War Crimes and the Limits of Legalism

In April 1945, Sir John Simon, Britain\u27s Lord Chancellor, drew up a memorandum that was the last gasp in the diplomatic struggle against Nuremberg. Under American pressure, and despite British objections, the Allies were poised to agree to put the Axis leadership on trial for war crimes. In the kind of magnificent understatement that the British government could sometimes inadvertently achieve, it was entitled The Argument for Summary Process against Hitler & Co. The memorandum was a series of arguments to be used by the British delegation at the San Francisco conference in a last-ditch effort to win over the Americans and Soviets. Simon\u27s case was simple: the Nazi leaders deserved to be punished, but trials were not the way to do that. Simon feared that a trial of the Nazi leadership would drag on, wear out public interest, unearth embarrassing facts, and allow the Nazis a final chance to make propaganda. The legal difficulties also seemed daunting. It would be nightmarish to merge the American, British, and Soviet legal traditions. Nor was it clear that aggression - which was to be the main charge at Nuremberg and the focus of the American prosecution - could be considered a war crime in any conventional sense. If the Nazi defense managed to score a few small victories, the trial might be denounced as a farce. So Simon had a simpler solution: avoid the niceties of a trial and just shoot the Nazi leaders. These arguments were to be quashed. Led by Henry Stimson, Franklin Roosevelt\u27s Secretary of War, the American government was determined to have sweeping trials for the Nazi war criminals. In the face of this, Britain decided not to push Simon\u27s argument any further but to acquiesce with the wishes of its more powerful American ally with as much good grace as could be mustered.2 Whether one agrees with them - and I don\u27t - Simon\u27s arguments were not weak ones. But they are strange to hear nevertheless. Nuremberg is seen in retrospect as so unimpeachable, an act of such extraordinary restraint and justice, that it is disturbing to hear that it was fought with such pragmatic objections. When considering a war crimes tribunal for the former Yugoslavia and then another one for Rwanda, the United Nations did not air such debates. To the contrary, there is a kind of orthodoxy in human rights circles that regards it as almost self-evident that war crimes deserve war crimes trials. So many of the arguments against war crimes trials have been made in bad faith - by apologists for Serb or Croat nationalists and Hutu genocidaires, who do not really question legalistic methods but the need for punishment itself - that it is easy to forget that there are some reasonable arguments made in good faith against the trials

Guest Artists Recital: Gary Karr, Double-Bass; Harmon Lewis, Piano; April 21, 1975

Hayden AuditoriumMonday EveningApril 21, 19758:30 p.m

Cholecystogastric fistula: a brief report and review of the literature.

Cholecystogastric fistula is a rare, life-threatening complication of cholelithiasis that presents a difficult challenge to the surgeon when it occurs in elderly and co-morbid patients. Following a case of a 68-year-old female who presented with a short history of epigastric pain and vomiting, and in whom a cholecystogastric fistula was identified on abdominal computed tomography and confirmed on upper gastrointestinal endoscopy, we performed a systematic review of the literature on the management of cholecystogastric fistula. Our patient underwent laparotomy without excision of the fistula nor cholecystectomy and had an uncomplicated post-operative course. Surgical management using an open approach remains the mainstay of treatment of cholecystogastric fistula although laparoscopic techniques are used with increasing success. Surgical closure of the fistula is not always necessary. Improved surgical techniques including the use of laparoscopic surgery have led to improved outcomes in the management of cholecystogastric fistula

How to Measure Efficiency, Effectiveness, and Equity Within the Complex Role of Police in a Democratic Society: An ICURS Economics of Policing Study

Policing is complex. No easy measures exist for determining efficiency, effectiveness or equity in the overall economics of police service. Perhaps this is related to the fact that the debate on issues like core policing and tiered policing is both contentious and not well understood. For example, dealing with mental health issues in vulnerable communities may not be considered core policing in some discussions but it certainly remains an important element of and a key activity in contemporary policing. We are, nevertheless, making major advances in the 21st Century. Simple crime rate or response time measures have some meaning, but the multi-agency, multi-role character of policing calls for better measures that take into account the underlying public meaning of crime, the varying demands for police service in different jurisdictions, and the rapid increase in cyber crime

Nine quick tips for efficient bioinformatics curriculum development and training.

Biomedical research is becoming increasingly data driven. New technologies that generate large-scale, complex data are continually emerging and evolving. As a result, there is a concurrent need for training researchers to use and understand new computational tools. Here we describe an efficient and effective approach to developing curriculum materials that can be deployed in a research environment to meet this need

Day surgery in a teaching hospital: identifying barriers to productivity.

Introduction: Ambulatory surgery is a standard of care for many surgical procedures due to cost-effectiveness and benefits to patients including the reduced risk of contracting hospital infection by reducing the hospital stay. However, late cancellations can be costly. We examined the utilisation of the surgical day ward in our institution over a four-year period. Methods: A retrospective study of surgical day ward records from September 2007 to September 2011 in one institution. Parameters investigated included the number of planned admissions. Reasons for cancellations were also collected. Results: A total of 17,461 procedures were intended as a day ward admission during the study interval. There were 3,539 procedures that were cancelled (20.3%). The prevalent proportion of cancellations (n = 1,367) (38.6%) were due to patients not showing up for their procedures (7.8% of planned admissions); 1,188 (33.6%) patients were cancelled by the admissions office due to bed shortages, accounting for 6.8 % of planned admissions and 650 (18.4%) of cases were due to last minute cancellations by patients, accounting for 3.7% of all planned admission. The remaining 334 (9.4%) of cases were cancelled on medical grounds including patients who were considered unfit for the intended procedure, or anti-coagulations not appropriately ceased prior to surgery, accounting for 1.9% of all planned admissions. Conclusion: The cancellation rate in this study was high, mainly due to failure of patients to attend or signal their intentions, inadequate bed capacity and bed closure strategies. The ring fencing and protection of day beds and a more active patient management interaction would have had the greatest impact on increased efficiency

Healthcare worker competencies for disaster training

BACKGROUND: Although training and education have long been accepted as integral to disaster preparedness, many currently taught practices are neither evidence-based nor standardized. The need for effective evidence-based disaster training of healthcare staff at all levels, including the development of standards and guidelines for training in the multi-disciplinary health response to major events, has been designated by the disaster response community as a high priority. We describe the application of systematic evidence-based consensus building methods to derive educational competencies and objectives in criteria-based preparedness and response relevant to all hospital healthcare workers. METHODS: The conceptual development of cross-cutting competencies incorporated current evidence through a systematic consensus building process with the following steps: (1) review of peer-reviewed literature on relevant content areas and educational theory; (2) structured review of existing competencies, national level courses and published training objectives; (3) synthesis of new cross-cutting competencies; (4) expert panel review; (5) refinement of new competencies and; (6) development of testable terminal objectives for each competency using similar processes covering requisite knowledge, attitudes, and skills. RESULTS: Seven cross-cutting competencies were developed: (1) Recognize a potential critical event and implement initial actions; (2) Apply the principles of critical event management; (3) Demonstrate critical event safety principles; (4) Understand the institutional emergency operations plan; (5) Demonstrate effective critical event communications; (6) Understand the incident command system and your role in it; (7) Demonstrate the knowledge and skills needed to fulfill your role during a critical event. For each of the cross-cutting competencies, comprehensive terminal objectives are described. CONCLUSION: Cross-cutting competencies and objectives developed through a systematic evidence-based consensus building approach may serve as a foundation for future hospital healthcare worker training and education in disaster preparedness and response

Patient-reported outcome measures (PROMs) after laparoscopic cholecystectomy: systematic review

BACKGROUND: Healthcare requires patient feedback to improve outcomes and experience. This study undertook a systematic review of the depth, variability, and digital suitability of current patient-reported outcome measures (PROMs) in patients undergoing laparoscopic cholecystectomy. METHODS: A PROSPERO-registered (registration number CRD42021261707) systematic review was undertaken for all relevant English language articles using PubMed version of MEDLINE, Scopus, and Web of Science electronic databases in June 2021. The search used Boolean operators and wildcards and included the keywords: laparoscopic cholecystectomy AND patient outcome OR patient-reported outcome OR patient-reported outcome measure OR PRO OR PROM. Medical Subjects Heading terms were used to search PubMed and Scopus. Articles published from 1 January 2011 to 2 June 2021 were included. RESULTS: A total of 4960 individual articles were reviewed in this study, of which 44 were found to evaluate PROMs in patients undergoing laparoscopic cholecystectomy and underwent methodological index for non-randomized studies (MINORS) grading. Twenty-one articles spanning 19 countries and four continents met all inclusion criteria and were included in the qualitative data synthesis. There was significant heterogeneity in PROMs identified with eight different comprehensive PROM tools used in the 21 studies. There was wide variation in the time points at which PROMs were recorded. Fourteen of 21 studies recorded PROMs before and after surgery, and 7 of 21 recorded PROMs only after surgery. Follow-up intervals ranged from 3 days to 2 years after surgery. CONCLUSIONS: This study identified that while post-laparoscopic cholecystectomy PROMs are infrequently measured currently, tools are widely available to achieve this in clinical practice. PROMs may not capture all the outcomes but should be incorporated into future cholecystectomy outcome research. The EQ-5D™ (EuroQoL Group, Rotterdam, the Netherlands) provides a simple platform for the modern digital era