Asian waters are geographically positioned as a lifeline for international maritime trade and commerce. Individual coastal state maritime interests aside, there is a legitimate international interest ...in ensuring international straits are safe for the vast volumes of merchant shipping transiting the region each day. The willingness of states external to the Asian region to become involved when maritime stability is threatened is well illustrated through an examination of the incidence of maritime piracy. The fact that the Asian states, particularly Indonesia and Malaysia, bristled at the principally Western interest in seeking enhanced maritime security indicates that at least in this instance, regional cooperation was driven more by a desire to keep Western powers out than a desire to work with neighbouring governments. This article examines the pattern of piracy and the regional initiatives which have been successful in reducing the number of reported incidents. It concludes that not only are effective regional responses to transnational security issues such as maritime piracy and illegal fishing in Asia unlikely, in the absence of intervention from the international community, but that states with sovereign interests at stake in the issue prevent the kind of broader international interest and participation needed to compel more cooperative regional action.
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BFBNIB, DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
AimsAs part of the Covid-19 recovery plan; nosocomial transmission of Covid-19 in hospital settings has been highlighted as a significant risk requiring mitigation. Reducing the number of patients ...attending departments and waiting in communal waiting and clinical areas has been highlighted as a way by which transmission of Covid-19 in hospital can be reduced.Our key objectives• Reduce unnecessary Emergency Department attendances and those requiring clinical assessment within the unit• Improve the flow of patients through the department to reduce the time each patient spends in the clinical area• Provide safe clinical alternatives including, caring for the child at home.• Influence parents and families to choose the most appropriate service for their child in the futureIn response in August 2020 we developed an enhanced triage deflection process with the aim to reduce the number of patients requiring clinical assessment on the PANDA Unit, subsequently reducing the patient footprint within the department and to improve adherence to social distancing national and trust guidance.MethodsOn arrival to the emergency department; Children and Young People 0 – 15 years undergo an enhanced triage assessment by a Registered Children’s Nurse who refer to condition led pathways to identify patients who are at a low, medium or high risk of serious illness.Children who are at low risk of serious illness and who do not meet the exemption criteria are discharged home from triage with advice for home management of common conditions whilst being given red flag symptoms to observe for.Children are assessed using condition led pathways based on NICE pathways. The pathways cover a range of illness and minor injury related presentationsResultsSince August 2020 on average, we have sent home 22% of our patients from triage using this process with an average length of stay time of 13.1 minutes calculated from the time patients book in for triage and when they are being discharged home.We have seen a less than 4% return rate with no serious incidents identified and the median length of stay for returning patients is 102 minutes.We have received a positive response from parents and families with 92% reporting being very satisfied with the service provided and 69% stating that the advice given at triage would alter their future behaviors in accessing services or not.ConclusionThis process works to ensure that that patients attending the Emergency Department are seen and managed in the correct setting including their own home, improving patient safety and flow by reducing unnecessary attendances.We hope to change future behaviors of which service patients and their families access and will continue to monitor this retrospectively.As well as benefiting patients and their families this new way of working has had a positive impact on staff morale both within the Clinical and Nursing Team giving opportunities for professional development and job satisfaction.
Overfishing threatens the viability of high seas living resources. Furthermore, controls to prevent overfishing are inadequate. Illegal, Unreported and Unregulated (IUU) fishing is a product of ...overfishing and affects all marine fisheries. Southern Ocean fisheries have been particularly targeted by IUU fishing. The efforts of the Convention for the Conservation of Antarctic Marine Living Resources Commission and the Australian government to adopt complementary measures to deter IUU fishing in the Southern Ocean form the basis of this study, although the examination is conducted following a comprehensive review of the legal and other factors contributing to the development of IUU fishing as well as the applicable international law. The author concludes that in the absence of flag State control, alternative measures and strategies have proved to be effective in influencing the behaviour of IUU fishing vessels. By improving coastal State surveillance, enhancing regional cooperation, imposing port and market State controls, establishing IUU vessel databases and vigorously prosecuting offenders, Regional Fisheries Management Organisations and coastal States can jointly increase the risk of conducting IUU fishing activities. At the same time financial returns can be diminished so that engaging in IUU fishing becomes economically unattractive. It is concluded that the application of a combination of these measures is required in order to achieve a degree of success in deterring IUU operators.
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FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
International and regional framework governing the Antarctic region - whether states have an obligation under the Antarctic Treaty system to take ownership of the issue, in spite of operation of the ...International Whaling Commission under the International Convention for the Regulation of Whaling.
Time-varying predictors in multilevel models are a useful tool for longitudinal research, whether they are the research variable of interest or they are controlling for variance to allow greater ...power for other variables. However, standard recommendations to fix the effect of time-varying predictors may make an assumption that is unlikely to hold in reality and may influence results. A simulation study illustrates that treating the time-varying predictor as fixed may allow analyses to converge, but the analyses have poor coverage of the true fixed effect when the time-varying predictor has a random effect in reality. A second simulation study shows that treating the time-varying predictor as random may have poor convergence, except when allowing negative variance estimates. Although negative variance estimates are uninterpretable, results of the simulation show that estimates of the fixed effect of the time-varying predictor are as accurate for these cases as for cases with positive variance estimates, and that treating the time-varying predictor as random and allowing negative variance estimates performs well whether the time-varying predictor is fixed or random in reality. Because of the difficulty of interpreting negative variance estimates, 2 procedures are suggested for selection between fixed-effect and random-effect models: comparing between fixed-effect and constrained random-effect models with a likelihood ratio test or fitting a fixed-effect model when an unconstrained random-effect model produces negative variance estimates. The performance of these 2 procedures is compared.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
Apprehension of foreign fishing vessels in Australian waters - passage of time between apprehension and court appearance - growing practice of the prosecution to seek jail terms for regulatory ...fishing offences and default imprisonment for non-payment of fines - capacity of courts and jails to deal with the increase in the number of apprehended fishers - legitimacy of charging of fishing crews under the Criminal Code Act rather than the Fisheries Management Act - whether this practice accords with international law and the Convention on the Law of the Sea.
Objective:
The objectives of this study are to evaluate incidence, duration, and quality of life (QOL) impact of early tympanostomy tube otorrhea and tube patency when comparing topical ciprofloxacin ...versus normal saline use in the perioperative period.
Methods:
Overall, 200 patients undergoing tube placement between November 19, 2015, and September 12, 2016, were randomized to intraoperative plus 5 days of either topical ciprofloxacin or normal saline. Parents or caregivers reported the incidence, duration, and QOL impact of early otorrhea via 4 weekly surveys. In addition, the patient’s otorrhea history and tube patency were evaluated at a 4- to 6-week postoperative visit.
Results:
Survey and in-office follow-ups were completed on 128 patients. The overall otorrhea incidence was 23.9% for normal saline and 16.7% for ciprofloxacin (P = .32). The week-by-week otorrhea incidence was not statistically different. The percentage of days otorrhea was present, likewise, was not statistically different (normal saline 4.5%, ciprofloxacin 2.8%; P = .74). The QOL impact was not statistically different (normal saline 1.2, ciprofloxacin 1.5; P = .71). Tube patency was not statistically different, with only 1 of 280 ears occluded at follow-up.
Conclusion:
We find no difference in the incidence, duration, and QOL impact of early tympanostomy tube otorrhea or tube patency between ciprofloxacin and normal saline. This supports the option to substitute normal saline for ciprofloxacin in ears without an active ear infection at the time of tube placement, which would reduce both cost and unnecessary antibiotic use.
Level of Evidence:
1b
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Measures taken by the Commission on the Conservation of Antarctic Marine Living Resources (CCAMLR) to address the issue of illegal, unreported and unregulated fishing - CCAMLR provides some ...encouraging examples how that global problem may be addressed.
Safety for merchant shipping - maritime security - maritime piracy - effective regional initiatives and responses for reducing piracy - illegal, unregulated and unreported (IUU) fishing - pirate ...attacks - Regional Maritime Security Initiative (RMSI) - Regional Cooperation Agreement on Combating Piracy and Armed Robbery against Ships in Asia (ReCAAP) - Information Sharing Centre.
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BFBNIB, DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
