Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5–10 years, 10–20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system

SYMPOSIUM ON B.S. CHIMNI, “CUSTOMARY INTERNATIONAL LAW: A THIRD WORLD PERSPECTIVE” “CUSTOMARY INTERNATIONAL LAW: A THIRD WORLD PERSPECTIVE”: REFLECTIONS IN LIGHT OF AN APPROACH TO CIL BASED ON FUNDAMENTAL ETHICAL PRINCIPLES

B.S. Chimni’s stimulating article makes an important contribution to the burgeoning literature on customary international law (CIL) by examining CIL from the perspective of developing states, a perspective underrepresented in this literature. His article articulates well many valid points about the sociohistorical biases of CIL. At the same time, there may be reasons for more optimism than Chimni appears to possess about the ability of CIL to serve global interests, including those of the ThirdWorld. Furthermore, some of Chimni’s proposals merit further refinement. In this essay I propose to evaluate the strengths and potential shortcomings of Chimni’s arguments in light of an approach to CIL that I have developed that is based on fundamental ethical principles recognized in international law. After laying out an alternative theory that still has many resonances with Chimni’s proposals, I discuss critically three of the key theses articulated by Chimni: First, that CIL is inherently colonialist and inconsistent with the values of Third World peoples; second, that even contemporary customary international human rights law (IHRL) is a means of furthering global capitalism to the detriment of Third World peoples; and third, that the remedy for CIL’s biases lies in the creation of a “postmodern” doctrine of CIL that incorporates reference to the “juridical conscience of humankind.

Novos Desenvolvimento no Direito Internacional dos Direitos Humanos: Suas Fontes, História e Instituições

NOVOS DESENVOLVIMENTOS NO DIREITO INTERNACIONAL DOS DIREITOS HUMANOS: SUAS FONTES, HISTÓRIA E INSTITUIÇÕES NEW DEVELOPMENTS IN INTERNATIONAL HUMAN RIGHTS LAW: ITS SOURCES, HISTORY AND INSTITUTIONS  Brian D. Lepard* RESUMO: Este artigo revisa as bases do direito internacional sobre os direitos humanos e as instituições que tentam implementá-lo. Ele apresenta as fontes principais do direito internacional geral, incluso do direito internacional dos direitos humanos. Posteriormente, ele revê a evolução do direito internacional sobre os direitos humanos e os processos pelos quais este direito é criado, interpretado, aplicado, implementado, e às vezes feito cumprir.  O artigo explora também as instituições internacionais que visam à promoção do direito internacional dos direitos humanos.  Tomando em conta esta revisão, ele considera o futuro incerto do direito internacional dos direitos humanos e das instituições que o promovem à luz de desenvolvimentos políticos e sociais contemporâneos que criam muitos desafios, incluindo o populismo e o nacionalismo. O artigo avalia em particular o funcionamento e o futuro do Conselho dos Direitos Humanos das Nações Unidas. Finalmente, ele propõe uma nova abordagem a estes problemas e discute o potencial de um princípio ético de “unidade em diversidade” para iluminar o caminho a seguir.  PALAVRAS-CHAVE: Direitos Humanos, Direito Internacional, Nações Unidas, Conselho dos Direitos Humanos ABSTRACT: This article reviews the bases of international human rights law and the institutions that attempt to implement it. It presents the principal sources of general international law, including international human rights law. Next, it reviews the evolution of international human rights law and the processes by which this law is created, interpreted, applied, implemented, and sometimes enforced.  The article also explores the international institutions that pursue the promotion of international human rights law. Taking this review into account, it considers the uncertain future of international human rights law and the institutions that promote it in light of contemporary political and social developments that create many challenges, including populism and nationalism. The article assesses in particular the functioning and future of the United Nations Human Rights Council.  Finally, it proposes a new approach to these problems and discusses the potential of an ethical principle of “unity in diversity” to illuminate the way forward.   KEYWORDS: Human Rights, International Law, United Nations, Human Rights Council  SUMÁRIO: Introdução. 1 Um panorama geral das fontes do Direito Internacional dos Direitos Humanos 2 Um panorama geral da história do Direito Internacional dos Direitos Humanos 3 Instituições internacionais que visam à promoção do Direito Internacional dos Direitos Humanos 4 O futuro incerto do Direito Internacional dos Direitos Humanos e das instituições que o promovem  Conclusão Referências. * Harold W. Conroy Distinguished Professor of Law, University of Nebraska College of Law

SYMPOSIUM ON B.S. CHIMNI, “CUSTOMARY INTERNATIONAL LAW: A THIRD WORLD PERSPECTIVE” “CUSTOMARY INTERNATIONAL LAW: A THIRD WORLD PERSPECTIVE”: REFLECTIONS IN LIGHT OF AN APPROACH TO CIL BASED ON FUNDAMENTAL ETHICAL PRINCIPLES

B.S. Chimni’s stimulating article makes an important contribution to the burgeoning literature on customary international law (CIL) by examining CIL from the perspective of developing states, a perspective underrepresented in this literature. His article articulates well many valid points about the sociohistorical biases of CIL. At the same time, there may be reasons for more optimism than Chimni appears to possess about the ability of CIL to serve global interests, including those of the ThirdWorld. Furthermore, some of Chimni’s proposals merit further refinement. In this essay I propose to evaluate the strengths and potential shortcomings of Chimni’s arguments in light of an approach to CIL that I have developed that is based on fundamental ethical principles recognized in international law. After laying out an alternative theory that still has many resonances with Chimni’s proposals, I discuss critically three of the key theses articulated by Chimni: First, that CIL is inherently colonialist and inconsistent with the values of Third World peoples; second, that even contemporary customary international human rights law (IHRL) is a means of furthering global capitalism to the detriment of Third World peoples; and third, that the remedy for CIL’s biases lies in the creation of a “postmodern” doctrine of CIL that incorporates reference to the “juridical conscience of humankind.