Статті в журналах з теми "Post-clearance audit"

Most imported/exported goods are not controlled by customs authorities at the border. This allows for the fast release of goods and the better functioning of international trade. The backbone of this system consists of customs declarations filed by the importers/exporters, selective control at the border, based on risk assessment, and the post-clearance audit (PCA) of the accepted customs declarations. This pape r deals with the questionable practice of the Serbian Customs Administration with regard to the conducting of the PCA, particularly its relation with the Law on General Administrative Procedure and the issues related to the classification of goods according to customs tariff. The author identifies issues regarding the transparency, interpretation and implementation of the PCA in Serbia and contests the (internationally recognized) practice of changing the classification of goods in accepted customs declarations. The author proposes possible solutions for identified challenges.

The Post-clearance Audit (PCA) is being used by the Customs administrations across the world to facilitate trade as well as to reduce revenue evasion. As a limited number of declarations or entities need to be audited, the selectivity criteria for identifying the riskiest ones for conducting PCA is of utmost importance for the effectiveness of audit. A wrong selection for audit will be counterproductive. That is why, this paper will examine how the selectivity criteria impacts the PCA. The WCO and WTO have advised the administrations to utilise the PCA mechanism to enhance cross-border trade. The Revised Kyoto Convention (RKC) of WCO and the Trade Facilitation Agreement (TFA) of WTO have focused on systematic use of PCA rather than examining every imported consignment at the ports. Therefore, the PCA assists the authorities expedite clearance of goods, while, at the same time, ensures plugging leakages and, finally, enhances collection of duties and taxes at the import stage. Moreover, the PCA also creates opportunities for the authorities to catch tax evaders in future as the results of PCA may further be used for the proper implementation of Risk Management (RM) mechanism. Effective RM helps single out the risky consignments and facilitate clearance of the low risk consignments. So, if the selectivity criteria for PCA are not properly set, both the PCA and RM system will be adversely affected, ultimately paralysing the revenue administration of a country thereby reducing its economic competitiveness. This study will scrutinise the existing selection procedures for PCA with qualitative analysis. Due to lack of availability of reliable data, the author interviewed some of the main stakeholders and the Customs and VAT officials to analyse the mechanism for identifying the loopholes and prospects of the PCA initiative. Furthermore, this paper will not only help the administrations to set the selectivity criteria for PCA, but also assist the administrations to redesign their existing PCA selectivity system.

To create new development opportunities in the Global South, developing countries must enable greater trade facilitation with the global economy. Customs officials, who are at the front line and act as gatekeepers for market access, must often balance competing priorities between ensuring regulatory compliance and efficient processing of a high volume of consignments and goods. Currently, customs processes in developing countries often act as bottlenecks in the global supply chain which create undue costs for exporters and traders, yet these countries must also tackle the growing problem of illegal or unlawful trade. Post-clearance audits (PCAs) provide an effective risk management technique that can be used in conjunction with automated risk-based selectivity. This approach provides a holistic, risk management approach to customs processing. PCAs can also assist customs to promote an expedited release of goods without compromising the control of high-risk consignments. This article examines the weakness and the challenges of implementing PCAs within the domestic regulatory framework of Bangladesh. To achieve this objective, this article has obtained primary evidence from key stakeholders including Bangladesh Customs to develop insight and analysis into implementing PCA into the Bangladeshi regulatory framework. As this article will explore, these challenges include implementing an automated risk-based selectivity approach, online connectivity among relevant agencies, customs-to-customs cooperation, customs-to-business cooperation and developing greater technical capacity through skilling-up the workforce. Post-clearance Audit, Risk Management, Customs Control, Trade Facilitation, Bangladesh Customs

The Department of Mines and Energy, South Australia (DME) contracted Michael Williams and Associates Pty Ltd to audit the environmental management of seismic exploration operations in the South Australian Otway Basin. The audit was carried out in early 1992 and covered petroleum exploration operators and DME environmental management systems. An innovative field sampling technique was developed to compare the environmental impact of two different seismic line clearing techniques. Recovery of native vegetation as measured by vegetation structure was also quantified.The audit found DME to have a dynamic and integrated environmental management system while company systems varied in standard. Wide consultation assisted the audit process.As a result of clearing for agriculture, native vegetation covers only six per cent of the Otway Basin. With the strict limitations to broad-scale vegetation clearance since the mid-1980s and the cessation since 1991, the greatest environmental impact of seismic exploration is the clearance of native vegetation for access by seismic vehicles. Native vegetation structure and associated abiotic variables on seismic lines and adjacent control sites, were subject to a classification and ordination analysis which compared the impact of seismic lines constructed by bulldozer or Hydro-ax (industrial slasher). Post-seismic recovery rates of three different vegetation associations were also determined. This analytical technique permits the effects of seismic line clearance to be compared with the natural variability of specific vegetation associations within a region. In interpreting the results however, there is a confounding effect of line type and year as most of the more recent seismic lines were constructed using a Hydro-ax. Results indicate that Hydro-ax clearing affects vegetation structure less than bulldozing. Most Hydro-ax sites recovered within a few years whereas some sites, bulldozed as early as 1971, particularly tussock grasslands, have not yet recovered.This study provides a significant break-through in the debate about the persistence of seismic impacts on native vegetation. As a rapid preliminary assessment, sampling vegetation structure rather than floristics, provides a cost-effective audit and monitoring technique which can be used by non-specialists in a range of petroleum exploration environments. Any significant structural differences may require more detailed analysis to determine if floristic composition also differed.

Increasing trade volumes breeds the risk of Customs fraud which challenges Customs administrations to do more with limited resources. Against this backdrop, the study employs mirror analysis in order to identify, classify and approximate Customs revenue fraud in Malawi’s 2015 trade data. The analysis reveals plausible fraud cases in various products and this will inform Customs policies in risk analysis, enforcement and post-clearance audit. To this effect, a fraud control plan which will help in sealing revenue leakages has been suggested. Implications of the study on economic operators and trade facilitation are also addressed.

Background: Post-vasectomy semen analysis timing and criteria guidelines have evolved over time. Through analysis of our unit’s practice of post-vasectomy semen analysis from earlier sampling protocols at 8 weeks to single sampling at 12 weeks then 16 weeks, the impact on success rates and patient compliance were assessed. In addition, the use of small numbers of non-motile sperm and azoospermia combined rates as a marker of sterility were examined. Methods: All patients who underwent vasectomy in 2011 (8 and 12-week samples), 2013 (12-week samples) and 2016 (16-week samples) were included. Patients were given written and verbal instructions explaining the sample delivery protocol and samples. χ2 Testing was used to compare patient compliance and the results of post-vasectomy semen analysis with significance set at P<0.05. Results: In total 1124 vasectomies were performed, with 21% ( N=232) of patients non-compliant with submitting samples at the requested time period. Azoospermia rates increased with a longer time to post-vasectomy semen analysis from 82% to 95%, P<0.001; however, declining compliance meant the proportion of patients given clearance remained the same (70% vs. 68%, P=0.32). Rates of small non-motile sperm declined over an increasing time to post-vasectomy semen analysis. Therefore combined azoospermia and small non-motile sperm rates remained stable over an increasing sampling time (95% vs. 99%, P=0.39). Conclusion: The use of earlier post-vasectomy semen analysis is recommended as patient compliance decreases with the time from vasectomy. When azoospermia and small non-motile sperm rates are combined the rates of success of the procedure remain the same over time therefore earlier testing at 8 weeks is feasible without compromising clearance rates. Level of evidence: Not applicable for this single centre audit.

Objective: To evaluate the success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi and determine the factors which influence outcome. Patients and methods: A retrospective audit of patients with a single ureteric stone receiving ESWL was performed. Success was defined as complete stone clearance on post-treatment imaging. Patient demographics and stone characteristics were correlated to ESWL outcome. Results: 108 patients met the inclusion criteria for this study. The mean age of the patients was 52.5 years (range 24–89 years). 80% (86/108) of patients were male. Stone sizes varied from 4 to 19 mm (mean 7.92 mm). The overall ESWL success rate for ureteric stones was 79%. Treatment was more effective for smaller ( p = 0.003) and more located stones ( p = 0.035). Stone size correlated with number of treatments required ( p =0.005). A JJ stent in situ at the time of ESWL reduced the success rate ( p = 0.002). Conclusions: Stone size, site in the ureter, and the presence of a JJ stent were predictors of ESWL success. Our study from a District General Hospital in the UK demonstrates that ESWL may be used with high efficacy to treat ureteric stones.

Hypothesis. Repeated epithelial cell injury secondary to viruses such as Epstein Barr and subsequent dysfunctional repair may be central to the pathogenesis of IPF. In this observational study, we evaluated whether a combination of standard and anti-viral therapy might have an impact on disease progression.Methods. Advanced IPF patients who failed standard therapy and had serological evidence of previous EBV, received ganciclovir (iv) at 5 mg/kg twice daily. Forced vital capacity (FVC), shuttle walk test, DTPA scan and prednisolone dose were measured before and 8 weeks post-treatment.Results. Fourteen patients were included. After ganciclovir, eight patients showed improvement in FVC and six deteriorated. The median reduction of prednisolone dose was 7.5 mg (44%). Nine patients were classified “responders” of whom four showed an improvement in all four criteria, while three of the five “non-responders” showed no response in any of the criteria. Responders showed reduction in prednisolone dosage (P=.02) and improved DTPA clearance (P=.001).Conclusion. This audit outcome suggests that 2-week course of ganciclovir (iv) may attenuate disease progression in a subgroup of advanced IPF patients. These observations do not suggest that anti-viral treatment is a substitute for the standard care, however, suggests the need to explore the efficacy of ganciclovir as adjunctive therapy in IPF.

Purpose Customs risk management has been widely recognized as a powerful tool to balance between trade facilitation and revenue maximization. However, most customs administrations worldwide, particularly in developing countries, are suffering from a lack of experience and knowledge to assess their risk management systems for revenue protection (RP). Customs risk management has a very limited legacy in the literature. Academic research is quite scarce and very limited, although its relevance to customs administrations. This paper aims to identify the key risk profiles and indicators that contribute to the protection of customs revenue and investigate the role of these risk profiles and indicators on customs RP using the case of Jordan Customs. Design/methodology/approach This study adopts a panel data approach by using the case of Jordan Customs. Data were collected from the risk targeting and selectivity system at Jordan Customs for the year 2019, a total of 600 observations. Findings The findings show that all risk targeting criteria except random selectivity (RS) and HS code have a significant positive association with RP. The findings also revealed that RS is an effective tool to prevent traders with fraud and offenses history from a prediction of targeting patterns and to assess the traders’ compliance and make sure their declarations are free from fraud or offenses. Moreover, the findings of this study indicate that customs administrations should adopt alternative programs such as authorized economic operator and post clearance audit as an effective means to measure and improve compliance. Research limitations/implications The main contribution of this study lies in proposing a model to assist customs administrations in assessing the performance of risk management systems to protect revenue. This model provides a comprehensive conceptualization and explanations necessary for numerous aspects of risk management projects and it assists to predict the outcomes based on formulated indicators. Practical implications This study provides guidelines for risk analysts on how to identify and assess the key risk profiles and indicators that effect on maximizing the detection of revenue leakage and to obtain interpretable and predictable results. In addition, the findings of this study will assist customs administrations in supporting revenue collection, minimizing uncertainty, allocating resources more effectively to target high-risk consignments, while simplifying the procedures for the safe consignments. Originality/value This paper is of significant value because it is one of the preliminary studies that empirically identify the risk indicators/profiles that contribute to the protection of revenue and investigate the predictive power of these risk indicators/profiles as a key predictor to protect customs revenue.

One third of all neonatal deaths are caused by intrapartum-related events, resulting in neonatal respiratory depression (i.e., failure to breathe at birth). Evidence-based resuscitation with stimulation, airway clearance, and positive pressure ventilation reduces mortality from respiratory depression. Improving adherence to evidence-based resuscitation is vital to preventing neonatal deaths caused by respiratory depression. Standard resuscitation training programs, combined with frequent simulation practice, have not reached their life-saving potential due to ongoing gaps in bedside performance. Complex neonatal resuscitations, such as those involving positive pressure ventilation, are relatively uncommon for any given resuscitation provider, making consistent clinical practice an unrealistic solution for improving performance. This review discusses strategies to allow every birth to act as a learning event within the context of both high- and low-resource settings. We review strategies that involve clinical-decision support during newborn resuscitation, including the visual display of a resuscitation algorithm, peer-to-peer support, expert coaching, and automated guidance. We also review strategies that involve post-event reflection after newborn resuscitation, including delivery room checklists, audits, and debriefing. Strategies that make every birth a learning event have the potential to close performance gaps in newborn resuscitation that remain after training and frequent simulation practice, and they should be prioritized for further development and evaluation.

Background: Medical certification of cause of death (MCCD) is the formal document in which the doctor records the time, causes and circumstances of death of an individual. Inaccuracies and incomplete MCCD will lead to biased estimation of several epidemiological parameters. Hence this study was done to determine the knowledge and practice of MCCD among junior doctors and assess the association between knowledge and some selected variables of interest.Methods: A cross-sectional study was conducted among junior doctors constituting of interns, junior residents and post-graduates trainees of a tertiary hospital of Manipur from February to March 2020. A semi-structured, self-administered questionnaire was used. Data was entered in MS Excel and exported to SPSS version 21 where analysis was done. Descriptive statistics and Chi-square test was used for analysis and p<0.05 was taken as significant. Ethical clearance was obtained from the Institutional ethics committee.Results: Out of the 334 total respondents females constituted 53%. Only 88(26.3%) had satisfactory knowledge, and only 14% (47) of the respondents had ever issued MCCD.No significant association was seen between knowledge score and current department of posting, current designation, gender, religion and work experience.Conclusions: Only a quarter of the respondents (26.3%) were having satisfactory knowledge. There is a need to organize frequent workshops, seminars and induction training highlighting the importance of MCCD for the junior doctors with regular audits.

Background: Previous research has identified deficient dual-task balance control at the time of return to play (RTP) and possible worsening after RTP in older adolescents/young adults with concussion. These findings have not been investigated in younger patients with concussion. Hypothesis/Purpose: We hypothesized that concussed adolescents would have slower walking speed and increased medial-lateral (ML) center of mass (COM) movement, which would normalize by the time of RTP but worsen after resuming activity. Methods: 13 adolescent concussion patients (7 male; age 10-17 years) were prospectively evaluated at their initial visit (IV) (mean 18, range 4-43 days post-concussion), at RTP clearance (mean 46, range 12-173 days post-concussion), and one month later (mean 26, range 20-41 days post-RTP) along with 11 controls (3 male) seen for similarly timed visits. Standing balance was assessed using range and root mean squared (RMS) COM motion in the anterior-posterior (AP) and ML directions during standing on both legs with eyes open while performing quiet standing, dual-task audio Stroop, side-to-side head turns, and side-to-side thumb tracking tasks. Dynamic balance was assessed using walking speed and COM ML range and velocity during walking alone and with side-to-side head turns and verbal fluency (reciting words starting with “F”) dual tasks. Patients were compared against controls using t-tests, and changes over time were evaluated using linear mixed-effects regression. Results: During standing, patients had higher COM ML RMS than controls at IV during head turns and higher COM AP range during thumb tracking. COM ML motion decreased from IV to RTP (head turns range -6.5mm, p=0.058; head turns RMS -16.8mm, p=0.002; thumb range 9.2mm, p=0.012) and increased from RTP to 1 month follow-up (head turns RMS +10.0mm, p=0.040; Stroop RMS +8.4mm, p=0.086). Patients walked slower than controls at IV during all tasks, and COM ML range was higher in patients vs. controls during verbal fluency at IV and RTP. Walking speed increased from IV to RTP during verbal fluency (+7.8cm/s, p=0.044), from RTP to post-RTP in single task walking (+6.1cm/s, p=0.041), and at each successive visit during head turns (+6.0cm/s and +6.5cm/s, p<0.07). COM ML range also decreased in patients from IV to RTP with verbal fluency (-14.7mm, p=0.011) and from RTP to post-RTP in single task walking ( 4.0mm, p=0.061). Conclusion: Adolescent concussion patients had deficits in static and dynamic balance control at initial presentation. This tended to improve by RTP and only worsened post-RTP for dual-task ML control during standing, suggesting that current conservative treatment protocols are appropriate.

ABSTRACT:The auditor should have eminence audit judgment to support their assignment This research aims to provide empirical evidence that self-efficacy, experience, level of education, and skepticism have an impact on audit judgment. The population are auditors who had carried out post-clearance audit assignments. This research uses a quantitative approach by testing the theories and hypotheses that have been prepared. Ordinary least square (OLS) linear regression as an analytical model is used in this study. Results show that experience and education level have no impact on audit judgment, whereas self-efficacy and skepticism have a positive and significant impact on audit judgment. Efforts to improve self-efficacy and auditor skepticism are urgently needed. The coefficient of determination describes the variation of variables of self-efficacy, experience, level of education, and skepticism able to explain the variation of audit judgment variables by 51%. The remaining 49% is explained by other variables not involved in this study. Future studies may enhance with other variables and employ in-depth interview methods.Keywords: audit judgment, experience, level of education, post-clearance audit, self-efficacy, skepticism, post-clearance audit ABSTRAK:Auditor seyogyanya memiliki kemampuan audit judgment yang berkualitas guna mendukung penugasannya. Tujuan penelitian adalah memberikan bukti empiris bahwa efikasi diri, pengalaman, tingkat pendidikan, dan skeptisisme memiliki pengaruh terhadap audit judgement. Populasi dalam penelitian ini adalah auditor Direktorat Jenderal Bea dan Cukai (DJBC) yang pernah melakukan post clearance audit. Ini merupakan pendekatan kuantitatif yang menguji teori serta hipotesis yang telah disusun. Riset ini menggunakan regresi linear ordinary least square (OLS) sebagai model analisis. Hasil studi memperlihatkan pengalaman dan tingkat pendidikan tidak berpengaruh pada audit judgement, namun efikasi diri dan skeptisisme berpengaruh signifikan pada audit judgement. Implikasinya DJBC perlu memberikan perhatian khusus terhadap berbagai upaya dalam peningkatan efikasi diri dan skeptisisme auditor. Tulisan ini adalah pengembangan beberapa penelitian sebelumnya namun dalam konteks pengujian untuk jenis audit ketaatan. Nilai koefisien determinasi menggambarkan variasi variabel efikasi diri, pengalaman, tingkat pendidikan, dan skeptisisme dapat menjelaskan variasi variabel audit judgement sebesar 51%. Sisanya sebesar 49% dijelaskan oleh variabel lainnya yang tidak diujikan dalam tulisan ini. Dengan adanya keterbatasan waktu pada penelitian ini diharapkan mendorong penelitian berikutnya untuk dapat menyertakan beberapa variabel lain yang relevan dan melengkapinya dengan metode in-depth interview.Kata Kunci: bea dan cukai, efikasi diri, pengalaman, skeptisisme, tingkat pendidikan

Abstract Aim Following vasectomy, patients undergo post-vasectomy semen analysis (PVSA) to determine whether they can be “cleared” to safely discontinue contraception. The adherence rates to PVSA are notoriously poor in the literature. The aim of this project is to assess our patient’s adherence to PVSA and identify areas for improvement. Method All vasectomies undertaken at a large urology centre between 01/01/2019 and 31/12/2019 were included. PVSAs were scrutinised one year later to determine clearance or special clearance according to the 2016 Laboratory Guidelines for Post-vasectomy Semen Analysis endorsed by the British Andrology Society. Results 256 patients underwent bilateral vasectomy, with 132 (51.6%) undergoing PVSA, at a median of 16.4 weeks (range 7.3 – 71.6). At time of review, 71 (54.5%) of these have been cleared; 45 (63.4%) after a single PVSA and 19 (26.8%) after the second. Seven patients (9.9%) received special clearance, two patients (1.5%) were not cleared despite meeting the special clearance criteria and one patient suffered early failure (0.8%). Clearance letters were issued at a median of 2.7 weeks (range 0.1 – 28.8) following satisfactory PVSA results. Moreover, 33 patients (25%) had at least one PVSA sample rejected by the lab, mainly due to timing issues or incomplete information on the request form. Conclusions The adherence rate to PVSA in our cohort is in keeping with the literature, and the majority of patients who are cleared achieve this with just one PVSA. Interventions aimed at counselling patients about the importance of PVSA, reducing unnecessary repeats and reducing rejected samples are necessary.

BackgroundVasectomy occlusive success is defined by the recommendation of ‘clearance’ to stop other contraception, and is elicited by post-vasectomy semen analysis (PVSA). We evaluated how the choice of either a postal or non-postal PVSA submission strategy was associated with compliance to PVSA and effectiveness of vasectomy.MethodsWe studied vasectomies performed in the UK from 2008 to 2019, reported in annual audits by Association of Surgeons in Primary Care members. We calculated the difference between the two strategies for compliance with PVSA, and early and late vasectomy failure. We determined compliance by adding the numbers of men with early failure and those given clearance. We performed stratified analyses by the number of test guidance for clearance (one-test/two-test) and the study period (2008–2013/2014–2019).ResultsAmong 58 900 vasectomised men, 32 708 (56%) and 26 192 (44%) were advised submission by postal and non-postal strategies, respectively. Compliance with postal (79.5%) was significantly greater than with non-postal strategy (59.1%), the difference being 20.4% (95% CI 19.7% to 21.2%). In compliant patients, overall early failure detection was lower with postal (0.73%) than with non-postal (0.94%) strategy (−0.22%, 95% CI −0.41% to −0.04%), but this difference was neither clinically nor statistically significant with one-test guidance in 2014–2019. There was no difference in late failure rates.ConclusionsPostal strategy significantly increased compliance to PVSA with similar failure detection rates. This resulted in more individuals receiving clearance or early failure because of the greater percentage of postal samples submitted. Postal strategy warrants inclusion in any future guidelines as a reliable and convenient option.

Abstract Objective: To measure the success rate of endoscopic retrograde cholangiopancreaticography biliary cannulation of a recently credentialed endoscopist at a tertiary hospital. Methods: The clinical audit was conducted at the Aga Khan University Hospital. Karachi, and comprised data of all patients who underwent endoscopic retrograde cholangiopancreaticography under the care of a single operator during 2016. Data was retrospectively extracted from patient charts by an assistant blinded to the study. Data extracted included demographics, admission type, details and indication for the procedure, diagnosis, cannulation outcome, duct clearance, complications, follow-up surgical intervention, radiological imaging and mortality post-endoscopy. Data was analysed using SPSS 19. Results: Of 143 procedures performed, 102(71.3%) were included. The mean age was 52±17 years and 54(52.9%) of them were females. Most common indication was choledocholithiasis in 70(68.6%). The average procedure time was 41.5±5.5 minutes. Cannulation success rate was 96(94.1%). Complications included post-procedure pancreatitis in 5(4.9%), minimal bleeding in 8(7.8%) and oesophageal perforation in 1(0.98%). There was no procedure-related mortality. Conclusion: The success rate was high and complications were low Continuous...

AbstractBackgroundNeoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management.MethodsMultidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item.ResultsThirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5–60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0–25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT.DiscussionThere is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes.

Abstract Background and Aims Inadequate dialysis has been linked to reduced quality of life, increased symptom burden and increased risk of cardiovascular illness in patients with chronic kidney disease. This is especially significant in long-term haemodialysis patients who have little to no residual urine output and are thus almost entirely dependent on good quality dialysis to remove toxins and fluid. In most conventional haemodialysis modes middle molecule clearance is inadequate. This in turn plays an important part in causing multiple complications. HDx is a new type of haemodialysis being introduced using Theranova® dialyzer. This claims to have medium cut-off membranes, functioning similar to a kidney, hence providing better clearance of middle molecules, whilst selectively preventing loss of proteins from the body. In order to test the safety and efficacy of HDx using Theranova® we tried it in a cohort of our patients in the form of an audit. Our primary objective was to find out the effect of HDx on quality of life. Secondary objective was to determine whether HDx improves blood biochemistry, with a reduction in medication & transfusion needs. Method Thirty seven Haemodialysis patients were switched from hemodiafiltration to HDx, out of these 3 patients were transplanted, 2 patients died, 1 patient switched back and 7 patients were transferred to satellite units. Audit was continued with the remaining 24 patients. All patients completed an Integrated Palliative Care Outcome Score (IPOS) prior to commencing on HDx and then at six months. Blood parameters including phosphorous, calcium, haemoglobin, Ferritin and CRP were measured monthly and mean values of 6 months before and after HDx initiation were compared. Comparison of erythropoietin, intravenous iron and packed red blood cell transfusion requirements pre and post HDx commencement were also undertaken. Results No obvious adverse effects were noted with use of HDx dialysis. All patients had an improvement in overall IPOS scores after being on HDx for 6 months. Shorter post dialysis symptom recovery times were also noted. 13 patients had a decrease in their erythropoietin requirements, in 2 patients requirement remained the same, 9 patients had increase in their requirement however 3 of these patients had been requiring packed red blood cell transfusion prior to HDx commencement, no longer required transfusion. We found an overall improvement in patients iron infusion need. 11 patients had a dose reduction, with 4 of these patients no longer requiring iron. 9 patients continued to have the same requirements. 4 patients had an increase in iron dose, but 3 of these patients previously being transfusion dependant no longer required regular transfusions. We also noted that with use of HDx clotting risk was reduced and patients who were switched from Evodial (heparin coated dialyzer membranes) to HDx did not have increased circuit clotting. With regards to inflammation we noted no significant changes in CRP, ferritin levels and other blood parameters. Conclusion Looking at our cohort of patients we concluded that HDx is safe to use with no obvious adverse effects. It seems that use of HDx is particularly helpful in improving quality of life in dialysis patients as indicated by improvement in IPOS scores. IPOS is a validated questionnaire to measure symptoms and concerns in patients with advanced illnesses. As life quality is a major concern in dialysis patients, this outcome is of particular significance. HDx was also helpful in reducing the overall burden of transfusions, iron and erythropoietin requirements. This is beneficial in overall patient health and cost burden. Based on the above we found out that HDX was safe and effective in our patient cohort, however large-scale studies will be required for more conclusive evidence.

Preface In the last twelve years of following copyright developments, I have witnessed an accelerating growth in the agitation over its application and increasing cries for reform. This was triggered by a mounting corporate hysteria for strengthening copyright which seems to mask other anxieties and other issues of bad faith beside the one at hand. This is in contrast with the more reasonable stance of the U.S. government in the 1980s when Congress refused to regulate video rentals and the Courts refused to cite the video recorder for ‘contributory infringement.’ In the 1990s, the Republican-controlled Congress passed several pieces of legislation extending copyright and punishing reverse engineering. Congressional giveaways and corporate shrillness has inspired a progressive movement to defend the intellectual ‘commons.’ The reality is that intellectual property is not owned by intellectuals, and so people are realising that further extensions of copyright no longer benefits the sciences and useful arts. Developments in copyright are driven by the challenges of new technologies of communication. This is a problem for the law, which does not like surprises and certainly proceeds by analogising new situations to old ones in order to build continuity. Case law (which is law that is developed by judges’ decisions and interpretations) proceeds by precedent. Yet old technologies are not the accurate precedents for new technology and this is particularly the situation today. The new technologies have a particular impact on the situation since they change not just one variable in the earlier balance of copyright, but all the variables. While the courts and the corporations have concentrated on the one variable of easy reproduction of content, we should also pay attention to how the new technologies have changed the very balance between the so-called ‘real world’ and cultural expression. The material world is now composed to a significant extent by cultural expression. We walk through physical landscapes dominated by billboards and other totems of the marketplace, while our mentalscapes are filled with trademarks and other commodity bits. This was not the case as copyright law developed; it is the case now, and the various underpinnings of copyright law have become embarrassingly ineffective in this new world. Edelman Bernard Edelman pushes back to find the moment of embarrassment. He finds it in photography. As Paul Hirst points out, ‘[Edelman’s title] Le Droit saisi par la photographie puns on the law being seized or caught by photography, surprised or caught out by it. Photography, a technical innovation developing independently of law, contradicts the existing formulations of property right in representations of things’ (Hirst 1-2). Prior to photography, representation inherently had stamps of personality that allowed such representation (painting, drawing, engraving et alia) to be easily and significantly distinguished from that part of the material world it was representing, as well as from other artistic representations (even of the same referent). The earliest French legal pronouncements on photography were reluctant to grant it copyright protection, precisely because it was thought to have no personality and to be a mechanical copy of nature. When the court did extend copyright protection to photography and admitted its personality, it was faced with how to distinguish it from the natural. The camera could no longer be interpreting as transparently reproducing the real. Edelman calls this the subjectivisation of the machine. The camera can no longer be both a transparent reproducer of the real; it has been found always to invest the real with the personality of its subject (the photographer). This has resulted in a number of ad hoc decisions to prevent ‘over-appropriation’ of the real. Anglo-American versus French Law Anglo-American writing about copyright has never wasted much time on subjectivisation of the machine. The basis of British copyright was pragmatic and economic to begin with, having originated with the Tudors’ desire to encourage printing by granting monopoly rights to printers, and to control and censor printing. The relocation of copyright ownership from printer to author in the 18th century was also an economically driven consideration reflecting the new spirit of competitive capitalism. Certainly the language of the U.S. Constitution that authorised the federal prerogative in setting copyright law was very pragmatic in its emphasis on promoting the progress of science and the ‘useful’ arts (Article 1 Section 8). The French tradition, which is somewhat paralleled by the German and those of other continental nations, was born out of a more courtly regard for the rights of genius. Although France recognised that works ‘made for hire’ were owned by the employer, it vested certain inalienable moral privileges in the real person of the artist. This legal doctrine is known as droit d’auteur. (see Ginsburg) Idea/Expression Yet the American tradition is not totally pragmatic. The balance between copyright and the First Amendment commitment to an absolute freedom of speech calls for a certain degree of abstraction. It was Thomas Jefferson who cautioned about the chilling effect copyright law might have with the spread of ideas. Fortunately in written language it was rather easy to work out that the way to protect ideas from property claims was to distinguish between the expression, which can be copyrighted, and the idea, which cannot. Siva Vaidhyanathan (109-15) goes over Judge Learned Hand’s development of the test to distinguish the idea from the expression in the 1920s and 1930s as particularly instructive for striking the balance. In Nichols v. Universal (1929), Hand develops the theme of ‘patterns of increasing generality’ as more incident is left out. At some point the abstraction is too great to be protected, since it now is more in the realm of idea then of particular expression. (45 F.2d 120) But Edelman’s work poses the question whether this works, as we move from machines of writing to machines of visual reproduction. Doesn’t Apply to Mechanical Mimetic Reproduction Photographs can be taken of the imaginary world and indeed the subjectivisation model holds that every photograph is determined by the imagination of the author. But it is commonsensical that photographs begin as traces of the material world. This is not analogous to the written word. The structural nature of language removes the written word from a direct relationship with its physical referent. Indeed, the entire linguistic turn in post-war philosophy is premised on the lack of any transparent or even determined relationship between language and things. Even in pre-war jurisprudence it was this lack of coincidence that allowed the easy split of the idea from its expression. As the expression floats above the idea, the word floats above the physical. Vincent Porter argues that in contrast to language, visual and audio recordings do not have this split, they do not float above the physical. He noted sound/image recordings have presented a problem in that they are speech acts without a language system, or in a distinction borrowed from Saussure ‘a series of paroles without a langue.’ (Porter 12) After all does a photograph fit into a grammar of images? Are there photographs that are ‘patterns of increasing generality?’ Where is the photograph that is the same idea as another photograph without being the same photograph? Is there a photograph that can do the same work as the word ‘mother?’ No. Every photograph will be of a particular mother of a particular age and particular ethnic group and the same difficulty applies even if we photograph a group of mothers or edit a montage of mothers. This has the effect of making the idea the same as the expression. If you protect one you have protected the other. At this point I was not certain how decisive an intervention these concepts could make in the current copyright ferment. Certainly the most exciting argument was the one mounted at the Berkman Institute at Harvard by several lawyers and argued before the Supreme Court by Lawrence Lessig in Eldred v. Ashcroft (2003). This presented the argument that the government had strayed from the original Constitutional mandate to allow exclusive rights only for a limited time. But as I read Lessig’s Free Culture and as I re-read Edelman, it strikes me that the idea/expression test does not adequately help the First Amendment rights of technologies of mimetic reproduction (film, audio recordings). It is that these technologies allow reproductions to easily re-enter the material world. When these reproductions do re-enter they will naturally become part of the domain of creative expression. Our artists must be allowed to freely comment on the world in which we live and the world in which we live is now visually and aurally full of copyrighted material. This image came to mind forcefully when Lessig explained the difficulties of documentarians when they film their subjects watching TV and then have to edit out the TV image rather than deal with the risk of being sued for infringement (Aufderheide and Jaszi 95-8). This image also comes to mind when reading of farmers who are not allowed to harvest their seed because they come from patented plants. But I will defer to patent philosophers on that apparent travesty of natural rights. I wish to stay focused on the argument that is the corollary of Edelman’s subjectivisation of the camera. The camera records the physical world and in turn that recording enters that world. This is to say that the genius of copyright is in the literary domain because written language never re-enters the material world. When copyright was extended beyond the literary, policy makers should have noticed that earlier tests were no longer capable of maintaining balance between our divine right to express our lives and the practical right to own our own expressions (for a limited time). The new test is almost already present in the law: it is the protection of parody from copyright infringement violation. The courts recognise that parody positions the original expression as an artifact of the world in order to comment on it. If only the policy makers could extend that view to documentarians and others who film the world and include in their film the physical fact of other videos being displayed in the world. Just as in parody they ought to consider the intent of the video makers is to comment on the original, not to plagiarise it. References Aufderheide, P., and P. Jaszi. Untold Stories: Creative Consequences of the Rights Clearance Culture for Documentary Filmmakers. 2004. 25 April 2005 http://www.centerforsocialmedia.org/rock/index.htm>. Edelman, B. Ownership of the Image: Elements for a Marxist Theory of Law. London: Routledge & Kegan Paul, 1979. Eldred v. Ashcroft, Attorney General. United States Supreme Court decision, 15 January 2003. http://www.supremecourtus.gov/opinions/02pdf/01-618.pdf>. Ginsburg, J. C. “A Tale of Two Copyrights: Literary Property in Revolutionary France and America.” Tulane Law Review 64.5 (1990): 991-1032. Hirst, P. Q. “Introduction.” In Bernard Edelman, Ownership of the Image: Elements for a Marxist Theory of Law. London: Routledge & Kegan Paul, 1979. Lessig, L. Free Culture. 2004. 8 April 2005 http://free-culture.org/get-it>. Porter, V. “Copyright: The New Protectionism.” InterMedia 17.1 (1989): 10-7. Vaidhyanathan, S. Copyrights and Copywrongs: The Rise of Intellectual Property and How It Threatens Creativity. New York: NYU Press, 2001. Citation reference for this article MLA Style Wasser, Frederick. "When Did They Copyright the World Without Us Noticing?." M/C Journal 8.3 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0507/05-wasser.php>. APA Style Wasser, F. (Jul. 2005) "When Did They Copyright the World Without Us Noticing?," M/C Journal, 8(3). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0507/05-wasser.php>.