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This chapter examines the reform of the Lome Convention which dominated European development policy in the late 1990s. The case of Lome illustrates the inflated expectations of the EU and ACP (African, Caribbean, and Pacific states), and the inadequate capacity to deliver policy objectives. The reform process can only be understood within the broader context of the EU’s attempt to establish a more effective and coherent international European presence.

This chapter provides an introduction to Advance Care Planning (ACP). It cites the underlying purpose and principles of ACP, in response to patient need. It reflects on the deeper significance of ACP conversations. Lastly, it presents some hope and expectations, and suggestions for planning ACP in different settings. ACP discussions are important. They are a key means of improving end of life care and of enabling better planning and provision of care in line with the needs and preferences of patients and their carers. The practice of ACP affirms the use of advance statements, in which patients clarify their wishes, needs, and preferences for the kind of care they would like to receive, and the means of leading a fuller life meanwhile. It can also include advance decisions or refusals of specific treatments including cardio-pulmonary resuscitation (CPR), and the appointment of a person to act as a proxy surrogate.

This chapter provides an overview of Advance Care Planning (ACP) within the hospice or specialist palliative care inpatient setting. It examines the breadth of ACP amongst the inpatient population, barriers to ACP in the hospice, triggers for ACP discussions, communication issues, and ACP as death approaches. It shows that the breadth of ACP reflects the heterogeneous population served by hospices and specialist palliative care units. ACP is a continuum and may change over several discussions or occur at unplanned moments. Teams should develop a professional culture which recognizes ACP as an integral part of holistic patient assessment. Communication of ACP wishes between professionals within primary care and inpatient units is essential. Meanwhile, successful ACP requires investment in training, specific communication skills development, and team debriefs.

This chapter discusses the purpose and use of advance directives (ADs) and advance care planning (ACP) within the context of ESRD. It also presents empirical evidence about the degree to which ADs and ACP have met their intended goals, interventions to enhance the use and value of ADs and ACP, and new research that helps define how to initiate and facilitate effective ACP for patients with ESRD.

Advance care planning (ACP) was introduced to Singapore in the late 2000s in the form of local projects that encouraged conversations on end-of-life concerns, beginning first with residents in several nursing homes. High patient receptivity to the concept of planning ahead for care and death was encouraging, which prompted Ministry of Health to approve an S$18.1m effort to develop and promote ACP nationally in 2011. Since then, the practice of ACP has gradually spread throughout the country’s public acute care hospitals, most community hospitals, and all nursing homes, as well as a handful of eldercare providers, with close to 5,000 plans lodged electronically, 2,000 ACP conversation facilitators trained across the health and social care continuum and more than 1,000 community ACP advocates activated.

In chemistry, many methods are available to synthesize carbon-carbon bonds, and the reactions proceed by both polar and radical mechanisms. However, enzymatic ligation of two molecules through carbon-carbon bond formation invariably proceeds by a polar mechanism. Often, the reaction involves a carbanionic intermediate or a carbanion-equivalent species such as an enamine, but carbenium ion intermediates also participate in terpene biosynthesis. The only well-known enzymatic processes leading to carbon-carbon bonding by radical mechanisms are the adenosylcobalamin-dependent isomerization reactions discussed in chapter 7. The basic mechanisms illustrated in fig. 14-1 lead to the ligation of molecules through the synthesis of carbon-carbon bonds. Fig. 14-1A depicts the addition of a stabilized carbanion to an aldehyde or ketone to form an adduct. The carbanion can itself be derived from an aldehyde or ketone, as it is in the reactions of aldolases and transketolase. In chapter 1, we discuss the mechanisms of aldolase reactions in connection with the catalytic power of metal ions and of iminium ions formed between substrate carbonyl groups and the lysyl-ε-amino groups of enzymes. In the actions of class I aldolases, X=C in fig. 14-1A is an iminium group formed between a lysyl residue of the enzyme and an aldehyde or ketone group of a substrate. In this case, the carbanion is more accurately described as an enamine, a resonance form in which the charges are not separated. In the actions of class II aldolases, X=C in fig. 14-1A is a carbonyl group (i.e., C=O) coordinated to a divalent metal ion, usually Zn2+, which facilitates carbanion formation through enolization. In this case, the carbanion may be more accurately described as an enolate ion with the charge localized on metal-coordinated oxygen. Iminium ion formation and divalent metal ion ligation both lower the pKa value of the α-C(H) by 7-10 units, thereby facilitating enolization and carbanion formation (see chap. 1). An enolate carbanion may also be derived from a CoA-thioester such as acetyl CoA in the reaction of citrate synthase. Once the carbanion or carbanion-equivalent is formed in an active site, its addition to an aldehyde or ketone group in an adjacent cosubstrate proceeds rapidly.

This chapter outlines a theory grounded on the so-called attentional constitution principle (ACP). The ACP contends that attention is constitutive of humans’ perceptual knowledge about individuals. It expands research on perception and demonstrative identification, and is grounded in the idea that the epistemology of empirical beliefs should fit together with the psychobiology of attention in order to explain how human agents navigate and analyze their environment. In contrast to the nonbiological epistemology of knowledge or the nonepistemological psychobiology of attention, the ACP holds that the function of human attention is mainly to serve perceptual knowledge through the extraction of causal information. The following sections of the chapter formulate the ACP and introduce a concept of information that is useful and relevant to the theory.