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We obtain some global features of totally disconnected locally compact (t.d.l.c.) groups G that are locally isomorphic to a just infinite profinite group, building on an earlier result of Barnea–Ershov–Weigel and also using tools developed by P.-E. Caprace, G. Willis and the author for studying local structure in t.d.l.c. groups. The approach uses the following property of just infinite profinite groups, essentially due to Wilson: given a locally normal subgroup K of G , then there is an open subgroup of K that is a direct factor of an open subgroup of G . This is a local property of t.d.l.c. groups and we obtain a characterization of the local isomorphism types of t.d.l.c. groups that have it.

Current regulatory approaches have not prevented the loss of biodiversity across the world. This book explores the scope to strengthen conservation by using different legal mechanisms such as biodiversity offsetting, payment for ecosystem services and conservation covenants, as well as tradable development rights and taxation. The authors discuss how such mechanisms introduce elemhents of a market approach as well as private sector initiative and resources. They show how examples already in operation serve to highlight the design challenges, legal, technical and ethical, that must be overcome.

Perioperative pain management of patients on chronic opioids is challenging. Although experts recommend regional anesthesia and multimodal analgesics for their opioid sparing effects, their use and predictors of use are unknown. To examine the patterns and predictors of use of regional anesthesia and multimodal analgesics for perioperative pain control of patients on chronic opioids. A secondary objective was to examine the association of patient and surgical factors with 24-hour postoperative opioid use. Retrospective cross sectional. Single center tertiary care academic hospital. We studied patients with chronic opioid use undergoing painful operations such as abdominal, gynecologic, breast, orthopedic, spine, amputation, and laparoscopic surgeries. Chronic opioid use was identified using the narcotic score - a score generated from the state prescription drug monitoring database via the NarxCare platform. A narcotic score >= 320 corresponding to a preoperative home dose of approximately 40 milligram morphine equivalents (MMEs) daily, was chosen as a cutoff since the risk of overdose death increases above 40 MMEs. We reported the use of regional anesthesia and >= 3 multimodal analgesics in this cohort (n = 155) and examined the association of this use with patient and surgical factors such as preoperative narcotic score, age, race, comorbidity index, operative timetime, and intraoperative opioid use. In addition, we examined the association of patient and surgical factors with 24-hour postoperative opioid use. Out of 2470 patients undergoing painful surgeries between July 2017and- December 2018, 155 patients had a narcotic score >= 320. The median narcotic score was 411 (interquartile range (IQR) 351-520), the median preoperative home MME dose was 67.5 (IQR 32-180) mg daily. Regional anesthesia was used in only 9.7% of cases and was associated with intraoperative opioid used, but not the preoperative narcotic score. Patients receiving 1 SD more MMEs intraoperatively had a higher odds of receiving regional anesthesia (OR = 1.57, 95% CI [1.06, 2.32]). Three or more multimodals were used in 83% of cases. Every 10-point increase in narcotic score and every additional hour of operative time was associated with higher odds of receiving >= 3 multimodals (OR = 1.05, 95% CI [1.00, 1.11] and OR = 1.49, 95% CI [1.11, 1.99] respectively). Total 24 hour post-operative opioid dose was associated with narcotic score, with an 8.6 higher mean MME for every 10-point increase in narcotic score (mean difference = 8.6, 95% CI [4.1, 13.1]). It was also moderately associated with age, where patients an year older received 4.7 MMEs less (mean difference = - 4.7, 95% CI [-9.3, -0.5]). This was a single center retrospective observational study. We could not adjust for inter-physician or inter-surgery effect on use of regional anesthesia or multimodal analgesics. Since this was one of the first studies to use narcotic scores to identify patients on chronic opioids, comparing the outcomes of interest to a control group was beyond the scope of the current study. Narcotic scores need to be validated to identify chronic opioid use. Despite consensus guidelines, regional anesthesia remains underutilized. Multimodals are used frequently and are modestly associated with preoperative narcotic scores.

We show that, given a compact minimal system $(X,g)$ and an element h of the topological full group $\\tau [g]$ of g, the infinite orbits of h admit a locally constant orientation with respect to the orbits of g. We use this to obtain a clopen partition of $(X,G)$ into minimal and periodic parts, where G is any virtually polycyclic subgroup of $\\tau [g]$ . We also use the orientation of orbits to give a refinement of the index map and to describe the role in $\\tau [g]$ of the submonoid generated by the induced transformations of g. Finally, we consider the problem, given a homeomorphism h of the Cantor space X, of determining whether or not there exists a minimal homeomorphism g of X such that $h \\in \\tau [g]$ .

This paper examines ideas about democratic legitimacy and sovereignty within Ulster unionist political thought during the revolutionary period in Ireland (c. 1912–22). Confronted by Irish nationalists who claimed that Home Rule (and later, independence) enjoyed the support of the majority of people in Ireland, Ulster unionists deployed their own democratic idioms to rebuff such arguments. In asserting unionism's majority status, first, across the United Kingdom and, second, within the province of Ulster, unionists mined the language of democracy to legitimise their militant stand against Home Rule. The paper also probes the unionist conception of sovereignty by examining the establishment of the Provisional Government of Ulster in 1913, which was styled as a ‘trustee’ for the British constitution in Ireland after the coming of Home Rule. The imperial, economic and religious arguments articulated by unionists against Home Rule are well known, but the space given to constitutional rights and democratic legitimacy in the political language of unionism remain obscure. While the antagonisms at the heart of the revolutionary period in Ireland assumed the form of identity politics and sectarianism, the deployment of normative democratic language by unionists reveals that clashing ideals of representative government underpinned the conflict.

Background Complex interventions are increasingly applied to healthcare problems. Understanding of post-implementation sustainment, sustainability, and spread of interventions is limited. We examine these phenomena for a complex quality improvement initiative led by care aides in 7 care homes (long-term care homes) in Manitoba, Canada. We report on factors influencing these phenomena two years after implementation. Methods Data were collected in 2019 via small group interviews with unit- and care home-level managers ( n  = 11) from 6 of the 7 homes using the intervention. Interview participants discussed post-implementation factors that influenced continuing or abandoning core intervention elements (processes, behaviors) and key intervention benefits (outcomes, impact). Interviews were audio-recorded, transcribed verbatim, and analyzed with thematic analysis. Results Sustainment of core elements and sustainability of key benefits were observed in 5 of the 6 participating care homes. Intra-unit intervention spread occurred in 3 of 6 homes. Factors influencing sustainment, sustainability, and spread related to intervention teams, unit and care home, and the long-term care system. Conclusions Our findings contribute understanding on the importance of micro-, meso-, and macro-level factors to sustainability of key benefits and sustainment of some core processes. Inter-unit spread relates exclusively to meso-level factors of observability and practice change institutionalization. Interventions should be developed with post-implementation sustainability in mind and measures taken to protect against influences such as workforce instability and competing internal and external demands. Design should anticipate need to adapt interventions to strengthen post-implementation traction.

Background Documentation during resident transitions from long-term care (LTC) to the emergency department (ED) can be inconsistent, leading to inappropriate care. Inconsistent documentation can lead to undertreatment, inefficiencies and adverse patient outcomes. Many individuals residing in LTC have some form of cognitive impairment and may not be able to advocate for themselves, making accurate and consistent documentation vital to ensuring they receive safe care. We examined documentation consistency related to reason for transfer across care settings during these transitions. Methods We included residents of LTC aged 65 or over who experienced an emergency transition from LTC to the ED via emergency medical services. We used a standardized and pilot-tested tracking tool to collect resident chart/patient record data. We collected data from 38 participating LTC facilities to two participating EDs in Western Canadian provinces. Using qualitative directed content analysis, we categorized documentation from LTC to the ED by sufficiency and clinical consistency. Results We included 591 eligible transitions in this analysis. Documentation was coded as consistent , inconsistent , or ambiguous . We identified the most common reasons for transition for consistent cases (falls), ambiguous cases (sudden change in condition) and inconsistent cases (falls). Among inconsistent cases, three subcategories were identified: insufficient reporting , potential progression of a condition during transition and unclear reasons for inconsistency. Conclusions Shared continuing education on documentation across care settings should result in documentation supports geriatric emergency care; on-the-job training needs to support reporting of specific signs and symptoms that warrant an emergent response, and discourage the use of vague descriptors.

We establish a new connection between local and large-scale structure in compactly generated totally disconnected locally compact (t.d.l.c.) groups G , finding a sufficient condition for G to have more than one end in terms of its compact subgroups. The condition actually results in an action of a quotient group G/N on a tree with faithful micro-supported action on the boundary, where N is compact, and is closely related to the Boolean algebra formed by the centralisers of the subgroups of G/N with open normaliser. As an application, we find a sufficient condition, given a one-ended t.d.l.c. group G , for all direct factors of open subgroups of G to be trivial or open.

The United Kingdom's decision to leave the European Union will have major consequences for environmental law. EU law is integrated into the UK's laws in many ways that will be difficult to disentangle and a continuity of laws provision seems desirable in order to avoid gaps in the law appearing. The effect of devolution within the UK is that most environmental matters will in future be the responsibility of the devolved administrations. The UK's freedom of action will continue to be constrained by obligations in international law, including those establishing a new relationship with the EU. Environmental law in the UK has changed greatly during the four decades of its membership in the EU and most of the innovations introduced through the EU are likely to be retained, although there may be a wish to restore more discretion over the outcomes to be achieved as opposed to having strict obligations to satisfy targets and standards. In structural terms the biggest changes are likely to be the loss of the stability provided by the slow processes of making and changing EU law and the loss of means to call to account the UK government (and devolved governments in Scotland, Northern Ireland and Wales) over their performance in meeting their environmental commitments.