In recent years Irish society has witnessed an upheaval in public opinion before the discovery of conspiracies of silence hiding stories of institutional abuse which had remained concealed from the ...public domain. These narratives of secrecy have been consistently identified and stripped away by writers like Emer Martin whose novel The Cruelty Men (2018) denounces the fact that forgetting and silence are woven into the fabric of society and politics in Ireland. Drawing on the notion of consensual silence, the article explores The Cruelty Men as a text that addresses institutional abuse and challenges official discourses by rescuing the unheard voices of the victims and inscribing their untold stories into the nation's cultural narrative. As the article will discuss, ultimately the novel calls attention to the healing power of storytelling as a way of renegotiating Ireland's relationship with the silences of the past. Keywords: silence, Irish storytelling, institutional abuse, Emer Martin, Cruelty Men. En años recientes la opinión pública irlandesa se ha conmocionado ante las frecuentes noticias de abusos en el seno de las instituciones y la existencia de una conspiración de silencio para evitar que los escándalos saliesen a la luz. Estos secretos encubiertos han sido identificados y abordados por escritores y escritoras como Emer Martin, cuya novela The Cruelty Men denuncia precisamente que el silencio y el olvido están inextricablemente vinculados al devenir mismo de la sociedad y la política en Irlanda. Basándose en el concepto de silencio consensuado, este artículo analiza The Cruelty Men como un texto que expone el tema de los abusos y contradice los discursos oficiales al rescatar las voces silenciadas de las víctimas e inscribirlas en la narrativa cultural de la nación. El artículo concluye que la novela subraya el poder regenerador del relato por su capacidad de renegociar la relación de Irlanda con los silencios del pasado. Palabras clave: silencio, narrativa irlandesa, abusos institucionales, Emer Martin, Cruelty Men.
"The numerous editions and early translations produced throughout the eighteenth century enabled the broad dissemination of Emer de Vattel’s juridical-political work Droit des gens. This book ...investigates the global impact of the Droit des gens with regard to the different political realities, the historical and legal contexts as well as the attempts, mechanisms and strategies used to put these ideas into practice and establish new doctrine between the eighteenth and nineteenth centuries. The Droit des gens had an extremely diverse impact, owing to its varied reception in different political situations, historical and legal contexts, and attempts at practical and theoretical implementation. The fact that Vattel’s book was a point of reference for a considerable number of jurists and politicians further demonstrates its authority in the eighteenth and nineteenth centuries. The question naturally arises whether the continuous references to the work may be regarded as «typical citations of style», simply confined to referencing Vattel’s thought, or whether they are a clear sign of a deeper significance; one springing directly from the characteristics of the Droit des gens, with its capacity to organise and regulate the State in its domestic and international relations. The dissemination of the Droit des gens is reconstructed via a broad overview of the dynamics that actually underpinned the use of the treatise, ranging from its influence on political power in domestic and foreign affairs to its use as a guidebook for diplomats and consuls, and even its use as a teaching manual. Co-existing in Vattel’s work are several topics—the legislative, the political and the social—which are developed independently of one another, yet are part of one unified framework. The book aims to bring together a study of the first publication in 1758 of Vattel’s Droit des gens, its constant interaction with subsequent editions, translations and annotated versions carried out by jurists in the 19th century and its critical reception (both positive and negative) in relation to the more complex legislative contexts. The publishing history of the Droit des gens will be accompanied by the methodological aspect—closely bound to the need to write a global legal history—in which translation, in the broader sense of the term, plays a key role. Concepts of fashion and modernity are examined within the context of the practical and theoretical legal entanglements of the eighteenth and nineteenth centuries, thanks to the voices of distinguished jurists and politicians who made use of the Droit des gens and who translated and annotated it, thereby encouraging the assimilation—not always unadulterated—of Vattel’s thinking."
In Enemies of Mankind Walter Rech offers a contextual history of the collective security doctrine articulated by Swiss international lawyer Emer de Vattel (1714-67) in the authoritative treatise ...Droit des gens of 1758.
This Open access book is a collection of essays and offers an in-depth analysis of silence as an aesthetic practice and a textual strategy which paradoxically speaks of the unspoken nature of many ...inconvenient hidden truths of Irish society in the work of contemporary fiction writers. The study acknowledges Ireland’s history of damaging silences and considers its legacies, but it also underscores how silence can serve as a valuable, even productive, means of expression. From a wide range of critical perspectives, the individual essays address, among other issues, the conspiracies of silence in Catholic Ireland, the silenced structural oppression of Celtic Tiger Ireland, the recovery of silenced stories/voices of the past and their examination in the present, as well as millennial disaffection and the silencing of vulnerability in today’s neoliberal Ireland. The book ’s attention to silence provides a rich vocabulary for understanding what unfolds in the quiet interstices of Irish writing from recent decades. This study also invokes the past to understand the present and, thus, demonstrates the continuities and discontinuities that define how silence operates in Irish culture. Grant FFI2017-84619-P AEI, ERDF, EU (INTRUTHS “Inconvenient Truths: Cultural Practices of Silence in Contemporary Irish Fiction”) Funded by the Spanish Research Agency AEI http://dx.doi.org/10.13039/501100011033 and by the European Regional Development Fund ERDF "A Way of Making Europe"
En este trabajo nos proponemos analizar el Programa de Expansión y Mejoramiento de la Educación Rural (EMER) en la provincia de Entre Ríos entre 1978 y 1992. Se trata de un Programa que plantea una ...vinculación entre la educación formal y las competencias laborales en las escuelas primarias rurales a partir de la incorporación de talleres de trabajo manual, artes del hogar y agricultura, viabilizada a través de la nuclearización de escuelas y la regionalización de los contenidos. El mismo ha sido financiado por el Banco Interamericano de Desarrollo, con una contrapartida equivalente proveniente del Tesoro Nacional y se llevó a cabo en todo el país, con diferentes ritmos y niveles de aplicación. Nos enmarcamos en el debate acerca de las influencias externas de los organismos financieros internacionales en las políticas educativas a nivel nacional y regional. Partimos de la hipótesis de que este programa tuvo en sus orígenes un correlato con las políticas de descentralización que se concretaron durante la última dictadura y que continuaron durante la década del ‘80. Concluimos que el Programa EMER fue un elemento legitimador de la política de transferencia de las escuelas primarias nacionales a las provincias y el principal ámbito de aplicación de las políticas de regionalización de los contenidos. El trabajo se sustenta en el análisis de documentos oficiales -estudios de factibilidad, normativas, convenios, proyectos, informes, evaluaciones, diseños curriculares- obrantes en diferentes archivos de la provincia y en la Biblioteca Nacional del Maestro y en entrevistas a los responsables del Programa en Entre Ríos.
Resumen Este artículo examina el programa de Expansión y Mejoramiento de la Educación Rural, como una puerta de entrada para estudiar el Estado y las políticas públicas a partir del análisis de sus ...funcionarios, normas y acomodamientos institucionales en un contexto atravesado por fuertes transformaciones políticas. Se analizarán las modificaciones en los organismos encargados de ejecutarlo, los vínculos con otras reparticiones y los márgenes de acción de las responsables. Se profundiza en Entre Ríos ya que ha sido una de las provincias que incluyó más escuelas y que tuvo mayor extensión en el tiempo.
Emergency department return visits significantly impact medical costs and patient flow. A comprehensive approach to understanding these patients is required to identify deficits in care, system level ...inefficiencies, and improve diagnosis specific management protocols. We aimed to identify factors needed to successfully analyze return visits to explore root causes leading to unplanned returns and inform system-level improvements.
A multidisciplinary committee collaborated to develop a quality review process for return visits within 72 hours to our pediatric emergency department that were then subsequently admitted to the hospital. The committee developed methodology and a web-based tool for chart review and analysis.
Of 197,076 ED visits (159,164 discharged at initial visit), 5390 (3.4%) patients were discharged and represented to the ED within 72 hours and 1658 (1.0%) of those resulted in admission. Using defined criteria, approximately one third (n = 564) of revisits with admission were identified for chart review. Reason for revisit included natural progression of disease (67.6%), new condition or problem (11.2%), diagnostic error (6.9%), and scheduled or planned readmissions (3.5%). All diagnostic errors had not been previously identified by ED leadership. Of the reviewed cases, most were not preventable (84.0%); however, a number of system-level actions resulted from discussion of the potentially preventable revisits.
Seventy-two-hour ED revisits were efficiently and systematically categorized with determination of root causes and preventability. This process resulted in shared provider-level feedback, identifying trends in revisits, and implementation of system-level actions, therefore, encouraging other institutions to adopt a similar process.
Diabetic ketoacidosis (DKA) is a common emergency department presentation of both new-onset and established diabetes mellitus (DM). β-Hydroxybutyrate (BOHB) provides a direct measure of the ...pathophysiologic derangement in DKA as compared with the nonspecific measurements of blood pH and bicarbonate. Our objective was to characterize the relationship between BOHB and DKA.
This is a cross-sectional retrospective study of pediatric patients with DM presenting to an urban pediatric emergency department between January 1, 2016, and September 30, 2018. Analyses were performed on each patient's initial, simultaneous BOHB and pH. Diagnostic test characteristics of BOHB were calculated, and logistic regression was performed to investigate the effects of age and other key clinical factors.
Among 594 patients with DM, with median age of 12.3 years (interquartile range, 8.7-15.9 years), 176 (29.6%) presented with DKA. The inclusion of age, transfer status, and new-onset in the statistical model did not improve the prediction of DKA beyond BOHB alone. β-Hydroxybutyrate demonstrated strong discrimination for DKA, with an area under the curve of 0.95 (95% confidence interval, 0.93-0.97). A BOHB value of 5.3 mmol/L predicted DKA with optimal accuracy (90.6% of patients were correctly classified). The sensitivity, specificity, and positive and negative predictive values of this cut point were 76.7% (95% confidence interval, 69.8%-82.7%), 96.4% (94.2%-98.0%), 90.0% (84.0%-94.3%), and 90.8% (87.7%-93.3%), respectively.
β-Hydroxybutyrate accurately predicts DKA in children and adolescents. More importantly, because plasma BOHB is the ideal biochemical marker of DKA, BOHB may provide a more optimal definition of DKA for management decisions and treatment targets.
To investigate the role of medical emergency teams in end-of-life care planning.
One month prospective audit of medical emergency team calls.
Seven university-affiliated hospitals in Australia, ...Canada, and Sweden.
Five hundred eighteen patients who received a medical emergency team call over 1 month.
None.
There were 652 medical emergency team calls in 518 patients, with multiple calls in 99 (19.1%) patients. There were 161 (31.1%) patients with limitations of medical therapy during the study period. The limitation of medical therapy was instituted in 105 (20.3%) and 56 (10.8%) patients before and after the medical emergency team call, respectively. In 78 patients who died with a limitation of medical therapy in place, the last medical emergency team review was on the day of death in 29.5% of patients, and within 2 days in another 28.2%.Compared with patients who did not have a limitation of medical therapy, those with a limitation of medical therapy were older (80 vs. 66 yrs; p < .001), less likely to be male (44.1% vs. 55.7%; p = .014), more likely to be medical admissions (70.8% vs. 51.3%; p < .001), and less likely to be admitted from home (74.5% vs. 92.2%, p < .001). In addition, those with a limitation of medical therapy were less likely to be discharged home (22.4% vs. 63.6%; p < .001) and more likely to die in hospital (48.4% vs. 12.3%; p < .001). There was a trend for increased likelihood of calls associated with limitations of medical therapy to occur out of hours (51.0% vs. 43.8%, p = .089).
Issues around end-of-life care and limitations of medical therapy arose in approximately one-third of calls, suggesting a mismatch between patient needs for end-of-life care and resources at participating hospitals. These calls frequently occur in elderly medical patients and out of hours. Many such patients do not return home, and half die in hospital. There is a need for improved advanced care planning in our hospitals, and to confirm our findings in other organizations.
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