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Technically speaking, this pattern implies that there is no endogeneity of trade and recognition; that is, we can assume that bilateral trade flows and recognition status are unlikely to strongly affect each other. This in turn allows us to analyze the impact of country recognition on Kosovo’s trade flows using standard economic methods.

The trade costs of not being recognized

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that predicts trade flows based on the common factors that influence trade (such as the size of the economy and the distance between trade partners) to test whether not being recognized as a country is a trade barrier for Kosovo. The model predicts how much Kosovo would trade with each country and with the world in general if its statehood were universally accepted. We estimate the impact on trade of not being recognized by another country (“bilateral nonrecognition”) and by the U.N. (“multilateral nonrecognition”), as well as the impact on the value of exports, the number of exporters (intensive margin), and the exports per firm (extensive margin). Then we examine whether the cost of nonrecognition is larger for some products than for others.

The Figure 1 shows the trade flows over time between Kosovo and its trading partners, which are grouped by their recognition of Kosovo’s sovereignty. Note the rapidly rising exports to countries that decided to recognize Kosovo during this period (red line).

However, the results of our gravity model, holding the above mentioned common factors that influence trade, are:

Our hypothesis is that it is the lack of U.N. membership, which restricts access to multilateral treaties and prevents representation in international government. These are prerequisites for access to basic legal, financial, and logistical services, without which the basic logistics of trade become costly.

Our findings suggest that obtaining (bilateral) recognition from new countries will not cause a dramatic increase in Kosovo’s trade with those countries; however, once the country obtains (multilateral) U.N. membership, its trade could surge. Our interviews with Kosovar businesses reveal that the main consequence of bilateral non-recognition for them is that they find it difficult to travel to countries that do not recognize Kosovo, whereas multilateral recognition increases the overall cost of exchanging goods and services with firms abroad, which is a bigger concern.

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Based on our calculations, the cost of trading with Kosovo today is the equivalent of a 14 percent tariff, which is enormous. In a global market increasingly reliant on convenience and speed, it is a surprisingly large consequence of disputed sovereignty.

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The training of physicians also has undergone significant change since the time of the ancient Greek physicians. For many centuries, and particularly between the late Middle Ages and the end of the 19th century, physicians were trained through lectures and rarely were taught at the patient’s bedside. This practice was altered by Canadian physician Sir William Osler during his time as professor of medicine at Johns Hopkins University Medical School in Baltimore, Md., U.S. One of the most renowned physicians of the early 20th century, he introduced the practice of instructing students at the bedside of the patient. He emphasized the importance of taking an accurate medical history, providing a thorough examination, and closely observing the patient’s behaviour to gather clues for a diagnosis before resorting to laboratory testing.

The medical history of a patient is the most useful and important element in making an accurate diagnosis, much more valuable than either physical examinations or diagnostic tests. The medical interview is the process of gathering data that will lead to an understanding of the disease and the underlying physiological process. To be effective, an interviewer must possess good communication skills and be alert to nonverbal clues as well as to the verbal message. Often, more information is conveyed by nonverbal actions and tone of voice than by words. The objective is to obtain an accurate and comprehensive picture of the patient’s situation, including the nature and timing of symptoms, emotional factors (including types of stress ), and past medical conditions that may place the patient at greater risk for certain diseases.

The accuracy and usefulness of the medical interview depend on the physician’s ability to elicit information pertinent to the problem at hand and on the patient’s accurate recall and articulation of the sequence of symptoms. This may be difficult, because meaningful data may be forgotten if the patient is experiencing or emotional distress. The skilled interviewer knows when to use silence, open-ended questions, or specific closed-ended questions to explore avenues in which the most useful information may be found. The real reason for the patient’s visit may not be apparent until a rapport has been established and the person feels comfortable describing what is most bothersome. Problems that are emotionally threatening may not be voiced until adequate courage has been summoned—sometimes not until the end of the appointment when the patient’s hand is on the doorknob.

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Visualisation is also called guided imagery and uses the power of your imagination to help you relax or relieve symptoms.

Learning to direct and control images in your mind can help you to relax and to manage problems.

These techniques are claimed to help with:

What visualisation involves

A trained therapist can help you learn how to practice visualisation.

You create images in your mind that can help you to relax, feel less anxious, sleep better, and reduce pain. You use all of your senses – sight, touch, hearing, smell, and taste. For example, you may want to think of a place or activity that made you happy in the past.

While you are learning the technique, your therapist talks you through the sort of images that it may be helpful to picture. They may ask you to imagine a peaceful place where you’d like to be. Or they might teach you to imagine yourself feeling well and strong.

Many people find that they feel better after they imagine feeling stronger. Some people like to picture their body fighting off the cancer cells.

A therapist may be able to teach you the best visualisation techniques for the times when you feel most stressed. They can show you short visualisation exercises or deeper relaxation techniques.

You can practice visualisation without a therapist, using a music file, CD or tape. You can buy these online, from some book stores or health shops, and from some cancer support groups or centres. Ask your nurse if they can recommend any. Or you could contact one of the complementary therapy organisations.

If you have to stay in bed or can't leave your home, imagery or visualisation techniques may help. You may feel less closed in if you have been indoors for a long time.

Visualisation and guided imagery are generally safe, especially under the guidance of a trained health professional.

It is best to use them alongside your conventional cancer treatment.

There are no reports of side effects.

Relaxation and imagery are two of the most popular types of complementary therapy that people with cancer use.

Research has looked into visualisation to help control symptoms and treatment side effects in people with cancer. It is difficult to do this type of research and the results are sometimes not clear. We need more research to see how guided imagery and visualisation can help people with cancer.

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In 2010 the PERI study reported its results. It looked at visualisation and guided imagery for patients with bowel cancer. The study included 151 patients and found that relaxation and guided imagery did not significantly change people’s mood or quality of life. But an earlier review of 6 studies in 2005 suggested that guided imagery may be helpful in managing stress, anxiety, and depression for people with cancer.

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Anna Alperovich , Connie Batlevi , Katy Smith , Zhitao Ying , Jacob D Soumerai , Amanda R Copeland , Erel Joffe , Philip Caron , Pamela Drullinsky , John F Gerecitano , Audrey Hamilton , Paul A Hamlin Jr. , Steven M Horwitz , Andrew M Intlekofer , Anita Kumar , Matthew J Matasar , Alison J. Moskowitz , Craig H Moskowitz , Ariela Noy , Maria Lia Palomba , Carol S Portlock , Craig S Sauter , David J Straus , Andrew D. Zelenetz , Ai Ni , Venkatraman E Seshan and Anas Younes
Blood 2016 128:2955;
Anna Alperovich
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Connie Batlevi
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Katy Smith
London, London, United Kingdom
Zhitao Ying
Peking University Cancer Hospital, Beijing, China
Jacob D Soumerai
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Amanda R Copeland
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Erel Joffe
Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
Philip Caron
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Pamela Drullinsky
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
John F Gerecitano
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Audrey Hamilton
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Paul A Hamlin
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Steven M Horwitz
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Andrew M Intlekofer
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Anita Kumar
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Matthew J Matasar
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Alison J. Moskowitz
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Craig H Moskowitz
Department of Medicine, Lymphoma and Adult BMT Services, Memorial Sloan Kettering Cancer Center, New York, NY
Ariela Noy
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Maria Lia Palomba
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Carol S Portlock
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Craig S Sauter
Department of Medicine, Lymphoma and Adult BMT Services, Memorial Sloan Kettering Cancer Center, New York, NY
David J Straus
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Andrew D. Zelenetz
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
Ai Ni
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
Venkatraman E Seshan
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
Anas Younes
Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY

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