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As the US tests models of care for the seriously ill, patient perceptions of the quality of care are important. Proxies are often needed for this group. We sought to understand the potential impact of proxy reports for the assessment of care quality and experience in cancer.
Methods
Secondary data analysis of a deidentified prospective study that included surveys of perceived care quality, including symptom management, from patients with advanced cancer receiving chemotherapy and their caregivers. Surveys were administered at diagnosis (time 1) and treatment (time 2), with top-box scoring used for analysis. Overall concordance was assessed using metrics including Gwet’s AC1. The proportion of the highest scores by respondent type within 2 subgroups were examined: (1) symptom burden and (2) practice setting.
Results
Data from 83 dyads were analyzed. Proxies and patients frequently reported the highest scores for quality (time 1: proxies: 77% and patients: 80%). At time 1, 14% of proxies and 10% of patients reported an unmet need for symptom palliation. Most patients reporting an unmet need gave the top score for quality (75%), but fewer proxies did so (45%). Proxy and patient reports were similar within practice settings. Concordance was at least moderate (nearly all outcomes >0.5 and some >0.8) by Gwet’s AC1.
Significance of results
Findings of at least moderate concordance and similar experience outcomes within subgroups suggest the use of proxies may not change estimates substantially. However, consideration should be taken when evaluating symptom management, particularly if such evaluations inform assessment of provider performance.
Clinicians are often called upon to assess the capacity of a patient to appoint a healthcare agent. Although a consensus has emerged that the standard for such assessment should differ from that for capacity to render specific healthcare decisions, exactly what standard should be employed remains unsettled and differs by jurisdiction. The current models in use draw heavily upon analogous methods used in clinical assessment, such as the “four skills” approach. This essay proposes an alternative model that relies upon categorization and sliding scale risk assessment that can be used to determine to how much scrutiny the proxy appointment should be subjected and how much certainty of accuracy should be required in order to maximize the patient’s autonomy and ensure that her underlying wishes are met.
Legal means of shareholder engagement in Australia vary considerably, ranging from reliance on shareholder rights conferred under the Corporations Act 2001 (Cth) to reliance on class actions seeking the collective enforcement of legal rights arising from corporate conduct. This chapter offers an introduction to Australia’s corporate governance framework in the context of corporate decision making and the exercise of shareholders voting rights. The balance of power between shareholders and the board of directors, and its legal impact on shareholder engagement, is highlighted. Insights are provided into the legal means of shareholder engagement in Australia and the manner in which votes are exercised. There is growing evidence of shareholder apathy and the dominance of institutional investors and proxy advisors. The chapter charts the recent trend towards active shareholder engagement on ESG and human rights issues at Annual General Meetings, notwithstanding the limited opportunities to propose advisory or non-binding resolutions at meetings.
In the opening of Plautus’ Casina the prologue warns the audience: ‘in case you’re waiting for [Euthynicus], he isn’t returning to the city in this comedy today. Plautus didn’t want him to. (64–6)’. The adulescens Euthynicus never becomes present onstage, and yet he is not completely absent either: his mother ‘knowingly supports him in his absence’, by supporting him against her lascivious husband. Euthynicus is not alone: Roman comedy is populated by a crowd of absent characters who are represented on stage by (guileful) proxies. Thanks to the poet’s imagination all these absent characters become present, and through their proxies they ‘benefit us in their absence as if they were present’, as the same prologue of Casina proclaims (20), with reference to the most important proxied absence of all, Plautus himself. There is something inherently theatrical about ‘proxiness’ and (Roman) comedy, a genre performed by actors proxying absent playwrights, featuring slaves proxying absent masters, and written by playwrights proxying both the Roman elite and the (lost) Greek models. The aim of the chapter is to delve into the world of proxied absentees in Roman comedy, investigating their meta-theatrical potential and the comic force of ‘proxiness’ in general.
Phytoliths can be an important source of information related to environmental and climatic change, as well as to ancient plant use by humans, particularly within the disciplines of paleoecology and archaeology. Currently, phytolith identification and categorization is performed manually by researchers, a time-consuming task liable to misclassifications. The automated classification of phytoliths would allow the standardization of identification processes, avoiding possible biases related to the classification capability of researchers. This paper presents a comparative analysis of six classification methods, using digitized microscopic images to examine the efficacy of different quantitative approaches for characterizing phytoliths. A comprehensive experiment performed on images of 429 phytoliths demonstrated that the automatic phytolith classification is a promising area of research that will help researchers to invest time more efficiently and improve their recognition accuracy rate.
As discussed in earlier chapters, a company has the legal powers and capacity of a individual, in addition to any specific powers conferred by law (s 124). The two key decision-making organs that can act as the company in exercising these powers are the board of directors and the members in general meeting. The general law and Corporations Act divide the company’s powers and responsibilities between these two groups. This chapter discusses this division of powers. Also discussed is how meetings of members and directors are held, and the requirements on companies to prepare and disclose key information, including financial reports.
This chapter specifies the methods used in the book to studying the alliances between local and intervening counterinsurgency allies. Nine wars are examined in the book. Five wars are studied using a combination of qualitative and quantitative methods, including the USA in Afghanistan, Iraq and Vietnam, as well as India in Sri Lanka and the USSR in Afghanistan. For these five wars, thousands of primary source US, Indian, and Soviet government documents describing the day-to-day workings of these alliances were examined and used to identify 460 specific policy requests, which were then incorporated in an original dataset tracking local compliance and other relevant variables. The coding rules for each variable are detailed in this chapter. The remaining four wars, namely Vietnam in Cambodia, Egypt in Yemen, Cuba in Angola, and Syria in Lebanon, rely on secondary historical accounts or primary source observations from outside actors such as US intelligence agencies.
Detailing the US intervention in Vietnam this chapter provides a list of policy requests from the USA to Vietnamese partners and the rate of Vietnamese compliance from 1964 to 1973. Providing a summary of the US-Vietnam counterinsurgency partnership, this chapter discusses several distinctive components of the Vietnamese-US alliance, including detailing how the shock of the 1968 Tet Offensive led to a sharp increase in local compliance, suggesting that significant enemy activity can motivate clients to cooperate with the demands of intervening patrons. Overall, similar to other interventions, local compliance was affected by the convergence or divergence of US and Vietnamese interests, interacting with US dependency on Saigon to implement particular reforms. There are 105 US policy requests identified and detailed, including pacification, reconciliation and development programs.
Detailing the US intervention in Afghanistan this chapter provides a list of policy requests from the USA to Afghan partners and the rate of Afghan compliance from 2001 to 2011. Providing a summary of the US-Afghan counterinsurgency partnership from the start of the US intervention to 2011, this chapter discusses several distinctive components of the Afghan-US alliance, namely the tension between US and Afghan officials, and an unusual pattern of free riding in Afghanistan not observed in other interventions examined in the book. Afghan compliance was affected by the convergence or divergence of US and Afghan interests, interacting with US dependency on Kabul to implement particular reforms. There are 148 US policy requests identified and detailed including working against corruption, expanding governance capacity, addressing counternarcotics, and aiding in development programs.
Detailing the US intervention in Iraq, this chapter provides a list of policy requests from the USA to Iraqi partners and the rate of Iraqi compliance with US requests from 2004 to 2010. Providing a summary of the US-Iraqi counterinsurgency partnership (2003–11), this chapter discusses several distinctive components of the Iraqi-US alliance, namely the imperfect and awkward transition to Iraqi sovereignty and Washington negotiating with not one, but two local governments in Iraq, namely the Shi’a-dominated government in Baghdad, and the Kurdish Regional Government in Erbil. Iraqi compliance was affected by the convergence or divergence of US and Iraqi interests, interacting with US dependency on Iraq to implement particular reforms. There are 106 US policy requests identified and detailed including working against sectarianism and corruption.
Summarizing, I detail the leverage sources for “weak” local COIN proxies. As postcolonial military intervention conceptualizes local partner regime success as a fundamental component of a successful foreign military intervention, local allies have much political influence over wealthy intervening patrons. Local allies that offer political inputs necessary for the COIN effort can capitalize on their indispensable role to extract concessions and assert influence over intervening wealthy patrons. Comparing the nine wars, I find consistency in local ally compliance, with one-third of requests from intervening forces resulting in compliance, one-third partial compliance, and one-third noncompliance. Interestingly, rates of local compliance had little impact on war outcome as intervening forces did not always offer great advice to local partners, and stronger local partners, such as Sri Lanka, that were more capable of combatting insurgents, could simultaneously resist the policy prescriptions of intervening patrons. These findings show the complexity of COIN by proxy, and should temper expectations about how much local reform can (and perhaps should) be coerced by intervening patrons.
I propose a model analyzing patterns in local compliance in response to requests from intervening COIN allies. I argue four primary variables affect the likelihood of compliance with policies proposed by intervening forces: (1) the capacity of the local partner to implement the requested policy, (2) whether the respective interests of the local and intervening forces converge or diverge over the policy, (3) the dependency of the intervening ally on the local regime to implement the requested policy, and (4) acute external threats from insurgent forces. The theory contends that these are key to understanding the seemingly curious behavior of local COIN partners, who at times seem to undermine the strength of a joint COIN effort by remaining obstinate against key reforms promoted by intervening patrons. Instead of presuming local allies comply with such requests when it is in their interest to do, and refuse when their interests diverge, I argue there is a specific pattern of interaction between interests, and the reliance of foreign intervening forces on local actors to implement policy, that affects the likelihood of compliance by local partners with policy demands.
Detailing the Indian intervention in Sri Lanka this chapter provides a list of policy requests from New Delhi to Colombo and the rate of Sri Lankan compliance from 1986 to 1989. Providing a summary of the Indian-Sri Lankan counterinsurgency partnership, this chapter discusses several distinctive components of the alliance, including the unique dynamics of New Delhi initially supporting the Tamil insurgents to later sending troops into Tamil regions of Sri Lanka to fight Tamil separatists alongside representatives from the Sri Lankan regime in Colombo. An overestimation of its ability to coercively influence both the Tamil insurgents as a proxy faction and the government in Colombo as a proxy ally backfired, costing New Delhi both politically and militarily. Overall, similar to other interventions, local compliance was affected by the convergence or divergence of Indian and Sri Lankainterests, interacting with Indian dependency on Colombo to implement particular policies. There are 79 Indian policy requests to Colombo identified and detailed, including electoral, law enforcement, and governance policies as well as policies to address Tamil grievances.
Introduces the big questions asked in this book, namely: When do intervening forces have coercive leverage over local partners in large-scale counterinsurgency interventions? When can local partners coerce their powerful patrons? What makes these partnerships so notoriously problematic? This chapter specifies why local allies matter in counterinsurgency and what political dynamics have changed from the colonial to postcolonial era of intervention, including the effect of local partners exercising (nominal) legal sovereignty that provides important political opportunities for local partners. The chapter also summarizes the argument that certain structural incentives embedded within intervention motivate local counterinsurgency proxies to comply with certain requests from intervening patrons, while defying others, detailing that the record on local compliance is varied.
Detailing the Soviet intervention in Afghanistan from 1978 to 1989 this chapter provides a list of policy requests from the Soviets to the Afghans and the rate of Afghan compliance from 1978 to 1980. Providing a summary of the Soviet-Afghan counterinsurgency partnership, this chapter discusses several distinctive components of the alliance, including the Soviet takeover of the Afghan state in 1980. Instead of asking its Afghan partners for new reforms, Moscow instead chooses to use internal Soviet agents embedded in Kabul to carry out requests within the Afghan regime. The chapter identifies and details 21 policy requests from 1978 to 1980 that pre-date the Soviet takeover of the Afghan state. Afghan compliance with those requests are remarkably similar with rates of compliance in other interventions, including the US intervention in Afghanistan. Soviet requests include negotiating with local powerbrokers and expanding governance structures.
In the two decades or so since ancient sedimentary DNA (sedaDNA) took its place as a new Quaternary paleo-proxy, there have been large advances in the scope of its applications and its reliability. The two main approaches, metabarcoding and shotgun sequencing, have contributed exciting insights into areas such as floristic diversity change, plant-herbivore interactions, extinction, conservation baselines and impacts of invasive species. Early doubts as to its potential to contribute novel information have been dispelled; more is now understood about the passage of sedaDNA from the original organism to a component of soil or sediment and about the range of uncertainties that must be addressed in the interpretation of data. With its move into the mainstream, it is now time to develop effective data archives for sedaDNA, refine our understanding of central issues such as taphonomy, and further expand the potential for describing, both qualitatively and quantitatively, the history of past ecosystems.
Why do powerful intervening militaries have such difficulty managing comparatively weak local partners in counterinsurgency wars? Set within the context of costly, large-scale military interventions such as the US war in Afghanistan, this book explains the conditions by which local allies comply with (or defy) the policy demands of larger security partners. Analysing nine large-scale post-colonial counterinsurgency interventions including Vietnam, Afghanistan, Iraq, Sri Lanka, Yemen, Lebanon, Cambodia, and Angola, this book utilizes thousands of primary source documents to identify and examine over 450 policy requests proposed by intervening forces to local allies. By dissecting these problematic partnerships, this book exposes a critical political dynamic in military interventions. It will appeal to academics and policymakers addressing counterinsurgency issues in foreign policy, security studies and political science.
This chapter discusses and analyses the roles that Hezbollah, a Lebanese militia, and Hamas, a Palestinian militia, played in the Syrian conflict. The fast pace of events in the first year of the conflict, along with the collapse of effective governance in large parts of Syria, created a political vacuum that quickly drew external powers into the Syrian arena. Since the beginning of clashes between the Syrian government and Syrian rebels, vast numbers of militia groups, armed forces, and military experts poured into Syria. These groups represented different agendas, effectively turning Syria into the battlefield of a multi-faceted proxy conflict. Hezbollah and Hamas represent different sets of interests and different stakeholders and consequently had different attitudes towards the crisis, explored in this chapter.
This study aimed to examine: (1) patient–proxy agreement on executive functioning (EF) of patients with primary brain tumors, (2) the relationships between patient- and proxy-report with performance-based measures of EF, and (3) the potential influence of performance-based measures on the level of agreement.
Methods:
Meningioma and low-grade glioma patients and their informal caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF-A) 3 months after surgery. The two index scores of the BRIEF-A, Behavioral Regulation and Metacognition, were evaluated. Mean scores of patients and proxies were compared with normative values and with each other. Patient–proxy agreement was evaluated with Lin’s concordance correlation coefficients (CCCs) and Bland–Altman plots. Pearson correlation coefficients between reported EF and performance-based measures of EF were calculated. Multiple regression analysis was used to evaluate the potential influence of test performance on differences in dyadic reports.
Results:
A total of 47 dyads were included. Patients reported significantly more problems on the Metacognition Index compared to norms, and also in comparison with their proxies. Effect sizes indicated small differences. Moderate to substantial agreement was observed between patients and proxies, with CCCs of 0.57 and 0.61 for Metacognition and Behavioral Regulation, respectively. Correlations between reported EF and test performance ranged between −0.37 and 0.10. Dyadic agreement was not significantly influenced by test performance.
Conclusions:
Patient–proxy agreement was found to be moderate. No clear associations were found between reported EF and test performance. Future studies should further explore the existing and new methods to assess everyday EF in brain tumor patients.
The Coalition Provisional Authority (CPA) governed Iraq from 2003 following Resolution 1483 of the UN Security Council. This Resolution affirmed that Iraq was in a state of occupation and that there were occupying powers. The Resolution referred to the United States of America and the United Kingdom as ‘occupying powers under the unified command of the “Authority”’, the ‘Authority’ being the CPA. However, the legal status of the CPA and its relationship to the US (the focus of this article) is not entirely clear, both under US domestic law and international law. This lack of clarity could have significant implications for the US’s responsibility for the CPA’s conduct. As with private military companies, a CPA-style administration of territory could become a tool for states to quarantine their risk under the law of occupation. This article contends that the theory of occupation by proxy may help clarify the legal status of the CPA and its relationship to the US and could assist in closing the identified gap in responsibility. To support this argument, this article establishes a legal framework for the theory of occupation by proxy which is then applied to the CPA and US.