Global Governance and Democracy : Democratization of Global Governance Processes

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Global governance cannot be understood as a single clear project above globalization. Instead there are several global governance mechanisms or processes. The relative democracy of these processes can be systematically evaluated based on a certain criteria. Thus, these mechanisms or processes can then also be democratized. Democratization is largely a matter of progressive inclusion of various groups and categories of people in political life. In the context of this study, democratization refers to increased levels of participation and creation of more inclusive global governance. The study begun with the basic assumption that there is a democratic deficit in current global governance. The aim was to find out what types of solutions to this deficit could be outlined through the Doha-Monterrey-Johannesburg-process, and if the process itself was an indication of a futuristic change, in terms of international relations a signal, of a more democratic phase in the conduct of international relations and global governance. The theoretical framework comprized of key conceptual considerations and two, state-centric and pluralist, approaches to global governance. The documented material was analyzed through the concept of participation. The results of the case study show that the Doha-Monterrey-Johannesburg-process has indicated creation of more inclusive global governance. In terms of participation it has indicated increased democracy on two accounts. First, it has meant gearing up the participatory mechanisms, technical assistance and capacity-building, aimed towards more equal participation of the developing countries in global policy-making. Second, the Doha-Monterrey-Johannesburg process has meant further pluralization of global governance by involving non-governmental actors, like non-governmental organizations, in the global governance processes through consultation, multi-stakeholder dialogue and partnership programs.Globalisaation hallintaa ei voida ymmärtää yhtenä selvänä projektina, jonka avulla globalisaatiota voitaisi hallita ikäänkuin ylhäältä käsin. Sen sijaan on olemassa erilaisia globaaleja hallintamekanismeja ja prosesseja, joiden suhteellista demokraattisuutta voidaan arvioida systemaattisesti tiettyjen kriteereiden pohjalta ja joita tyypillisesti voidaan myös demokratisoida. Demokratisaatiossa on kyse pitkälti progressiivisesta inkluusiosta, jonka avulla eri ryhmittymiä otetaan mukaan poliittiseen päätöksentekoon. Tutkimuksen perusoletus oli, että tämänhetkiseen globaaliin hallintaan liittyy demokratia vaje. Tavoitteena oli selvittää minkälaisia ratkaisuja tuohon demokratia vajeeseen olisi mahdollista löytää tarkastelemalla Doha-Monterrey-Johannesburg-prosessia, ja onko prosessi itsessään mahdollinen singnaali demokraattisemmasta vaiheesta kansainvälisessä päätöksenteossa. Tutkimuksen teoreettinen viitekehys muodostui keskeisistä käsitteistä ja kahdesta, valtiokeskeisestä ja pluralistisesta, lähestymistavasta globaaliin hallintaan. Tutkimuksen dokumenttiaineistoa tarkasteltiin osallistumisen käsitteen kautta. Tapaustutkimuksen tutkimustulokset osoittavat, että Doha-Monterrey-Johannesburg-prosessi on merkinnyt inklusiivisemman globaalin hallinnan syntymistä. Osallistumisen käsitteen kautta arvioituna, prosessi on osoittanut globaalin hallinnan demokratisaatiota kahdella eri tavalla: Ensiksi, se on merkinnyt kehitysmaiden tasa-arvoisemman osallistumisen edistämistä teknisen avun ja kapasiteetin luomisen avulla. Toiseksi, prosessi on merkinnyt globaalin hallinnan pluralisoitumista. Dialogin ja uusien kumppanuusohjelmien myötä myös kansalaisyhteiskunnan ja erityisesti kansalaisjärjestöjen rooli globaalissa hallinnassa on korostunut

Percutaneous stenting of a dissected superior mesenteric artery in a patient with previous surgical repair of Stanford type a aortic dissection

Background/Aim: We report a case of a 54-year-old male patient with background history of hypertension, which suffered a Stanford type A thoraco-abdominal aortic dissection with extension to the visceral arteries. Description of case: The patient initially underwent surgical repair with replacement of the ascending aorta and of the hemiarch in the acute phase of the dissection. Postoperatively, he developed non-specific abdominal pain that was not related to meals but led to weight loss of 20 kg within the first five post-operative months. Follow-up computerized tomography scan revealed a chronic subphrenic aortic dissection extending to the celiac axis (with involvement of the left gastric and the splenic artery), the left renal artery and the superior mesenteric artery (SMA). The hepatic artery took origin from the SMA and received blood from the true lumen of the vessel, and the right renal artery was entirely supplied from the true aortic lumen. After exclusion of other causes of abdominal pain, the patient was treated with percutaneous stent placement in the dissected SMA with significant improvement of his symptoms. Conclusion: This case report emphasizes the role of visceral artery endovascular techniques in the management of patients with complicated chronic aortic dissectio

Percutaneous Treatment of Malignant Jaundice Due to Extrahepatic Cholangiocarcinoma: Covered Viabil Stent Versus Uncovered Wallstents

To compare clinical effectiveness of Viabil-covered stents versus uncovered metallic Wallstents, for palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, 60 patients were enrolled in a prospective and randomized study. In half of the patients a bare Wallstent was used, and in the other half a Viabil biliary stent. Patients were followed up until death. Primary patency, survival, complication rates, and mean cost were calculated in both groups. Stent dysfunction occurred in 9 (30%) patients in the bare stent group after a mean period of 133.1 days and in 4 (13.3%) patients in the covered stent group after a mean of 179.5 days. The incidence of stent dysfunction was significantly lower in the covered stent group (P = 0.046). Tumor ingrowth occurred exclusively in the bare stent group (P = 0.007). Median survival was 180.5 days for the Wallstent and 243.5 days for the Viabil group (P = 0.039). Complications and mean cost were similar in the two groups. Viabil stent-grafts proved to be significantly superior to Wallstents for the palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, with comparable cost and complication rates. Appropriate patient selection should be performed prior to stent placement

Osseous changes following reverse total shoulder arthroplasty combined with latissimus dorsi transfer: a case series

Background: This is the first report on the incidence of proximal humerus osseous changes and associated clinical consequences in reverse total shoulder arthroplasty combined with a latissimus dorsi tendon transfer (RTSA+LDT). Methods: A multicenter, retrospective review identified all patients who had undergone a primary RTSA+LDT and had at least 3-month radiographic follow-up between 2012 and 2017. Data collection included demographics, oral steroid use, repair technique for LDT fixation, radiographic humeral osseous changes, complications, and need for revision surgery. Results: Twenty-four patients were included with an average age of 70.7 ± 7.9 years and follow-up of 16.3 (3-50) months. Ten patients (41.7%) developed osseous changes at the transfer location. There was no increased risk of developing osseous changes based on the surgical fixation technique (P = .421). Average time to earliest radiographic detection of osseous changes was 2.7 ± 1.7 months, with all changes occurring at or before 6 months. Two patients developed proximal humerus fractures, of which 1 had osseous changes through which the fracture occurred. Discussion: RTSA+LDT may place the proximal humeral cortex at greater risk than previously described. Using a long-stem prosthesis in the setting of RTSA+LDT may limit the consequences of this complication

The Use of Preoperative Epoetin-α in Revision Hip Arthroplasty

PURPOSE: To evaluate the efficacy of preoperative epoetin-α on the revision hip arthroplasty patient. We hypothesized that epoetin-α will reduce blood transfusion. A pertinent review of the literature is provided. METHODS: Forty-six patients were retrospectively reviewed. Sixteen patients received epoetin-α. Patients were case matched by age, preoperative hemoglobin, surgery, gender, and BMI. The clinical triggers for blood transfusion during or after the procedure were determined based on peri- and postoperative hemoglobin levels, ASA score, and/or clinical symptoms consistent with anemia. Blood salvage was not used. RESULTS: Blood transfusion and length of stay were decreased in the epoetin-α group. Hemoglobin in the intervention group increased from 12.0 to 14.5, preoperatively. Patients who received epoetin-α were 0.78 (RR=0.225) times as likely to receive a transfusion. Number Needed to Treat (NNT) to avoid one allogeneic transfusion was 1.84. Age, Gender, BMI, ASA, total and hidden blood loss, preoperative Iron supplements, preop Hct, preop PLT, PT, PTT, and INR were similar. One (6.0%) patient developed an uncomplicated deep venous thrombosis in the intervention group. CONCLUSIONS: The mildly anemic revision hip arthroplasty patient is at increased risk for transfusion. Epoetin-α increased preoperative hemoglobin counts and reduced transfusions in this study; it also decreased patient length of hospital stay likely allowing for an earlier readiness to resume normal activities and/or meet short-term milestones. A randomized study to evaluate the direct and indirect costs of such a treatment methodology in the mildly anemic revision patient may be warranted

Techniques of biliary drainage for acute cholecystitis: Tokyo Guidelines

The principal management of acute cholecystitis is early cholecystectomy. However, percutaneous transhepatic gallbladder drainage (PTGBD) may be preferable for patients with moderate (grade II) or severe (grade III) acute cholecystitis. For patients with moderate (grade II) disease, PTGBD should be applied only when they do not respond to conservative treatment. For patients with severe (grade III) disease, PTGBD is recommended with intensive care. Percutaneous transhepatic gallbladder aspiration (PTGBA) is a simple alternative drainage method with fewer complications; however, its clinical usefulness has been shown only by case-series studies. To clarify the clinical value of these drainage methods, proper randomized trials should be done. This article describes techniques of drainage for acute cholecystitis

On Spanish Dvandva and its restrictions

As noted by Bauer, real dvandva compounds –that is, coordinative compounds that properly express the aggregation of two different entities, not the intersection of properties in one entity– are extremely rare in English or Spanish. This article explores the empirical domain of dvandva compounding in Spanish, and notes that they are productive when not used as heads within their phrases. We propose that the explanation for this is that Spanish can only productively build dvandva compounds using flat structures without internal hierarchy. This causes the compound to look externally for a head noun that defines the interpretation of the relation established between the two members of the dvandva. The proposal also explains why proper names is preferred in dvandva compounding, given that they do not denote properties