International perspectives on the influence of structure and process of weaning from mechanical ventilation.

Background 
Recently, clinical and research attention has been focused on refining weaning processes to improve outcomes for critically ill patients who require mechanical ventilation. One such process, use of a weaning protocol, has yielded conflicting results, arguably because of the influence of existing context and processes.

Objective 
To compare international data to assess differences in context and processes in intensive care units that could influence weaning.  

Methods 
Review of existing national data on provision of care for critically ill patients, including structure, staffing, skill mix, education, roles, and responsibilities for weaning in intensive care units of selected countries.

Results 
Australia, New Zealand, Denmark, Norway, Sweden, and the United Kingdom showed similarities in critical care provision, structure, skill mix, and staffing ratios in intensive care units. Weaning in these countries is generally a collaborative process between nurses and physicians. Notable differences in intensive care units in the United States were the frequent use of an open structure and inclusion of respiratory therapists on the intensive care unit’s health care team. Nurses may be excluded from direct management of ventilator weaning in some institutions, as this role is primarily assumed by respiratory therapists guided by medical directives. Availability of critical care beds was highest in the United States and lowest in the United Kingdom.

Conclusion 
Context and processes of care that could influence ventilator weaning outcomes varied considerably across countries. Further quantification of these contextual influences should be considered when translating research findings into local clinical practice and when designing randomized, controlled trials.

An accelerated method of developing DBT projects using CDIO partner institutions as parallel processors

The cycle of the academic year impacts on efforts to refine and improve major group design-build-test (DBT) projects since the time to run and evaluate projects is generally a full calendar year. By definition these major projects have a high degree of complexity since they act as the vehicle for the application of a range of technical knowledge and skills. There is also often an extensive list of desired learning outcomes which extends to include professional skills and attributes such as communication and team working. It is contended that student project definition and operation, like any other designed product, requires a number of iterations to achieve optimisation. The problem however is that if this cycle takes four or more years then by the time a project’s operational structure is fine tuned it is quite possible that the project theme is no longer relevant. The majority of the students will also inevitably experience a sub-optimal project experience over the 5 year development period. It would be much better if the ratio were flipped so that in 1 year an optimised project definition could be achieved which had sufficient longevity that it could run in the same efficient manner for 4 further years. An increased number of parallel investigators would also enable more varied and adventurous project concepts to be examined than a single institution could undertake alone in the same time frame.
This work-in-progress paper describes a parallel processing methodology for the accelerated definition of new student DBT project concepts. This methodology has been devised and implemented by a number of CDIO partner institutions in the UK & Ireland region. An agreed project theme was operated in parallel in one academic year with the objective of replacing a multi-year iterative cycle. Additionally the close collaboration and peer learning derived from the interaction between the coordinating academics facilitated the development of faculty teaching skills in line with CDIO standard 10.

The International Protection of Refugees and Asylum Seekers: the Role of Article 3 of the European Convention on Human Rights

This book presents a comprehensive assessment of regional responses to the crisis in the asylum/refugee system and critically examines how different regions tackle the problem. The chapters consider the fundamental challenges which undermine an effective asylum process as well as regional difficulties with the various circumstances surrounding asylum seekers. With contributions on Africa, Europe, Latin America, South Asia and the Middle East, and the Pacific, the collection strives to appreciate what informs each region’s approach to the asylum process and asks if there are issues common to every region and if regions can learn from one another. The book seeks an understanding of the existing legal regime for the protection of asylum seekers and how regional institutions such as human rights commissions and regional courts enforce and adjudicate the law.

New governance for higher education institutions:prospects for female university careers and equality law

This paper analyses the reforms in employment conditions at German public universities from the 1990s to the 2000s, considering how these impact on practical equal opportunities between women and men. It concludes that while the so called "new governance" in universities would have offered opportunities to integrate positive measures to increase female participation in research and teaching, these opportunities were missed in most German states.

The resilience of democratic institutions in Britain, Australia and the United States under conditions of total war

To what extent are democratic institutions resilient when nation states mobilise for war? Normative and empirical political theorists have long argued that wars strengthen the executive and threaten constitutional politics. In modern democracies, national assemblies are supposed to hold the executive to account by demanding explanations for events and policies; and by scrutinising, reviewing and, if necessary, revising legislative proposals intended to be binding on the host society or policies that have been implemented already. This article examines the extent to which the British and Australian parliaments and the United States Congress held their wartime executives to account during World War II. The research finds that under conditions approaching those of total war, these democratic institutions not only continued to exist, but also proved to be resilient in representing public concerns and holding their executives to account, however imperfectly and notwithstanding delegating huge powers. In consequence, executives—more so British and Australian ministers than President Roosevelt—were required to be placatory as institutional and political tensions within national assemblies and between assemblies and executives continued, and assemblies often asserted themselves. In short, even under the most onerous wartime conditions, democratic politics mattered and democratic institutions were resilient.

Implementação e integração do modelo de acreditação da Joint Commission International na unidade de imagiologia do Hospital Privado da Boavista

Este trabalho descreve a abordagem abrangente sobre a melhoria do sistema de gestão da qualidade na Unidade de Imagiologia do Hospital da Boavista através da implementação das normas de acreditação da Joint Commission International (JCI). Fundamental para a melhoria geral da qualidade é a redução contínua de riscos para os doentes e para os profissionais da Unidade. Tais riscos podem existir ao nível do ambiente físico assim como no circuito dos exames e dos doentes. A acreditação em Saúde é uma das prioridades estratégicas do Ministério da Saúde e tem como objetivo fortalecer a confiança dos cidadãos nos profissionais de saúde bem como nas instituições de saúde. É importante que Portugal cultive a melhoria da qualidade e segurança nas instituições de saúde mantendo uma relação adequada custo/benefício. A União Europeia tem feito um esforço para que a acreditação seja harmoniosa nos seus princípios, no entanto é respeitada sempre a prevalência da legislação de cada país, bem como as suas especificações culturais e religiosas (Shaw, 2006), responsabilizando-o pelo seu sistema de saúde O trabalho aqui apresentado tem como objetivo principal fundamentar a escolha do modelo de acreditação da JCI para o Hospital da Boavista, nomeadamente para a Unidade de Imagiologia, ver se os padrões estão de acordo com os procedimentos da Unidade, identificar falhas e apontar possiveis melhorias. Pretende-se ainda mostrar a importância da implementação dos sistemas de certificação e acreditação da gestão da qualidade, documentada pela experiência profissional, bem como o know-how do Hospital da Boavista, assim como a complementaridade dos programas da gestão da qualidade, certificação e acreditação. A escolha do modelo de acreditação da JCI, foi uma opção do Hospital da Boavista baseada na credibilidade e no grau de exigência que a entidade impõe. Foi imperativo que a Unidade de Imagiologia realizasse as suas funções de forma válida e fiável e que disponibilizasse produtos / serviços de qualidade. A monitorização e consequente controlo de qualidade do serviço prestado pela Unidade de Imagiologia, foi difícil mas simplificado, em parte, devido ao sistema de gestão da qualidade ISO 9001:2008 já implementado, tendo este sido consolidado com a implementação da acreditação da JCI, com padrões específicos bem definidos na gestão do controlo de qualidade na Unidade de Imagiologia do Hospital da Boavista.

Banco BPI SA financial institutions

Equity research report

Harmonization guidelines for HLA-peptide multimer assays derived from results of a large scale international proficiency panel of the Cancer Vaccine Consortium.

PURPOSE: The Cancer Vaccine Consortium of the Cancer Research Institute (CVC-CRI) conducted a multicenter HLA-peptide multimer proficiency panel (MPP) with a group of 27 laboratories to assess the performance of the assay. EXPERIMENTAL DESIGN: Participants used commercially available HLA-peptide multimers and a well characterized common source of peripheral blood mononuclear cells (PBMC). The frequency of CD8+ T cells specific for two HLA-A2-restricted model antigens was measured by flow cytometry. The panel design allowed for participants to use their preferred staining reagents and locally established protocols for both cell labeling, data acquisition and analysis. RESULTS: We observed significant differences in both the performance characteristics of the assay and the reported frequencies of specific T cells across laboratories. These results emphasize the need to identify the critical variables important for the observed variability to allow for harmonization of the technique across institutions. CONCLUSIONS: Three key recommendations emerged that would likely reduce assay variability and thus move toward harmonizing of this assay. (1) Use of more than two colors for the staining (2) collect at least 100,000 CD8 T cells, and (3) use of a background control sample to appropriately set the analytical gates. We also provide more insight into the limitations of the assay and identified additional protocol steps that potentially impact the quality of data generated and therefore should serve as primary targets for systematic analysis in future panels. Finally, we propose initial guidelines for harmonizing assay performance which include the introduction of standard operating protocols to allow for adequate training of technical staff and auditing of test analysis procedures.

The political economy of international regulatory convergence in public utilities

To what extent should public utilities regulation be expected to converge across countries? When it occurs, will it generate good outcomes? Building on the core proposition of the New Institutional Economics that similar regulations generate different outcomes depending on their fit with the underlying domestic institutions, we develop a simple model and explore its implications by examining the diffusion of local loop unbundling (LLU) regulations. We argue that: one should expect some convergence in public utility regulation but with still a significant degree of local experimentation; this process will have very different impacts of regulation.

Expanding to institutionally different countries. Reasons, Firm International Experience, and Entry Mode Choice

We examine entry mode choice and its consequences when a multinational enterprise (MNE) expands into an institutionally different country. We argue that discussions of entry mode should distinguish between informal (e.g., culture) and formal (e.g., laws) institutions, and should take into account not just the home country of the MNE and its distance to the focal host country, but the MNE's overall footprint and experience across the world in general, especially in countries with an institutional structure that is similar to that of the focal host country. Specifically, we argue that firms with experience in countries with different informal institutions will be more likely to enter via acquisitions than firms without such experience, that such experience will not matter as much in the case of formal institutions, and that such firms will exit more quickly when they enter via equity alliances than through full acquisitions. We also distinguish between balanced and unbalanced alliances and argue that balanced alliances will be more enduring, but only when the host country is culturally (not legally) different from the other countries where the MNE has experience. Our arguments suggest that entry mode should be conditioned on a firm's experience in other markets, and that intercountry differences in formal versus informal institutions have distinct influences on entry mode.

Ethnic conflicts and international politics : an analysis of the communal regional, and global dimensions of the Cyprus problem

The thesis assesses the impact of international factors on relations between Greek and Turkish Cypriots during and after the Cold War. Through an analysis of the Cyprus problem it explores both why external actors intervene in communal conflicts and how they influence relations between ethnic groups in plural societies. The analytical framework employed throughout the study draws on contributions of International Relations theorists and students of ethnic conflict. The thesis argues that, as in the global political system, relations between ethnic groups in unranked communal systems are anarchic; that is, actors within the system do not recognize a sovereign political authority. In bipolar communal systems dominated by two relatively equal groups, the struggle for security and power often leads to appeals for assistance from external actors. The framework notes that neighboring states and Great Powers may heed calls for assistance, or intervene without a prior request, if it is in their interest to do so. The convergence of regional and global interests in communal affairs exacerbates ethnic conflicts and precludes the development of effective political institutions. The impact of external intervention in ethnic conflicts has the potential to alter the basis of communal relations. The Cyprus problem is examined both during and after the Cold War in order to gauge how global and regional actors and the structure of their respective systems have affected relations between ethnic groups in Cyprus. The thesis argues that Cyprus's descent into civil war in 1963 was due in part to the entrenchment of external interests in the Republic's constitution. The study also notes that power politics involving the United States, Soviet Union, Greece and Turkey continued to affect the development of communal relations throughout the 1960s, 70s, and, 80s. External intervention culminated in July and August 1974, after a Greek sponsored coup was answered by Turkey's invasion and partition of Cyprus. The forced expulsion of Greek Cypriots from the island's northern territories led to the establishment of ethnically homogeneous zones, thus altering the context of communal relations dramatically. The study also examines the role of the United Nations in Cyprus, noting that its failure to settle the dispute was due in large part to a lack of cooperation from Turkey, and the United States' and Soviet Union's acceptance of the status quo following the 1974 invasion and partition of the island. The thesis argues that the deterioration of Greek-Turkish relations in the post-Cold War era has made a solution to the dispute unlikely for the time being. Barring any dramatic changes in relations between communal and regional antagonists, relations between Greek and Turkish Cypriots will continue to develop along the lines established in July/August 1974. The thesis concludes by affirming the validity of its core hypotheses through a brief survey of recent works touching on international politics and ethnic conflict. Questions requiring further research are noted as are elements of the study that require further refinement.

L’arrêt Baker : Le rôle des règles administratives dans la réception du droit international des droits de la personne en droit interne

Un résumé en anglais est également disponible.

La légitimité constitutionnelle de la réception directe des normes du droit international des droits de la personnes en droit interne canadien

Un résumé en anglais est également disponible.

L'accord de Cotonou et les contradictions du droit international : l'intégration des règles de l'Organisation mondiale du commerce et des droits humains dans la coopération ACP-CE

"Thèse présentée à la Faculté des études supérieures de l'Université de Montréal en vue de l'obtention du grade de Docteur en Droit (LL.D.) Et à A la faculté de droit Jean Monnet en vue de l'obtention du doctorat en Sciences Juridiques"

Idées, institutions et intérêts dans le changement de la protection sociale : les politiques de transfert de revenu au Brésil

Cette thèse porte sur l’introduction des politiques de transfert de revenu au Brésil. L’objectif central de la recherche est de comprendre comment ces politiques se sont imposées dans le cadre des réformes de la protection sociale brésilienne pendant les années 1990, notamment à partir de 1995 et comment elles ont engendré un changement paradigmatique de troisième ordre de la politique nationale d’assistance sociale. Nous posons deux hypothèses de recherche : la première est que l’introduction de telles politiques au Brésil fut le résultat du rôle historique des intellectuels engagés dans la défense du revenu minimum en tant qu’alternative au modèle de protection sociale brésilien. Cette défense du revenu minimum fut soutenue par des intellectuels, des communautés épistémiques et par des politiciens qui ont inscrit le débat sur le revenu minimum à l’agenda politique brésilien. La deuxième hypothèse suggère que la convergence d’idées, d’institutions et d’intérêts a favorisé l’adoption de ces politiques. Cette convergence d’idées, d’institutions et d’intérêts repose sur le rôle de plusieurs acteurs tels les intellectuels, le président Cardoso et d’autres politiciens qui se sont mis à la défense du social au Brésil depuis 1999, des institutions parlementaires brésiliennes et des organisations internationales, notamment le FMI, la Banque mondiale et la Banque interaméricaine de développement – BID. Nous proposons l’approche des trois i pour rendre compte de ce changement. L’apprentissage social, les processus de diffusion et de lesson-drawing sont les facteurs à l’origine de la formation de la convergence autour des programmes de transfert de revenu. Nous montrerons que l’expérience brésilienne de programmes de transfert de revenu a non seulement engendré un processus d’apprentissage social renversé auprès de la Banque Mondiale mais qu'elle a aussi eu un effet aussi sur les actions de la BID. Nous suggérons que le changement paradigmatique de la protection sociale brésilienne a été amorcé par le gouvernement Cardoso dans un processus d’essais et d’erreurs. Ce processus, qui est à l’origine des réaménagements du programme « Comunidade Solidária », a permis la création du « Projeto Alvorada » et du « Réseau de protection sociale » en 2001. Les programmes de transfert de revenu reliés à l’éducation et aux soins de santé ont été les plus influents dans la construction du consensus qui s’est établi autour des programmes de transfert de revenu comme alternative à l’ancien modèle de protection sociale puisqu’ils procurent le renforcement du capital social en même temps qu’ils fonctionnent comme facteur structurant de la protection sociale. Ce legs du gouvernement Cardoso a permis au gouvernement de Luis Inácio Lula da Silva de consolider le nouveau paradigme avec la création du programme national Bolsa-Família. Le gouvernement Lula a donc bénéficié de l’héritage historique des deux mandats de Cardoso et, ironiquement, a récolté les fruits de l’apprentissage social. Le phénomène du « lulismo » en est la preuve. Par ailleurs, cette thèse met en question la paternité du programme Bolsa-Família puisqu’elle montre la création de ce programme d'abord comme la consolidation du processus d’apprentissage et puis comme conséquence de la création d’un nouveau paradigme pour la politique d’assistance sociale au Brésil qui a eu lieu pendant les deux mandats de Cardoso.