In Western Europe, cities that host International Organizations (IOs) have to deal with more and more competition. The last decade many IOs settled in Eastern European and Asian countries. Distributing IOs over several cities in Europe for reasons of political balance and give-and-take among governments play a role in these decisions. However, public policy networks are more and more operational in these negotiations. Apart from the political and administrative actors, others – as private actors and external lobbyists – play a role as well. This often leads to increased complexity and ineffective decisions. This paper examines four cases in which political gameplay influenced the location decision-making of IOs in The Hague and Geneva. First, I will introduce the subject, research method and the four cases. Second, I will discuss how public policy networks are increasingly complicating factors to the settling processes of IOs. Third, a reconstruction of the settlement processes of four IOs will illustrate this.
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BackgroundCritically ill patients are subject to severe skeletal muscle wasting during intensive care unit (ICU) stay, resulting in impaired short- and long-term functional outcomes and health-related quality of life. Increased protein provision may improve functional outcomes in ICU patients by attenuating skeletal muscle breakdown. Supporting evidence is limited however and results in great variety in recommended protein targets.MethodsThe PRECISe trial is an investigator-initiated, bi-national, multi-center, quadruple-blinded randomized controlled trial with a parallel group design. In 935 patients, we will compare provision of isocaloric enteral nutrition with either a standard or high protein content, providing 1.3 or 2.0 g of protein/kg/day, respectively, when fed on target. All unplanned ICU admissions with initiation of invasive mechanical ventilation within 24 h of admission and an expected stay on ventilator support of at least 3 days are eligible. The study is designed to assess the effect of the intervention on functional recovery at 1, 3, and 6 months following ICU admission, including health-related quality of life, measures of muscle strength, physical function, and mental health. The primary endpoint of the trial is health-related quality of life as measured by the Euro-QoL-5D-5-level questionnaire Health Utility Score. Overall between-group differences will be assessed over the three time points using linear mixed-effects models.DiscussionThe PRECISe trial will evaluate the effect of protein on functional recovery including both patient-centered and muscle-related outcomes.Trial registrationClinicalTrials.gov Identifier: NCT04633421. Registered on November 18, 2020. First patient in (FPI) on November 19, 2020. Expected last patient last visit (LPLV) in October 2023.
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