On the development of horizontal CEN standards supporting the implementation of EU directives on sludge, soil and biowaste - Project HORIZONTAL

We give an overview on the development of "horizontal" European Committee for Standardisation (CEN) standards for characterising soils, sludges and biowaste in the context of environmental legislation in the European Union (EU). We discuss the various steps in the development of a horizontal standard (i.e. assessment of the possibility of such a standard, review of existing normative documents, pre-normative testing and validation) and related problems. We also provide a synopsis of European and international standards covered by the so-called Project HORIZONTAL. (C) 2004 Elsevier Ltd. All rights reserved.

The influence of medical enduring power of attorney and advance directives on decision making by Australian intensive care doctors

OBJECTIVE: Despite government encouragement for patients to make advance plans for medical treatment, and the increasing numbers of patients who have done this, there is little research that examines how doctors regard these plans.
DESIGN: We surveyed Australian intensive care doctors, using a hypothetical clinical scenario, to evaluate how potential end-of-life treatment decisions might be influenced by advance planning - the appointment of a medical enduring power of attorney (MEPA) or an advance care plan (ACP). Using open-ended questions we sought to explore the reasoning behind the doctors' decisions.
RESULTS: 275 surveys were returned (18.3% response rate). We found that opinions expressed by an MEPA and ACP have some influence on treatment decisions, but that intensive care doctors had major reservations. Most did not follow the request for palliation made by the MEPA in the hypothetical scenario.
CONCLUSIONS: Many intensive care doctors believe end-of-life decisions remain medical decisions, and MEPAs and ACPs need only be respected when they accord with the doctor's treatment decision. This study suggests a need for further education of doctors, particularly those working in intensive care, who are responsible for initiating and maintaining life support treatment.

Advance directives and the persistent vegetative state in Victoria: a human rights perspective

With advances in medical technology, it is now possible to sustain the life of a person in a persistent vegetative state (PVS) until a decision is made to withhold or withdraw life-sustaining treatment. Who makes that decision? Under the Medical Treatment Act 1988 (Vic) there is no legally enforceable right for a person to choose, in advance, what intervention that person will and will not accept if he or she ends up in a PVS. The best that can be achieved is that a person can appoint an agent who is empowered to refuse medical treatment on the person's behalf in the event of incompetence. It is suggested that this mechanism ignores two fundamental human rights: self-determination and the inherent right to dignity. This article proposes the development of an advance directive mechanism that provides for a person to refuse, in advance, specified intervention, thereby respecting fundamental human rights and alleviating the existing need for an agent to second-guess a person's desires and best interests.

Global education policy directives : impact on teachers from the north and south

Education policies from international organisations such as the World Bank and OECD are restructuring education to promote a utilitarian vision of education. By examining the experiences and opinions of teachers from countries representing north-south global regions, it is possible to identify the social and political implications of education reform as it impacts on teachers as not only practitioners, but also as social and political agents. As global communities are more inexorably linked through global, macro policies, an outcome of this trend is a growing political and social divide between the global north and south. The paper aims to identify and discuss the significant concerns of teachers from the global north and south in relation to education reform.

Assessment policies, curricular directives, and teacher agency: quandaries of EFL teachers in Inner Mongolia

In the debate over English language teaching approaches and methods, the influence of examinations on classroom pedagogy and the nature of these examinations are critical considerations for teachers. In the Inner Mongolian context, as for all China, examinations reflect traditional conceptions of teaching and learning, classroom teaching conditions such as class sizes, and the English-as-a-foreign language setting. In this situation, decisions about classroom pedagogy and objectives and whether teaching focuses on test-taking rather than on the learning of language go to the core of teacher agency. In this paper we foreground the struggles and dilemmas experienced by English language teachers in Inner Mongolia in attempts to exercise agency amidst the instructional demands of an exam-oriented community, and a misalignment created by an exam remaining centered on discrete skills rather than students' proficiency in applying ranging uses of the language they are learning. These conditions are now located within New English Syllabus expectations are that teachers will implement their knowledge of educational theories and of current English teaching methodology to create opportunities for more broadly based learning and proficiency. © 2014 © 2014 Taylor & Francis.

Costs and advance directives at the end of life: a case of the ‘Coaching Older Adults and Carers to have their preferences Heard (COACH)’ trial

BACKGROUND: Total costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature. Healthcare utilisation and associated health care costs for a group of older Australians who entered Transition Care following an acute hospital admission were calculated. Costs were differentiated according to a number of health care decisions and outcomes including advance directives (ADs).

METHODS: Study participants were drawn from the Coaching Older Adults and Carers to have their preferences Heard (COACH) trial funded by the Australian National Health and Medical Research Council. Data collected included total health care costs, the type of (and when) ADs were completed and the place of death. Two-step endogenous treatment-regression models were employed to test the relationship between costs and a number of variables including completion of ADs.

RESULTS: The trial recruited 230 older adults with mean age 84 years. At the end of the trial, 53 had died and 80 had completed ADs. Total healthcare costs were higher for younger participants and those who had died. No statistically significant association was found between costs and completion of ADs.

CONCLUSION: For our frail study population, the completion of ADs did not have an effect on health care utilisation and costs. Further research is needed to substantiate these findings in larger and more diverse clinical cohorts of older people.

La collecte de l'eau: directives pour de bonnes pratiques

La collecte de l’eau est réalisée avec succès depuis des millénaires dans les régions du monde entier – certaines interventions récentes ont également eu un impact local significatif. Pourtant, le potentiel de cette technique reste largement inconnu, non reconnu et non apprécié. Il est temps de transposer à plus grande échelle les « bonnes pratiques » de collecte de l’eau, celles qui ont survécu au temps ou qui ont émergé des nouvelles expériences, après des décennies de focalisation presque exclusive sur la maîtrise des flux d’eau douce dans les rivières et les lacs grâce à des investissements dans des infrastructures d’irrigation.La collecte de l’eau offre des opportunités sous-exploitées pour les systèmes principalement d’exploitation pluviale des zones arides dans le monde en développement. Celle-ci fonctionne mieux précisément dans les zones où la pauvreté rurale est la pire. Quand elle est bien réalisée, son impact est à la fois de réduire la faim et de lutter contre la pauvreté, tout en améliorant la résilience de l’environnement. Ces connaissances sur les technologies de collecte d’eau et sur les milieux dans lesquels elles ont tendance à donner de meilleurs résultats, représentent une véritable richesse cachée. Pour la première fois, ces connaissances sont traitées, rassemblées et rendues disponibles à travers un tel outil organisé, illustré et instructif reliant les technologies aux réseaux des connaissances, outil qui servira aux utilisateurs présumés de ces directives pratiques pour mieux comprendre et mettre en oeuvre leurs choix

The feasibility of self-report advance directives among elderly patients with cognitive impairment

The central objective of this dissertation was to determine the feasibility of self-completed advance directives (AD) in older persons suffering from mild and moderate stages of dementia. This was accomplished by identifying differences in ability to complete AD among elderly subjects with increasing degrees of dementia and cognitive incompetence. Secondary objectives were to describe and compare advance directives completed by elders and identified proxy decision makers. Secondary objectives were accomplished by measuring the agreement between advance directives completed by proxy and elder, and comparing that agreement across groups defined by the elder's cognitive status. This cross-sectional study employed a structured interview to elicit AD, followed by a similar interview with a proxy decision maker identified by the elder. A stratified sampling scheme recruited elders with normal cognition, mild, and moderate forms of dementia using the Mini Mental-State Exam (MMSE). The Hopkins Competency Assessment Test (HCAT) was used for evaluation of competency to make medical decisions. Analysis was conducted on "between group" (non-demented $\leftrightarrow$ mild dementia $\leftrightarrow$ moderate dementia, and competent $\leftrightarrow$ incompetent) and "within group" (elder $\leftrightarrow$ family member) variation.^ The 118 elderly subjects interviewed were generally male, Caucasian, and of low socioeconomic status. Mean age was 77. Overall, elders preferred a "trial of therapy" regarding AD rather than to "always receive the therapy". No intervention was refused outright more often than it was accepted. A test-retest of elders' AD revealed stable responses. Eleven logic checks measured appropriateness of AD responses independent of preference. No difference was found in logic error rates between elders grouped by MMSE or HCAT. Agreement between proxy and elder responses showed significant dissimilarity, indicating that proxies were not making the same medical decisions as the elders.^ Conclusions based on these data are: (1) Self reporting AD is feasible among elders showing signs of cognitive impairment and they should be given all opportunities to complete advance directives, (2) variation in preferences for advance directives in cognitively impaired elders should not be assumed to be the effects of their impairment alone, (3) proxies do not appear to forego life-prolonging interventions in the face of increasing impairment in their ward, however, their advance directives choices are frequently not those of the elder they represent. ^

Simulation analysis of the EU ELV/RoHS directives based on an applied general equilibrium model with Melitz-type trade specification

This paper explores the potential usefulness of an AGE model with the Melitz-type trade specification to assess economic effects of technical regulations, taking the case of the EU ELV/RoHS directives as an example. Simulation experiments reveal that: (1) raising the fixed exporting cost to make sales in the EU market brings results that exports of the targeted commodities (motor vehicles and parts for ELV and electronic equipment for RoHS) to the EU from outside regions/countries expand while the domestic trade in the EU shrinks when the importer's preference for variety (PfV) is not strong; (2) if the PfV is not strong, policy changes that may bring reduction in the number of firms enable survived producers with high productivity to expand production to be large-scale mass producers fully enjoying the fruit of economies of scale; and (3) When the strength of the importer's PfV is changed from zero to unity, there is the value that totally changes simulation results and their interpretations.

Directives for a Correct Diagnosis

A special Working Group, to study and develop standars related to Building Restoration, Rehabilitation and Maintenance, was formed in January 2001 in AENOR (Spanish Association for Codes and Standars) under the management of the Department of Building Construction of the School of Architecture of Madrid (DCTA-UPM). Three groups were organized to deal with different topics: Diagnosis, Techiques and Materials, and Maintenance. In this paper the differents topics in which the Diagnosis Subgroup is working are described: historical studies, constructive description of the building and building pathology. These will be basic to carry out a correct diagnosis of any type of building, whether it is historic or not. In the development of such topics, the recognizable architectural values are justified as they are prior to the diagnosis stage. As an example of the subgroup work, several pathology cards are shown which include: longitudinal cracks of mechanical origin in beams of concrete structures, façade closings and claddings, and general symptoms of installation services.