Perspectives on Better Regulation in the EU. ZEI Discussion Paper C256 2019

For most people concerned with ensuring good governance, “Better Regulation” (BR) sounds like a nigh irresistible proposition. This is especially so when combined with a governmental pledge to be “big on big things, small on small things." Under different names, the core ideas behind BR have in fact been on the European agenda for several decades already. Initially, the recipes were formulated with relative ease, undergoing repeated refinements and adjustments over the years. As always, however, the proof of the pudding remains entirely in the eating: what have been the achievements of the BR program? Still today, alas, it does not seem appropriate to unfold a “mission accomplished!” banner

Judicial Activism in the European Court of Justice – The Case of LGBT Rights

Article published in the Michigan State International Law Review

Democratische politie

Als een fundamentele kracht binnen de democratische samenleving begeeft de politie zich vaak in een smalle doorsnede van het gezagsgetrouw handelen en het duurzame behoud van het vertrouwen van de burger. In navolging van Peter Manning’s bijdrage staat dit cahier stil bij de conceptuele invulling van het begrip ‘Democratic Policing’ en de manier waarop politiediensten democratische waarden onderschrijven binnen hun eigen organisatie en naar de burger toe. Daarbij zal dieper ingegaan worden op wat Manning (2010) het ‘difference principle’ noemt en hoe het gelijkheidsprincipe ook binnen de politiediensten zijn aandacht verdient. Politiediensten bezitten immers het monopolie van legaal geweld, met het oog op het garanderen van rechten en vrijheden in een democratische samenleving (Ponsaers, Devroe en Meert, 2006). We stellen ons dan ook de vraag of politiediensten, indien de noodzaak zich opdringt, ten opzichte van iedereen dezelfde mate van dwang gebruikt? En of sommige burgers meer nadeel ondervinden dan andere burgers? Daarnaast focust dit themanummer eveneens op de inconsistentie die Manning (2013) aanhaalt tussen de democratische waarden en de vrije marktideologie binnen de publieke diensten met nadruk op efficiëntie en effectiviteit. Concreet zal nagegaan worden hoe politiediensten toerekenbaar zijn en hoe zij zich verantwoordelijk stellen voor individuele en collectieve acties van haar personeel

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570