Prosecuting Mass Atrocities at the Extraordinary Chambers in the Courts of Cambodia (ECCC)

After a lapse of nearly a quarter century, the United Nations and the Cambodian government agreed in 2003 to establish a hybrid internationalised domestic tribunal in an effort to address the legacy of impunity left in the wake of the Khmer Rouge regime. Several features make the Khmer Rouge Tribunal a unique experiment in international justice. It is the first internationalised court to seat a majority of judges from the affected nation. It is the first hybrid court to be established using a primarily civil law framework. Consequently, it was also the first to accord a central role to victims, who can join the proceedings as civil parties

Diverse Patient Perspectives on the Use of Artificial Intelligence for Healthcare Decisions

Importance: Artificial intelligence (AI) has the potential to improve diagnostic accuracy and treatment efficacy. Yet people are often reluctant to trust automated systems, and some patient populations may be particularly distrusting of healthcare innovations. Objective: To determine how diverse patient populations feel about the use of AI diagnostic tools, and whether framing the choice around proven accuracy, lack of bias, or other factors affects uptake. Design: After structured interviews with diverse actual patients, a randomized, blinded survey experiment placed respondents as mock patients into clinical vignettes and manipulated eight variables in factorial design. Each respondent viewed one vignette where their primary care physician (PCP) presented the choice of referral to a specialist clinic operated by an AI or human physician. Setting: Internet-based survey experiment

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons