After Bush Lynch, Timothy J.; Singh, Robert S.
04/2008
eBook
The foreign policy of the George W. Bush administration has won few admirers, and many anticipate that his successor will repudiate the actions of the past eight years. In their provocative account ...Lynch and Singh argue that Bush's policy should be placed within the mainstream of the American foreign policy tradition. Further, they suggest that there will, and should, be continuity in US foreign policy from his presidency to those of his successors. Providing a positive audit of the war on terror (which they contend should be understood as a Second Cold War) they maintain that the Bush doctrine has been consistent with past policy at times of war and that the key elements of Bush's grand strategy will continue to shape America's approach in the future. Above all, they predict that his successors will pursue the war against Islamist terror with similar dedication.
This paper shares a health and wellbeing partnership, modelling implementation of physical education (PE) advocated by the United Nations (UN). The Sustainable Development Goals (SDGs) exemplifies ...global efforts towards equality, specifically Goal 3 and 4 address health and wellbeing. The purpose of this paper is to provide insights into cross sector "partnerships", identified as essential for the implementation of the SDGs. This is significant as the UN acknowledge a present gap of information on partnerships in action and a need for reporting from the ground level. The project "Best Start: A community collaborative approach to lifelong health and wellness", began as a partnership between a university and nearby schools and quickly grew to involve Australian Registered Training Organisations, the local health industry, Education departments and sport governing bodies. The collaborations involved pre-service teachers teaching Health and PE lessons to children in a disadvantaged socio-economic area, creating valuable learning experiences for stakeholders.
Local and global communities were involved in research and reform. The project creatively optimised resources available through state, Australian and international connections. International partnerships enabled identification of unique contextual opportunities. Programme planning was strengthened with data gathered from an England and Wales Ofsted awarded Primary Physical Education course. Various methods, including; semi-structured interviews, reflective journal, observations, document analysis, and Student Evaluation of Teaching Units (SETU) were adopted. SETU is valid and reliable data collected by the university for the purposes of research. The findings support that partnerships enable SDG implementation and the research paper offers direction for localisation.
Recent work has highlighted the tumor microenvironment as a central player in cancer. In particular, interactions between tumor and immune cells may help drive the development of brain tumors such as ...glioblastoma multiforme (GBM). Despite significant research into the molecular classification of glioblastoma, few studies have characterized in a comprehensive manner the immune infiltrate in situ and within different GBM subtypes.In this study, we use an unbiased, automated immunohistochemistry-based approach to determine the immune phenotype of the four GBM subtypes (classical, mesenchymal, neural and proneural) in a cohort of 98 patients. Tissue Micro Arrays (TMA) were stained for CD20 (B lymphocytes), CD5, CD3, CD4, CD8 (T lymphocytes), CD68 (microglia), and CD163 (bone marrow derived macrophages) antibodies. Using automated image analysis, the percentage of each immune population was calculated with respect to the total tumor cells. Mesenchymal GBMs displayed the highest percentage of microglia, macrophage, and lymphocyte infiltration. CD68
and CD163
cells were the most abundant cell populations in all four GBM subtypes, and a higher percentage of CD163
cells was associated with a worse prognosis. We also compared our results to the relative composition of immune cell type infiltration (using RNA-seq data) across TCGA GBM tumors and validated our results obtained with immunohistochemistry with an external cohort and a different method. The results of this study offer a comprehensive analysis of the distribution and the infiltration of the immune components across the four commonly described GBM subgroups, setting the basis for a more detailed patient classification and new insights that may be used to better apply or design immunotherapies for GBM.
Increasing trust in health care Wolfson, Daniel B; Lynch, Timothy J
The American journal of managed care,
12/2021, Letnik:
27, Številka:
12
Journal Article
Recenzirano
Trust in American health care and in the people running medical institutions is in decline, which poses a threat to the physician-patient relationship. In response, the ABIM Foundation has ...established the Building Trust initiative, which includes the Trust Practices Network, advancing research in trust, leadership convening, and various communications vehicles. The Trust Practices Network includes hospitals and health systems, specialty societies, health plans, consumer organizations, employers, and others who are working to reaffirm and strengthen trust as a pillar in their own missions. Participants offer examples of how they have built trust, and their contributions have illuminated 4 dimensions of trust: competency, caring, communication, and comfort. This commentary discusses an exemplary practice for each of these dimensions and describes the "positive deviance" strategy that underlies the Trust Practices Network. It also offers an overview of the other elements of Building Trust, such as a grant program to promote trust as well as diversity, equity, and inclusion in internal medicine education, and an effort to spur additional research on trust.
Objective
To evaluate the tolerability of clobazam in patients with drug-resistant epilepsy aged 50 years and older.
Methods
We performed a single center, retrospective chart review of patients at ...least 50 years of age with drug resistant epilepsy of any type who started clobazam as an add on therapy. Retention rate, safety, and tolerability at 6 and 12 months and last follow-up, and the discontinuation rate due to side effects were analyzed.
Results
A total of 26 patients met inclusion criteria. Mean age was 62 ± 7.1 years, and 69.2% of patients were female. The mean baseline seizure frequency before initiation of clobazam was 2 (range 1–30) seizures per month. The mean total daily dose of clobazam administered was 13 (range 5 to 30) mg/day. At the 12-month follow-up visit after clobazam initiation, 40% of patients were seizure-free and an additional 45% of patients had > 50% reduction in seizure frequency. The mean seizure frequency at 12-month follow-up was 1.5 (range 0–24) seizures per month. The mean total dose of clobazam at 12-month follow-up was 14.25 (range 5 to 25) mg/day. The mean duration of clobazam at last follow was 55.2 ± 27.02 (mean ± SD months) and 18 (69.2%) patients remained on clobazam. Twenty out of 26 (76.9%) patients reported at least one side effect and 6/26 (23%) discontinued the medication within a month of initiation. At last follow-up, 40% remained seizure free on stable dosing.
Conclusion
Clobazam can be a safe and tolerable, add-on treatment older adults with drug-resistant epilepsy. Those who responded tolerated the medication well. Discontinuation due to side effects occurred soon after initiation of therapy.
The authors describe the importance of trust in health care, while noting with concern the documented decline in Americans’ trust in the medical system, its leaders, and to a lesser degree, ...physicians themselves. They examine a number of reasons for this decline, including both larger societal trends and elements that are specific to health care. They then link trust to medical professionalism, explaining why the ABIM Foundation has decided to champion trust as an issue in the coming years. Finally, they offer thoughts on the specific actions the ABIM Foundation may take, including the launch of a Trust Practice Challenge designed to uncover practices that are currently working to build trust in a variety of practice settings and health care relationships, and the exploration of potential avenues to combat medical misinformation.
•New method to evaluate cortical responses to electrical stimulation.•Causal determination of cortical connectivity using electrical stimulation.•Automated removal of electrical ...artifacts.•Quantification of timing and magnitude of evoked activity.•Comparison of broadband changes and evoked potentials.
Electrical stimulation of the cortex using subdurally implanted electrodes can causally reveal structural connectivity by eliciting cortico-cortical evoked potentials (CCEPs). While many studies have demonstrated the potential value of CCEPs, the methods to evaluate them were often relatively subjective, did not consider potential artifacts, and did not lend themselves to systematic scientific investigations.
We developed an automated and quantitative method called SIGNI (Stimulation-Induced Gamma-based Network Identification) to evaluate cortical population-level responses to electrical stimulation that minimizes the impact of electrical artifacts. We applied SIGNI to electrocorticographic (ECoG) data from eight human subjects who were implanted with a total of 978 subdural electrodes. Across the eight subjects, we delivered 92 trains of approximately 200 discrete electrical stimuli each (amplitude 4–15 mA) to a total of 64 electrode pairs.
We verified SIGNI's efficacy by demonstrating a relationship between the magnitude of evoked cortical activity and stimulation amplitude, as well as between the latency of evoked cortical activity and the distance from the stimulated locations.
SIGNI reveals the timing and amplitude of cortical responses to electrical stimulation as well as the structural connectivity supporting these responses. With these properties, it enables exploration of new and important questions about the neurophysiology of cortical communication and may also be useful for pre-surgical planning.
It is argued that a learning environment underpinned by a strengths-based collaborative approach between universities and schools offers extended pre-service teacher learning opportunities and ...subsequently enhanced preparation. The term "hybrid space" describes the ideal environment of shared partnership where knowledge is jointly created, and consequently, as too is collaborative egalitarianism between stakeholders. This study investigates a possible "hybrid space" course within Physical Education Teacher Education (PETE) in the UK. While much literature discusses the advantages of the "hybrid space" ideal across education disciplines, high-quality research into PETE hybrid spaces is limited, if not non-existent. Hence, the particular course was chosen for data collection as it advocates intricate connections with schools in the local community. Furthermore, the course was awarded "Outstanding" by the national regulatory authority, England and Wales Office for Standards in Education (Ofsted), one of the major reasons explicitly stated was for its community connections. A qualitative, interpretive study using a case study methodology was adopted to examine the successful primary PETE course. The findings offer insights into the ideal of hybrid spaces in PETE, which appear to benefit various stakeholders within communities. The study is significant as it assists teacher educators from around the world, challenged to rethink their connections between university courses and school field experiences through illustrating a highly successful example.
The promotion of democracy by the United States became highly controversial during the presidency of George W. Bush. The wars in Iraq and Afghanistan were widely perceived as failed attempts at ...enforced democratization, sufficient that Barack Obama has felt compelled to downplay the rhetoric of democracy and freedom in his foreign-policy.
This collection seeks to establish whether a democracy promotion tradition exists, or ever existed, in US foreign policy, and how far Obama and his predecessors conformed to or repudiated it. For more than a century at least, American presidents have been driven by deep historical and ideological forces to conceive US foreign policy in part through the lens of democracy promotion. Debating how far democratic aspirations have been realized in actual foreign policies, this book draws together concise studies from many of the leading academic experts in the field to evaluate whether or not these efforts were successful in promoting democratization abroad. They clash over whether democracy promotion is an appropriate goal of US foreign policy and whether America has gained anything from it.
Offering an important contribution to the field, this work is essential reading for all students and scholars of US foreign policy, American politics and international relations.
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