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This chapter serves as the general introduction to the volume. It discusses two major impasses plaguing EMU in the 2020s: the first, a clash between politicization of EMU decisions, on the one hand, and an institutional structure designed to reject political conflict, on the other; the second, a scholarly impasse between those analysing EMU accountability comparatively and those doing so through EMU specific standards. The chapter briefly introduces the core concepts used in the volume as a means of overcoming this impasse: the distinction between procedural and substantive accountability as well as the normative goods framework developed in Chapter 1. It finally provides an overview of the structure and content of the volume, concluding with a plea to focus scholarly attention on EMUs substantive accountability deficits.
Guidelines on epilepsy monitoring unit (EMU) standards have been recently published. We aimed to survey Canadian EMUs to describe the landscape of safety practices and compare these to the recommendations from the new guidelines.
Methods:
A 34-item survey was created by compiling questions on EMU structure, patient monitoring, equipment, personnel, standardized protocol use, and use of injury prevention tools. The questionnaire was distributed online to 24 Canadian hospital centers performing video-EEG monitoring (VEM) in EMUs. Responses were tabulated and descriptively summarized.
Results:
In total, 26 EMUs responded (100% response rate), 50% of which were adult EMUs. EMUs were on average active for 23.4 years and had on average 3.6 beds. About 81% of respondents reported having a dedicated area for VEM, and 65% reported having designated EMU beds. Although a video monitoring station was available in 96% of EMUs, only 48% of EMUs provided continuous observation of patients (video and/or physical). A total of 65% of EMUs employed continuous heart monitoring. The technologist-to-patient ratio was 1:1–2 in 52% of EMUs during the day. No technologist supervision was most often reported in the evening and at night. Nurse-to-EMU-patient ratio was mostly 1:1–4 independent of the time of day. Consent forms were required before admission in 27% of EMUs.
Conclusion:
Canadian EMUs performed decently in terms of there being dedicated space for VEM, continuous heart monitoring, and adequate nurse-to-patient ratios. Other practices were quite variable, and adjustments should be made on a case-by-case basis to adhere to the latest guidelines.
An electroencephalogram (EEG) is a critical tool in epilepsy diagnosis. The three common EEG durations are 25 minutes, 1 hour, and 24 hours. One-hour EEGs are superior in showing epileptiform abnormalities, while 24-hour EEGs are used to characterize seizure and nonepileptic event semiology and guide treatment of status epilepticus. The term EEG montage refers to the way EEG electrodes are ordered for interpretation. Odd numbered electrodes are on the left, with even numbered on the right. Smaller numbers are closer to the midline, while z means the electrode is on the midline.This chapter will explore the numerous normal and variant findings like posterior dominant rhythm (PDR) and wicket spikes. Epileptiform findings like sharp waves or seizure patterns are indicative of epilepsy. Slowing or increased amplitude can indicate cerebral changes that are not epileptiform.Electroencephalogram reports should concisely accurately convey both the electrical findings and their clinical relevance to patient care. Electroencephalogram reports should indicate an epilepsy diagnosis only when clear electrical evidence exists.
A common care location for seizure and epilepsy patients is the emergency department and inpatient setting. A thorough history to discern a specific diagnosis and localization guides testing and treatment decisions. These decisions include the need for additional imaging/laboratory testing and whether to start an antiseizure medicine (ASM). Electroencephalograms (EEGs) are often required with time length depending on clinical question. If an epilepsy diagnosis is certain without clear localization, one hour of testing is preferred. If the question (or diagnosis) is status epilepticus, 24-hour EEG is indicated. For patients with known epilepsy, ASM alteration can occur for seizures with appropriate compliance. If there is noncompliance, an ASM increase may not be required. The perioperative period requires ASM continuation, although the administration route may change. Patients with renal or hepatic impairment often necessitate dose adjustment. Specific situations like alcohol withdrawal seizures have accepted paradigms to follow and are discussed. Lastly, patients in epilepsy monitoring units (EMUs) are hospitalized for diagnostic reasons with management needs different than other epilepsy patients.
Chapter 9 introduces the metaphor of a pendulum to characterize the sharp swings in Brandt’s policies toward European integration; the chancellor frequently backed ambitious EC projects that proved premature and unworkable. In 1970, fierce debates arose among the six EC members concerning how to pursue economic and monetary union (EMU). Brandt’s point person on Europe, Katharina Focke, sympathized with the French desire to tighten monetary cooperation among the EC partners right away. Bonn’s economy ministry under Karl Schiller took a more cautious line, insisting that macroeconomic convergence was necessary first. An EC agreement on EMU in early 1971 favored the French line; but soon thereafter a currency crisis prompted Brandt’s cabinet to “float” the mark, putting the EMU project on hold. Bonn’s policies helped the Nixon administration as it sought to stabilize the remnants of the Bretton Woods system – much to the dismay of French president Georges Pompidou. Afterwards Brandt worked to mend fences with France, and at a summit of the newly expanded EC in 1972 they pledged to form a European Union complete with a unified currency by 1980.
This chapter discusses the currency union’s original set-up. It first discusses the history of European monetary integration, distinguishing between two sorts of motives: one economic, the other political. From the establishment of the European Economic Community up until the Treaty of Maastricht, both have been important drivers of monetary integration. The chapter subsequently turns to the original legal set-up of the euro, in particular its internal policy dimension. The economic and political forces behind the currency union’s creation also exercised great influence on its set-up, which came to institutionalise a stability paradigm. Characteristic of this paradigm was that it granted overriding importance to price stability as a policy goal and argued for a privileged position of the central bank in achieving this. The chapter shows how its influence was most notably evident at the level of aims and principles and in the constitutional position of the European Central Bank. Yet it also shaped the single currency’s economic foundations, in particular, the Union’s limited competences in this area and its focus on fiscal prudence. It even informed the rules governing accession.
In their fight against the debt crisis, the European Union and its member states took measures that have profoundly changed the euro. It now differs fundamentally from when it was introduced by the Treaty of Maastricht. Surprisingly, this change has come about with hardly any formal amendment to the Union's 'basic constitutional charter', the Treaties. How, then, to understand it? This book argues that the constitution of the EU has transformed, which occurs when constitutions change without amendment. The transformation is characterized by a broadening of the currency union's stability conception from price stability to also financial stability. Using solidarity as a lens, the book conceptualises the unity of the member states and analyses how this was preserved during the crisis. Subsequently, it explains how that changed the currency union's set-up and why the European Court of Justice could not turn against the change in Pringle and Gauweiler.
The COVID-19 pandemic has had a major impact on clinical practice. Safe standards of practice are essential to protect health care workers while still allowing them to provide good care. The Canadian Society of Clinical Neurophysiologists, the Canadian Association of Electroneurophysiology Technologists, the Association of Electromyography Technologists of Canada, the Board of Registration of Electromyography Technologists of Canada, and the Canadian Board of Registration of Electroencephalograph Technologists have combined to review current published literature about safe practices for neurophysiology laboratories. Herein, we present the results of our review and provide our expert opinion regarding the safe practice of neurophysiology during the COVID-19 pandemic in Canada.
Edited by
Nauro F. Campos, University College London,Paul De Grauwe, London School of Economics and Political Science,Yuemei Ji, University College London
Over recent years, a consensus has emerged that 'policy failures that allowed imbalances to get so large' were probably the main root cause of the Euro area crisis.Reflecting this, the new Euro area governance arrangements include a Macroeconomic Imbalances Procedure (MIP) that seeks to identify and take corrective action against emerging imbalances.This chapter uses a Bayesian structural VAR model to assess the feasibility of managing macroeconomic imbalances in the Euro area using four macroeconomic policy tools:fiscal policy, macroprudential policy, product market structural reforms and labour market reforms.Consistent with the emerging literature, it finds that managing macroeconomic imbalances is likely to be difficult.However, it raises the tantalising prospect that a combination of eliminating structural rigidities before macroeconomic imbalances arise plus using macroprudential policy to manage emerging macroeconomic imbalances could be effective.
This paper analyses the politicisation of the Eurozone crisis in Finnish public debate, in May-November 2010. We emphasise how the mainstream parties responded to the radical right Finns Party's framing, in addition to two context factors: first, the constraints posed on domestic policymakers by EU and EMU-level decisions, and secondly, the sharp, economic downturn, encouraging a zero-sum interpretation of distributive claims. To trace actor positions, we analyse 1183 actor-issue statements coded from Finland's main newspaper, Helsingin Sanomat. Our findings suggest that radical right-wing parties can benefit from the high salience of socio-economic issues, if distributive conflict can plausibly be portrayed as a in- and out-group conflict, and that the mainstream parties did not only adopt nationalistic rhetoric as a response to the radical right-wing Finns Party's framing, but were responding to a constraints such as the diminished room for maneuver in the EMU, moving them towards the Finns Party's position.
This article argues that the integration of financial assistance capacity in the eurozone, which was meant to remedy institutional shortcomings and mitigate the distributional implications of financial support in the European Monetary Union (EMU), has instead contributed to a deepening of the existing political cleavages and the creation of new ones. This dysfunctional effect reflects the empowerment of some national parliaments in decisions on financial assistance. These arguments are tested against the empirical examination of the negotiations of the three adjustment programmes for Greece. Specifically, the article shows that negotiations moved towards the radicalization of creditors’ positions and increased divisions between creditors in conjunction with the development of financial assistance capacity. While advancing its theses, the article strikes a note of caution regarding the argument that the empowerment of national parliaments in EU policymaking is one of the most powerful antidotes to its legitimacy deficit and thus a safeguard for the integration project.
The European sovereign debt crisis has revived the debate about appropriate fiscal rules in the European Economic and Monetary Union. Whereas the Stability and Growth Pact and the Fiscal Compact make no distinction between public consumption and investment expenditure, the aim of the current paper is to analyze the implications of the adoption of the Golden rule in a monetary union, distinguishing between the two types of public expenditure. With the help of a macroeconomic model, we show that introducing a Golden rule and smoothing public investment expenditure would be welfare-improving, and mostly for countries where taxation rates and the productivity of public investment are highest, and for the most closed countries. It would also be the most beneficial for countries where the monetary transmission parameter, the propensity to consume, and the price elasticity of supply are weakest, whereas supply-side distortions are the strongest.
With the current sovereign debt crisis, the incompleteness of economic integration in the Economic and Monetary Union (EMU) has become patent, leading to an intense debate among academics and policy makers. Much of the debate concerns fiscal rules and austerity measures, both of which weigh on growth prospects. In this paper we look at the main structural shortcomings of EMU through the lens of general equilibrium theory. We address two issues (international sharing of macroeconomic risks and coordinated growth stimulation) which are at the heart of the sustainability of EMU. We propose: (A) a specific scheme for mutual insurance of macroeconomic risks; (B) locating responsibility for demand policies at the EMU level, with ambitious investment programs (public, or fiscally-neutral private) as main instrument.
With the advent of EMU, monetary policy can no longer be used to prevent housing market bubbles in regional economies such as Ireland or Spain. However, fiscal policy can and should be used to achieve the same effect. This paper shows that the advent of EMU relaxed existing financial constraints in Ireland and Spain, allowing a more rapid expansion of the housing stock in those countries to meet their specific demographic circumstances. However, the failure to prevent these booms turning into bubbles did lasting damage to the two economies, damage that could have been avoided by more appropriate fiscal policy action.
There is only a sparse literature on the determination of real exchange rate volatility, and little attention has been given to the possible impact of EMU on volatility of real exchange rates of EU countries. A number of papers suggest a negative impact of exchange rate volatility on investment or growth, for advanced as well as developing countries, although we note that price and wage adjustment that might link to real exchange rate volatility is also part of the adjustment mechanism to macroeconomic shocks in EMU. We assess whether an effect of EMU on conditional volatility of real effective exchange rates can be detected, both for EMU and non EMU members. We find that the advent of EMU was accompanied by a reduction in conditional real exchange rate volatility for most EMU countries, as well as Sweden and Denmark that did not join EMU, but did not lead to a reduction in real rate volatility for Germany, Belgium, the Netherlands, nor, outside EMU, for the UK.
This paper develops a new approach for investigating the determinant of the mark-up of prices over costs. We estimate basic price equations around an expression for marginal cost that is derived from a cost minimisation problem, using a vector error correction approach to avoid endogeneity bias. Observed basic prices include the mark-up over marginal costs, and this mark-up is of interest to policymakers as an indicator of competition and ultimately as a determinant of the level of equilibrium employment. We look at the factors driving this mark-up, and in particular look at the role of EMU, as well as globalisation, the European Single Market and openness to trade and the introduction of the euro. We use a panel data set that includes both EMU and non-EMU members. The results indicate an important role for trade liberalisation in determining the mark-up, but openness itself and the introduction of the euro do not appear to have a significant role.
The EMU fiscal adjustment paths of the four Southern Europe members (Italy, Spain, Greece, and Portugal – SE-4) vary along two dimensions: (a) cross-temporal pre- and post-EMU accession and (b) cross-country. We account for the cross-temporal variation by distinguishing between the ‘hard’ and ‘soft’ EMU conditionality of the pre- and post-accession stage. External constraints in the form of the Maastricht eligibility criteria constituted a significant common ‘push’ factor in the fiscal stabilization process of EMU candidate countries throughout the 1990s. However, their power does not necessarily lead to fiscal sustainability as demonstrated by the post-accession budgetary outlook of the SE-4. We account for the cross-country variation by introducing additional ‘pull’ factors related to the reform content, context and capability, such as unemployment, the level of social concertation, and government effectiveness. Only in cases where such factors were at work did governments engage in structural reforms to consolidate public finances instead of the less controversial path of macroeconomic policy reform.
The skin of the emu Dromaius novaehollandiae is described in its entirety by light microscopy for the first time, therefore providing a basis for comparison with the integument of volant birds. The epidermal and dermal layers have a similar arrangement to other avian species. The concentration of lipid spheres in the basal layer of the epidermis is unique to emus. Although no differences in collagen density with depth of the dermis were observed, collagen bundle diameter is significantly smaller in the stratum superficiale compared to the stratum compactum (P=0.001). The extensive stratum laxum, comprised predominantly of adipose tissue, may be an evolutionary adaptation to support the large feathers and also enhance insulation against ambient subzero temperatures. Males have a significantly thicker cellular epidermis (P=0.024) and stratum compactum (P=0.04) than females. In contrast, females have denser collagen (P=0.04) within the stratum superficiale and stratum compactum.
Both the EU- and the EC-Treaties refer in prominent places to the establishment of economic and monetary union (Articles 2 EU and EC). This union is mentioned as one of the principal means of achieving the Union's and the Community's economic and social objectives. Such a prominent place is not allotted it in the Constitution. In its effort to separate the basic provisions from the other provisions in the treaties, the Convention decided to retain only the European Union's objectives in the actual constitutional part. The concrete activities pertaining to the economic and monetary union, as well as its ‘guiding principles’ of stable prices, sound public finances and monetary conditions and a sustainable balance of payments were relegated to Part III that deals with the Union's policies.
Cette étude revient sur la distinction établie entre deux règles de fixation
irrévocable des cours de change: une règle temporelle suivant laquelle le
gel de la parité est programmé à une date arbitraire; une règle d'état sous
laquelle cette décision résulte de l'atteinte d'un seuil par les
déterminants fondamentaux. En les replaçant dans un cadre d'analyse commun,
ces stratégies apparaisent en fait rigoureusement équivalentes en l'absence
d'incertitude sur le déroulement de la transition. Une correspondance en
termes probabilistes est établie dans un contexte stochastique plus général.
Ce cadre d'analyse unifié s'avère un préalable utile pour entreprendre une
relecture de la stratégie maastrichtienne en matière cambiaire et mettre à
jour certaines propriétés du scénario finalement adopté par les autorités
européennes.