endogenous enzyme activity is also explained, as is the technique for antibody optimization. Borrowing the basic fundamental IHC protocol used in diagnostic histopathology, the researcher should be able to adopt and change parameters to suit their research applications.
Leica’s current IHC instrument is the Bond III. A review is conducted by a medical scientist using it on a daily basis so that an honest evaluation is afforded from first-hand experience. Topics of interest include the machinery Leica employs for epitope retrieval and the coverplate technology to assist in reagent delivery. A discussion about proprietary reagents and consumables whilst highlighting the various components of the machine is provided. There are tips and tricks offered to get the most out of the platform. Programming stain protocols for both chromogenic, fluorescence and double labelling IHC are specified along with equipment servicing and maintenance requirements. The reader in essence, gets to appreciate what it is really like to operate and work with the Bond III. The chapter concludes with both good and bad aspects of this form of automation and some opportunities for improvement.
Immunohistochemistry assays can be technically difficult. There are countless opportunities for errors. Some faults can be fixed, and this chapter contains a precise appraisal of common problems encountered along with suggested solutions. Incorporating both pre-analytic conundrums and analytic challenges from a staining perspective, it is written by a medical scientist able to think outside the square and offer resolutions ranging from the practical to the unconventional. All prescribed advice has been tested and proven successful. Suggesting corrective actions is an exercise in giving the worker options and workarounds for certain situations. Doing more with less and less testing material and lifting sections from slides to be used again when the paraffin block is exhausted are two examples of what can be achieved. Ultimately, it is about tuning protocols to make the most of the precious test tissue given whilst eliminating unnecessary wastage.
Immunohistochemistry robotics and automation as defined by Agilent comes in the form of the Dako Omnis. An appraisal is given by a medical scientist with intimate knowledge of the principles behind the technology, the various machine components and Dako’s proprietary reagents. Daily operations with the instrument allow for an honest review of stain protocols, workflow logistics and maintenance obligations. An explanation of the unique dynamic gap technology is provided along with in-built quality assurance measures. As the Omnis is a new instrument when compared to Leica’s Bond III and Ventana’s BenchMark ULTRA, discussions are based upon the good and bad points of both the hardware and the software aspects. The reader should get an idea of how the Omnis produces stained slides and the capabilities of the machine.
Roche’s answer to current immunohistochemistry automation is the Ventana BenchMark ULTRA. An evaluation of the machine’s design, operation and maintenance is provided from a user’s viewpoint. Technologies which differentiate Ventana from other manufacturers are discussed in detail. The liquid coverslip, hapten-based detection system and random access points are examples of these differences when compared to traditional coverplate and polymer technology as used by other vendors. A commentary about proprietary reagents and staining protocols are offered along with advice on achieving workflow efficiencies. Discovering quality control measures of the instrument is another topic covered. Ultimately, it is hoped the reader understands the intricacies of this platform and the advantages and disadvantages of such a system, and gains a sense of the technology behind the BenchMark ULTRA.
Seasonal variations directly impacted the social and economic activities of past human populations. Cementochronology is one of the methods available to address seasonality questions. It relies on the cyclic deposition rate of dental cementum observed microscopically on petrographic thin‐sections of animal teeth from archaeological contexts. However, no protocol exists to select a Region of Interest (ROI) or to identify the last cementum increment. This chapter proposes consensual biological and optical criteria for the selection of optimal ROIs and their analysis. Interobserver tests were performed to assess the criteria, as well as age and season of death, on thirty thin‐sections of modern documented reindeer teeth. Results demonstrate the accuracy, and replicability of this protocol, and emphasize the influence of training and experience for the proper implementation of cementochronology.