Restorative und Transitional Justice im Völkerrecht

Das Völkerrecht behandelt Regimewechsel und Post-Konflikt-Situationen eher aus der Perspektive der Transitional Justice behandelt als aus der der Restorative Justice. Es sieht eine breite Palette von Mechanismen vor, die sich auf (1.) Wahrheitsfindung, (2.) Strafjustiz, (3.) Wiedergutmachung und (4.) Garantien der Nichtwiederholung beziehen. Internationale Institutionen haben wichtige Standards der Transitional Justice kodifiziert. Die UN-Grundprinzipien und -Leitlinien für das Recht auf einen Rechtsbehelf und Wiedergutmachung und die UN-Grundsätze zur Bekämpfung der Straflosigkeit sind Beispiele dafür. Einige Institutionen wie der IStGH sind direkt an der Schaffung von Transitional Justice beteiligt. Der Al-Mahdi-Fall veranschaulicht, wie eine internationale Institution internationale Standards im Bereich der Transitional Justice und insbesondere der Wiedergutmachung weiterentwickeln kann. Schließlich bieten auch die internationalen Menschenrechtsnormen einen Rahmen für den Umgang mit der Transitional Justice. Dies gilt insbesondere für EMRK mit den vom EGMR entwickelten spezifischen Standards. So muss jedes Projekt der Transitional Justice oder der Restorative Justice die internationalen Standards der Herrschaft des Rechts respektieren

Phantom-based training of ultrasound-guided breast biopsy in medical education: a randomized controlled trial comparing handheld and high-end ultrasound

Background: Modern handheld ultrasound devices (HUDs) are attractive for teaching programs in undergraduate medical education due to their miniaturization and portability along at relatively low cost. They offer high-resolution imaging and are easy to use, opening up new possibilities for training of novices in ultrasound (US)-guided percutaneous procedures. The objective of this study was to investigate if guidance by HUD is on par with a cart-based high-end ultrasound scanner (HEUS) regarding performance times and success rates in video- and phantom-based training of novices in US-guided freehand breast biopsy. Methods: 32 medical students without any experience in performing US-guided percutaneous biopsies, who had previously completed a standardized diagnostic US training program, were randomized into either a HUD-group (n = 16) or a HEUS-group (n = 16). After a video training lecture participants performed US-guided biopsies of hypoechogenic and hyperechogenic target-lesions in a breast phantom using either a HUD or a HEUS. Performance times and success rates were primary outcomes. Participants were asked to complete a post-study questionnaire (Likert Scale and Raw NASA Workload Task Load Index) for subjective assessment of the operability and individually perceived workload of both US imaging tools and guidance-techniques as secondary outcomes. Results: Biopsy success rates were slightly higher using the HUD (79.7%) in comparison to the HEUS (68.8%, p = 0.045). Median performance times were similar for the HUD (0.63 min, interquartile range IQR = 0.37–1.08 min) compared to the HEUS (0.60 min, IQR = 0.30–2.09 min, p = 0.751). Operability and the individually perceived workload were rated equal. Conclusions: Percutaneous biopsy performed by novices using HUDs is feasible, performance times, success rates, operability and the individually perceived workload were on par with HEUS-guidance. HUDs can be used as cost-effective tools for percutaneous biopsy training purposes in medical education

Відновне та перехідне правосуддя в міжнародному праві

International law deals with regime change and post-conflict situations under the perspective of transitional justice rather than restorative justice. It envisages a broad range of mechanisms which relate to (1.) truth-seeking, (2.) criminal justice, (3.) reparations, and (4.) guarantees of non-recurrence. International institutions have codified important standards for transitional justice. The UN Basic Principles and Guidelines on the Right to a Remedy and Reparation and the UN Principles to Combat Impunity are examples of this. Some institutions like the International Criminal Court are directly involved in providing transitional justice. The Al-Mahdi case illustrates how an international institution can further develop international standards pertaining to transitional justice and to reparation in particular. Finally, international human rights law provides a framework for dealing with transitional justice. This is particularly true for the European Convention on Human Rights with the specific standards developed by the European Court of Human Rights. In essence, any project of transitional or restorative justice must respect the international rule of law

Estimation of Minimal Clinically Important Difference for Tinnitus Handicap Inventory and Tinnitus Functional Index

Objective The minimal clinically important difference (MCID) represents the smallest change in treatment outcome deemed clinically meaningful. This study estimates the MCID for 2 widely used tinnitus measures: the Tinnitus Handicap Inventory (THI) and the Tinnitus Functional Index (TFI), using anchor-based approaches while accounting for baseline severity and time interval. Study Design A multi-center randomized clinical trial. Setting European tinnitus centers. Methods Anchor-based approaches, including the effect size, receiver-operating characteristics, and ΔTHI/TFI methods, were employed to determine the MCID. The “minimally improved” category of the Clinical Global Impression Scale-Improvement (CGI-I) served as the anchor. The standard error of measurement was used to assess random variation. Results For the THI, MCID estimates ranged from 7.8 to 12, with a point estimate of 11 after 12 weeks of treatment (N = 364). For the TFI, MCID estimates ranged from 7.3 to 9.4, with a point estimate of 9 points after 12 weeks (N = 359). Both measures indicated that higher baseline severity and longer time intervals required greater score reduction for clinical relevance. Conclusion This study highlights the context-specific nature of MCID values for tinnitus measures and emphasizes the need for consensus on optimal anchor-based approaches to improve comparability

Are multiple limb injuries in severely injured patients negligible? Evaluation of progression and outcome using a new scoring system for extremity injury: the Extremity Severity Score (ESS)

Introduction Extremity injuries appear to have less impact on the mortality of multiple trauma patients (ISS ≥ 16). The Primary Survey of the Advanced Trauma Life Support (ATLS) only lists pelvic and femur fractures among the extremity injuries. The aim of this study was to evaluate the role of multiple extremity injuries in terms of lethality, progression, and complications in multiple trauma patients and the actual influence of concomitant blood loss. The Extremity Severity Score (ESS) was developed as a central instrument for this purpose. Material & methods This investigation is a retrospective single center study at a Level I trauma center over the period 2008–2019. The study cohort was identified as patients who met an Injury Severity Score (ISS) of at least 16. People who were < 16 years old at the time of the accident, patients who were primarily treated in other hospitals or transferred directly from the trauma bay, and cases without a Revised Injury Severity Classification Score 2 (RISC2) were excluded. Similar to the calculation of the ISS or NISS, the three most severe limb injuries (including the bony pelvis, corresponding to the ISS region of the extremities) were squared and added together to calculate the ESS. The study cohort was divided into the groups ESS ≥ 16 and ESS < 16 and these were examined with regard to the primary endpoint of lethality and several secondary endpoints. In addition to the univariate analysis of the data set, a logistic regression model was calculated. Results Out of 3.101 cases 1.227 patients and 5.824 extremity injuries met the inclusion criteria. Both unadjusted lethality and Standardized Mortality Rate (SMR) were not significantly different for the EES  0.05). Patients in both groups died most frequently from Traumatic Brain Injury (TBI) (72.9%/47.4%), followed by exsanguination (9.8%/19.3%) and Multi Organ Failure (MOF) (6.8%/17.5%). More patients in the ESS ≥ 16 group died of exsanguination (4.6% vs. 23.1%, p = 0.007), while patients in the ESS < 16 group died more frequently of TBI (77.0% vs. 30.8%, p = 0.002). For the secondary endpoints, there were significantly more surgical interventions (2.5 vs. 7.6, p ≤ 0.001), an increased blood transfusion rate (20.3% vs. 50.6%, p ≤ 0.001) and longer ICU (8.9 d vs. 12.1d, p ≤ 0.001) and total hospital stay (8.9 d vs. 12.1 d, p ≤ 0.001) for the ESS ≥ 16 group. Conclusion In this study multiple severe extremity injuries did not influence lethality but the clinical course. ATLS is right for the first moment. However, treating more extremity injuries requires more resources. The result of comparable lethality can only be achieved, if a hospital can provide these resources for this vulnerable patient group. Patients with injuries to several extremities therefore still require special attention

Performance of Ultra-High-Frequency Ultrasound in the Evaluation of Skin Involvement in Systemic Sclerosis: A Cross-Sectional Pilot Study

Objective: The aim of this study was to assess the performance and feasibility of ultra-high-frequency ultrasound (UHF-US) in clinical practice for measuring skin thickness in patients with systemic sclerosis (SSc) compared to age- and sex-matched controls. Materials and Methods: A total of 14 patients with SSc and 14 healthy controls (HCs) were enrolled in the study. All subjects underwent US evaluation of the epidermis, dermis and cutis by three experts in the 17 sites of the modified Rodnan skin score (mRSS). All the sonographers were blinded to the mRSS, which was assessed by an experienced rheumatologist who was not involved in, and blinded to, the US assessment. Results: In comparison to HCs, dermal thickness was significantly higher in patients at six sites: the right (p < 0.001) and left (p = 0.001) finger; right (p = 0.027) and left (p = 0.048) hand; left foot (p = 0.010) and face (p < 0.001). The epidermal layer did not differ significantly. At all mRSS sites except for the chest, there were moderate to strong positive correlations between US-assessed dermal thickness and local mRSS. The interobserver reliability for all sites of the mRSS, with the exception of the face, was good to excellent (with an intraclass correlation coefficient [ICC] ranging from 0.724 to 0.939). Conclusions: These data support the use of UHF-US as an objective and reliable tool for the assessment of skin involvement in patients with SSc. Considering its feasibility in clinical practice, we suggest that US assessment of skin in patients with SSc should be restricted to the dermal layer of the fingers and hands, since they are the sites that skin fibrosis typically starts from

The (Statistical) Power of Incentives

I study the optimal design of monetary incentives in experiments where incentives are a treatment variable. I propose a novel framework called the Budget Minimization problem in which a researcher chooses the level of incentives that allows her to detect a predicted treatment effect while minimizing her expected budget. The Budget Minimization problem builds upon the power analysis and structural modeling. It extends the standard optimal design approach by explicitly incorporating the budget as a part of the objective function. I prove theoretically that the problem has an interior solution under fairly mild conditions. To showcase the practical applications of the Budget Minimization problem, I provide examples of its implementation in several well-known experiments. I also offer a practical guide to assist researchers in utilizing the proposed framework. The Budget Minimization problem contributes to the experimental economists’ toolkit for an optimal design, however, it also challenges some conventional design recommendations

Pharmaceutical potential of willow leaves in terms of salicylic alcohol content

Salicis cortex has analgesic, anti-inflammatory, antipyretic, and anti-rheumatic properties, primarily due to the content of salicylic alcohol derivatives (SAD) and other phenolic compounds. The Pharmacopoeia Europaea monographs willow bark and does not specify a particular species but requires a minimum content of 1.5 % SAD. This study aimed to determine whether the leaves of certain willow species could also be pharmaceutically relevant due to their SAD concentration, to identify species with high SAD levels, to figure out ideal harvest times, to investigate intraspecific variability, and to determine differences between the sexes in terms of SAD content, including less-studied species. Using a UPLC®-RP18-PDA method, 12 willow species with 42 individuals were analyzed. Concerning the average content of the entire observation period, the following species were identified as particularly SAD-rich (mean ± standard deviation): S. purpurea (6 ± 4 %), S. aurita (3 ± 4 %), S. fragilis (3.2 ± 2.3 %), S. cinerea (2.5 ± 3.0 %), and S. lapponum (1.7 ± 1.4 %). S. daphnoides (0.11 ± 0.20 %) and S. caprea (0.08 ± 0.21 %) are displayed as SAD-poor species. Statistical analysis revealed a slight intraspecific variation, but the interspecific variability of the SAD content was higher. The SAD values were significantly higher in mid- and late summer, except for S. purpurea (May) and S. caesia (June), as well as in 2019 compared to 2018. Moreover, no significant effect of sex could be detected. Considering the high costs of producing willow bark extracts, supplementing with willow leaves, particularly from SAD-rich species and genotypes, could be beneficial

Layer-selective spin-orbit coupling and strong correlation in bilayer graphene

Spin-orbit coupling (SOC) and electron-electron interaction can mutually influence each other and give rise to a plethora of intriguing phenomena in condensed matter systems. In pristine bilayer graphene (BLG), which has weak SOC, intrinsic Lifshitz transitions and concomitant van-Hove singularities lead to the emergence of many-body correlated phases. Layer-selective SOC can be proximity induced by adding a layer of tungsten diselenide (WSe2) on its one side. By applying an electric displacement field, the system can be tuned across a spectrum wherein electronic correlation, SOC, or a combination of both dominates. Our investigations reveal an intricate phase diagram of proximity-induced SOC-selective BLG. Not only does this phase diagram include those correlated phases reminiscent of SOC-free doped BLG, but it also hosts unique SOC-induced states allowing a compelling measurement of valley g-factor and a correlated insulator at charge neutrality, thereby showcasing the remarkable tunability of the interplay between interaction and SOC in WSe2 enriched BLG