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Change in climate extremes and the increased risk associated with human-induced global warming is apparent. Less apparent is the impact such changes may have on vulnerable systems in our society. Climate change impact assessments using state-of-the-art climate models coupled with damage information can offer actionable insight for stakeholders to better protect vulnerable systems.Cultural heritage is an example of a system that is vulnerable to climate change, especially built cultural heritage which is directly exposed to changing climate extremes. In the UK, significant development has been achieved to better understand the potential change in climate extremes following the release of UK Climate Projections 18 (UKCP18), however, understanding of risk posed by these climate extremes to built cultural heritage is poorly constrained. How to assess and quantify this risk is in its infancy.We have developed a new methodology building on previous work by cultural heritage experts - the Cultural Heritage Climate Risk Assessment (CHCRA) framework. The CHCRA framework focuses on combining stakeholder engagement and high-resolution climate models to develop site-specific projections of potential damage to cultural heritage assets. This integrated framework when applied with adequate information allows estimation of expected damages to cultural heritage assets through the 21st century.We applied the CHCRCA framework to cultural heritage buildings in the Edinburgh World Heritage Site, Scotland, considering one-day extreme rainfall events. This pilot study used UKCP18 2.2 km resolution climate projections alongside qualitative and quantitative damage data obtained from multiple sources.Importantly, UKCP18 2.2 km model is a Convection Permitting Climate Model with the ability to better represent extreme rainfall events. Furthermore, expert elicitation through interviews with practitioners from cultural heritage organisations within Edinburgh were carried out to obtain damage information specific to cultural heritage buildings in the Old and New Town Edinburgh (ONTE), part of the Edinburgh World Heritage Site. A damage function was derived based on expert elicitation and other sources.Key findings include annual expected damage per year increases from 0.6% in the baseline period (1981-2000) to 1.5% in 2021-40 and 2.3% in 2061-80. A three-to-four-fold increase in annual expected damage to cultural heritage buildings in the ONTE is expected towards the end of the 21st century.This is the first application of the CHCRA framework. This pilot study considered only one climate stressor, extreme one-day rainfall events. Damage at built cultural heritage is likely exacerbated and accelerated by other climate stressors, as well as non-climate related factors such as poor maintenance. Furthermore, damage caused by pluvial and/or fluvial flooding mechanisms were not taken into consideration, as well as no consideration given to reduction in risk due to adaptive measures.This study provided insight into the changing risk posed by an impactful climate stressor to cultural heritage buildings in the ONTE. The study highlights the importance of stakeholder engagement from the outset when carrying out a climate change impact assessment. Further work may benefit from considering a more wide-ranging array of climate stressors to capture synergistic damage processes.

This article re-examines Krapp, ou La Dernière bande (1961), an opera adaptation of Samuel Beckett’s Krapp’s Last Tape (1958), which was a collaboration between the playwright and the Romanian composer Marcel Mihalovici. Beckett’s changes to the libretto give new insights into the writer’s developing concerns around form and his aesthetic of failure. In the programme for the Bielefeld production of the opera in 1961, Beckett supplied a sentence from the German translation of his Texts for Nothing, although inverting its first two clauses. His inclusion of this line in the programme affords us greater insight into Beckett’s ever evolving conception of the play. Shane O’Neill’s doctoral research on Samuel Beckett’s self-translated drama is funded by the Irish Research Council. He teaches at Mary Immaculate College, University of Limerick, and has published essays in Samuel Beckett Today/Aujourd’hui and the edited volume Samuel Beckett and Translation (Edinburgh University Press, 2021).

What is the fundamental purpose that justifies the existence of the modern university? The answer proposed in this essay is the promotion of social freedom. The essay begins by distinguishing social freedom from negative freedom and reflective freedom along the lines proposed by other theorists of social freedom, such as Frederick Neuhouser and Axel Honneth. After noting the need for a more developed account of the university than has so far been provided by these other theorists, the essay analyses the various dimensions in which universities have, at their best, promoted social freedom. The essay then explains why it is through the promotion of social, as distinct from negative or reflective freedom, that universities fulfil their purpose. It concludes with some reflections on how this understanding of the purpose of the university fits an “immanent” model of social criticism.

PurposeThe purpose of this study is to identify a comprehensive list of main enablers of successful implementation of green manufacturing (GM) practices in small and medium-sized enterprises (SMEs). Based on the inputs from Irish SMEs' experts, a validated conceptual hierarchy model of the identified enablers is developed to analyse and prioritise the most dominant ones.Design/methodology/approachData were collected using a questionnaire survey responded by various professionals in Irish manufacturing SMEs. Experts' opinions were analysed using interpretive structural modelling (ISM) and cross-impact matrix multiplication applied to classification (MICMAC) to distinguish the mutual influences amongst the nine identified enablers.FindingsThe findings revealed that from the Irish SMEs' perspective, strong green supply chain relations are the outcome of successfully implementing GM and not a driver of the other enablers. Furthermore, lower manufacturing costs are found to arise as a result of GM practices in SMEs.Practical implicationsIt is discussed that emulating the actions of larger companies will not necessarily yield the same results for SMEs. Innovation will become a cornerstone of remaining competitive in a sustainable environment, which is facilitated by closer green supply chain relations.Originality/valueThe reported findings in this article contribute to theory and practice of GM and SMEs research domains by systematically identified, classified and ranked enablers in a conceptual hierarchal model from the perspective of Irish SMEs. This research lays the foundations for further analysis of the GM practices enablers in a time when UN mandates and EU regulations are increasingly impacting SMEs all around Europe and especially Ireland.

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Modern burn care is centralised, and studies show that early, prompt referral to dedicated burn services improve clinical outcomes. We describe the use of a novel clinical instrument, the burn injury Transfer Feedback Form, to support and educate referring clinicians about the early assessment and management of burn injuries. Since 2005, Transfer Feedback Forms have been completed for all burn-injured patients with inter-hospital transfer to a specialised burn unit in the state of New South Wales (NSW), Australia. The aim of this study was to review physiological, procedural, and system or process issues in the care of both adult and paediatric burn-injured patients needing retrieval and transfer in NSW as identified by the Transfer Feedback Form. Secondary objectives were to determine any significant differences in these parameters between metropolitan and regional or remote referring institutions, and if any improvements occurred in these parameters over time.This was a retrospective analysis of all patients who were transferred to a burn unit in NSW between July 2005 and July 2021 using their prospectively completed Transfer Feedback Forms. Patients were divided into metropolitan and non-metropolitan referral sources based on geographic location. Clinical issues or deficiencies identified during each patient transfer were then classified into various groups. To determine if transfer-related clinical concerns had changed with time, two distinct periods before and after 2015, when the NSW Trauma App was introduced, were analysed. We compared trends in frequency of transfer-related concerns before and after App introduction by using interrupted time series analysis.A total of 3233 patients had Feedback Forms submitted during the 16-year period. We included 929 children (28.7%) and 2304 adults (71.3%). Transfer-related clinical issues were identified in 904 adults (39.0%) and 484 children (52.0%). In both adult and paediatric patients, the most common transfer-related clinical deficiency was in relation to burn size estimation with 525 patients (43.7%) and 207 patients (30.6%), respectively. Between the time periods analysed, the number of issues arising during inter-hospital transfer fell significantly for both adults (from 46.1% to 26.1%; p 0.05) and children (from 55.3% to 40.7%; p 0.05). Segmented regression analysis demonstrated a significant break in the rate of transfer-related clinical issues in 2014 (p 0.05) and 2015 (p 0.01) for adults. Accurate body surface area estimations also increased significantly by 53% and 50% for adults and children (p 0.05 for both), respectively, after 2015.Our analysis indicates that the early care of burn-injured patients undergoing inter-hospital transfer is associated with clinical, technical, and logistical challenges. However, introduction of the burn injury Transfer Feedback Form has been associated with improvements in early burn care by referring centres both temporally and geographically. Smartphone-based applications such as the NSW Trauma App have also probably contributed to these findings. Adopting these simple, inexpensive strategies into burn care systems will augment inter-hospital transfer of burn-injured patients, and improve clinical outcomes.

This chapter examines the importance of genetic manuscript studies in relation to Samuel Beckett’s self-translation process. The author considers the reasons for Beckett’s failure and eventual success at translating Not I into French. He also studies the ways in which Beckett recaptured the musical cadences of Not I, while still preserving the text’s negativity and punctured rhythms in Pas moi. Throughout the translation process, according to O’Neill, Beckett refined the text, carefully selecting French words and expressions that matched those from Not I. Keeping the frantic pace of the English original in French was paramount for Beckett, so that if there was an excess of words in the translation of certain expressions, or if the sounds in French produced a different effect from the original, Beckett took pains to search for a better solution. The author highlights Beckett’s preference for ‘Beckettian’ terms in his own translation, so that this particular work resonates with echoes of his whole literary production.

Capsule: Our findings regarding Hen Harrier Circus cyaneus territory site selection and breeding success in Ireland offer an opportunity for the development of initiatives and conservation actions aimed at enhancing the suitability of upland areas for breeding Hen Harriers and ensuring the long-term persistence of the species.Aims: To investigate landscape-scale associations between habitat composition and Hen Harrier territory site selection, and to explore the influence of habitat and climate on breeding success.Methods: We used multi-model inference from generalized linear models and Euclidean distance analyses to explore the influence of habitat, topographic, anthropogenic and climatic factors on Hen Harrier territory selection and breeding success in Ireland, based on data from national breeding surveys in 2010 and 2015.Results: Hen Harrier territories were associated with heath/shrub, bog and pre-thicket coniferous forests. Comparisons between territories and randomly generated pseudo-absences (upland and lowland) showed that breeding pairs preferentially select for these habitats. Breeding success was negatively influenced by rainfall early in the breeding season and by climatic instability, and was positively influenced by the presence of heath/shrub and bog.Conclusions: The results suggest that Hen Harrier breeding success is compromised by the synergistic effects of climate, landscape composition and management. Effective conservation of Hen Harriers in Ireland will therefore rely on landscape-scale initiatives.

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TPS2699 Background: Immunotherapy has transformed the treatment of NSCLC and other solid tumors, such as SCCHN and UBC. However, even with standard-of-care anti-PD-1/PD-L1 therapies, few patients achieve durable benefit even when PD-L1 is overexpressed. IO102-IO103 is a potentially first-in-class, dual-antigen, immune-modulatory therapy that stimulates T cells to target tumoral immune escape via key checkpoint molecules IDO and PD-L1. It is thought that activating IDO/PD-L1-specific T cells in cancer patients through vaccination may support anticancer immunity by restricting immunosuppressive signaling and restoring the tumor immune microenvironment to render the tumor more susceptible to anti-PD-1 blockade. Thus there is a rationale for combining IO102-IO103 with anti-PD-1 therapy in the first-line treatment of metastatic tumors, such as NSCLC, SCCHN, or UBC. Combined IO102-IO103 and anti-PD-1 therapy (nivolumab) has already shown a robust signal of clinical activity (overall response rate [ORR], 80%; complete response rate [CRR], 43%; median progression-free survival [PFS], 26 months) and was well tolerated with minimal added toxicity to nivolumab in a Phase 1/2 study of anti-PD1-naïve patients with metastatic melanoma (Kjeldsen, et al. Nat Med 2021). Methods: This is a Phase 2, international, multicenter (US and Europe), non-comparative, open-label, multi-arm (basket) trial (EudraCT No. 2021-003026-69; ClinicalTrials.gov No. NCT05077709). Patients with recurrent, unresectable or metastatic solid tumors in 3 indications and no prior treatments for metastatic disease are being enrolled: NSCLC with a PD-L1 Tumor Proportion Score (TPS) ≥50% (Arm A); SCCHN with PD-L1 Combined Positive Scores (CPS) ≥20 (Arm B); or UBC with PD-L1 CPS ≥10 and not eligible for platinum-containing chemotherapy (Arm C). All patients, ̃30 in each arm, will receive 3-week cycles of IO102-IO103 (85-85 µg on Day [D] 1 and 8 of Cycle 1 and 2, and D1 thereafter) subcutaneously plus pembrolizumab (200 mg on D1) intravenously, for up to 2 years. Primary endpoints are ORR by RECIST v1.1 or 6-month PFS rate by investigator assessment (to be analyzed either 6 months after last patient started treatment or after target ORR is achieved, whichever is earliest). Secondary endpoints include PFS, duration of response, complete response rate, disease control rate, time to response, overall survival, and safety. Exploratory endpoints include biomarker and immune marker correlative studies, and PFS by iRECIST. The trial will assess the opportunity for a positive risk–benefit based on 2 efficacy boundaries for the ORR and 6-month PFS rate in each arm, with cohort expansion permitted if a clinically relevant efficacy signal is observed. Clinical trial information: EudraCT No. 2021-003026-69; ClinicalTrials.gov No. NCT05077709.

Although the impact Brexit might have on Ireland has generated a vast array of critical analyses, insufficient attention has been paid to this project as a question of justice or a matter of potential injustice. It is suggested here that the relative academic silence on this moral dimension of Brexit is connected to a widespread failure to connect theory and practice within the dominant approach to conceptualising the demands of justice both within and beyond the state. If we are to grasp the fabric of justice today, including just relations between political communities, then we need to be less reliant on methods of rational abstraction and focus instead on the history and structure of those hierarchical relations between the peoples of the world that have been imposed throughout the colonial and neo-colonial eras. This will lead us to re-conceive justice among the world’s peoples as a project of substantive decolonisation, an alternative paradigm that offers a critical perspective on how best to address the legacy of historical injustice at a global level. This theoretical framework equips us too with the language required to assess the moral dimensions of Brexit, specifically in relation to its impact on Ireland.

The Internet is utilized now more than ever to research medical conditions and treatments by patients and physicians alike. The aim of this study was to evaluate the quality and readability of information available online for plantar fasciitis. Web sites were identified using the search term “plantar fasciitis.” The first 25 Web sites from 5 different search engines gave a total of 125 being evaluated. Readability of each Web site was assessed using the Flesch Reading Ease score, the Flesch-Kincaid grade level, and the Gunning Fog Index. Quality was assessed using the DISCERN instrument ( www.discern.org.uk ) and the Journal of the American Medical Association (JAMA) benchmark criteria. The presence of Health on the Net (HON) code certification was also assessed. The authorship of each Web site was categorized into 1 of 5 categories (Physician, Academic, Commercial, Allied health or Other eg, blogs). A total of 83 Web site pages were evaluated with the majority of the web sites being authored by physicians (32.53%) and blogs (25.30%). Only 24 Web sites were HON certified (28.91%). Physician and Academic Web sites were the most credible sources, with the highest mean DISCERN (p = .00001) and JAMA (p = .0278.) scores, respectively. These Web sites were also the most difficult to read according to the readability score testing. The information available on the Internet pertaining to plantar fasciitis is highly variable and provides moderate quality information about treatment choices. Given this variability in quality, health care providers should direct patients to known sources of reliable, readable online information.

Capsule: Patterns in the frequency and co-occurrence of anthropogenic pressures associated with suitable breeding habitat for Hen Harriers Circus cyaneus demonstrates the need for specific, focussed management and policy options aimed at mitigating impacts on this threatened population. Aims: To describe anthropogenic pressures and threats in the upland breeding range of Hen Harriers and to explore their potential impacts on the declining Hen Harrier population. Methods: We used text mining, mixed-effects models, principal component analysis and clustering methods to explore anthropogenic pressures on suitable breeding and foraging habitats for Hen Harriers in Ireland, based on the 2015 national breeding Hen Harrier survey data. Results: Mixed-effects models described a strong influence of agriculture, forestry, predator activity, and recreational activities on survey areas that contained Hen Harrier territories. Cluster analyses described three discrete pressure clusters and showed consistent co-occurrence of independent pressures. Conclusions: Areas of suitable habitat for Hen Harriers in the uplands overlap with areas that experience anthropogenic pressures known to negatively impact on this vulnerable bird species. Combined with clear evidence for the co-occurrence of multiple pressures at a regional scale, this demonstrates a clear need for statutory agencies to consider the potential cumulative impacts of individual pressures when developing conservation strategies for Hen Harriers.

To answer directly: ‘freedom’ is, I suggest, the best answer. Many writers, who have pondered this question longer than me, have said much the same thing. 1 It seems obvious that universities play ...

This study is expanding the previous studies that were focused on the material properties and transportation costs of the two alternative feedstocks for manufacturing wood-plastic composites (WPCs): wood flour and pellets. Besides the material properties and cost analysis, life-cycle assessment (LCA) is equally important to assess the environmental impacts of these two alternative wood feedstocks to manufacture WPCs and gain the knowledge of influences from the manufacturing and transportation processes. The main goal of this study was to compare the environmental impacts from the production and transportation of wood flour and pellets utilized in WPC manufacture. The environmental impacts on air, water, soil and human health, as well as the cumulated energy consumption for one tonne and one truckload of the two wood feedstocks were compared. The case-study was based on a commercial wood pellet manufacturer in the state of Maine (ME). The cradle-to-gate approach was considered including the processing of mill residues, manufacturing of the two feedstocks and transporting them to commercial WPC manufacturers. LCA analysis showed that transportation of both feedstocks had the highest impact on the environment as opposed to the inputs associated with production. The global warming potential (GWP) from one tonne production and shipment of wood flour was higher by 8% compared to the pellets. One tonne production and shipment of wood pellets appears more environmentally friendly. Normalization results of one truck load of wood flour (22 tonnes) and pellets (30 tonnes) showed similar environmental impacts. Based on this study, from an environmental perspective, it is inferred that besides use as bio-fuels, wood pellets could be a better alternative feedstock for the manufacture of WPCs.

Deliberative models of democracy tie political legitimacy to the achievement of reasoned agreements. 1 Citizens bring a diversity of perspectives to public debate and in the encounter with others they seek mutual understanding so that they can think of the laws that emerge from their deliberations as shared rules they give to one another as a self-regulating legal community. One of the main advantages of deliberative models, therefore, is that legitimate decisions are conceived as the outcome of a process of open and inclusive public dialogue that takes place under conditions of fairness. Rival models of democracy that are based on bargaining, as opposed to the quest for mutual understanding, tend not to distinguish adequately between fair compromises and those bargains that reflect a relation of power. If bargaining positions are unequal, those who occupy the less advantaged positions will eventually feel forced into a compromise. Not only is the outcome unstable, since power relations can change, but it is unfair, since the interests of some citizens have been allowed to count for more than those of others. For this reason outcomes that are based on the force of argument alone as it emerges through public deliberation provide a more just and stable basis for a democratic community.

This proposal offers a unique solution for a unique challenge: using oil to pay for Venezuela’s debt. Venezuela and PDVSA’s creditors currently receive little in the way of coupon payments and have minimal means of recourse over limited assets located outside Venezuela’s borders. We suggest using a creditor trust to consolidate creditors into a single entity that would purchase the oil from Venezuela with bonds tendered by the creditors to the trust. This transaction would give the creditors trust a priority claim over oil as title holders. It allows a restructuring process with relatively few changes to current bonds, thus reducing the possibility of litigation. In addition to the legal and structural benefits offered to both Venezuela and the creditors, this proposal offers something that no other proposal does — the potential for successful execution under current U.S. sanctions based on the issuance of a specific license from OFAC. Although there is no assurance as to whether such license would be obtained, it is arguable that this structure runs outside the scope of the Executive Order No. 13,808, and that there is precedent supporting the issuance of such a license authorizing commercial transactions.

Background:. The first carpometacarpal joint (CMCJ) in the hand is a commonly affected joint by osteoarthritis. It causes significant thumb base pain, limiting functional capacity. Microfracturing and application of autologous stem cells has been performed on large joints such as the knee but has never been evaluated for use in the smaller joints in the hand. Our aim was to determine the potential benefit of microfracturing and autologous bone marrow stem cells for treatment of osteoarthritis of the first CMCJ in the hand. Methods:. All inclusion criteria were satisfied. Preoperative assessment by the surgeon, physiotherapist, and occupational therapist was performed. The first CMCJ was microfractured and the Bone Marrow Stem Cells were applied directly. Postoperatively, the patients were followed up for 1 year. Results:. Fifteen patients met inclusion criteria; however, 2 patients were excluded due to postoperative cellulitis and diagnosis of De Quervain's tenosynovitis. The mean scores of the 13-patient preoperative and 1 year follow-up assessments are visual analog score at rest of 3.23–1.69 (P = 0.0292), visual analog score on activity of 7.92–4.23 (P = 0.0019), range of motion 45.77o–55.15o (P = 0.0195), thumb opposition score 7.62–9.23 (P = 0.0154), Disability of the Arm, Shoulder and Hand score of 51.67–23.08 (P = 0.0065). Strength improved insignificantly from 4.7 kg preoperatively to 5.53 kg at 12 months (P = 0.1257). All patients had a positive Grind test preoperatively and a negative test after 12 months. Conclusions:. This innovative pilot study is a new approach to osteoarthritis of the thumb.

The National Acute Medicine Programme (NAMP) was established to address the unsatisfactory management of acutely ill medical patients in Ireland. It aimed to improve quality of care and patient safety, streamline access to healthcare, and reduce cost through efficiency gains.A model of care was developed to describe 4 distinct clinical pathways for medical patients streamed through acute medical assessment units. A patient flow model was used to build system capacity and predict demand for each hospital. Specific practice changes necessary were identified for each pathway. A performance framework, with national benchmarks that mirrored the model of care, was also developed. The program team met regularly with hospitals and fed back performance information and, using appreciative enquiry, supported local improvement plans.Thirty-two out of 33 Irish hospitals that admit acute medical patients are now operating the program. Process improvement lies at the core of all the success achieved by the program. Available inpatient data were improved and harnessed to support ongoing audit and quality improvement. A reduction of 1.6 days in average length of stay nationally was achieved between 2010 and 2013.Despite a 25% increase in hospital discharges and the severe financial constraints experienced during this implementation period, the NAMP achieved significant efficiency gains through process improvements, while ensuring patient safety and likely improving the quality of care delivered to patients in Ireland.