The MDGs, Archeology, Institutional Fragmentation and International Law

INTRODUCTION When considering the Millennium Development Goals (MDGs) the first characteristic that struck me was the fact that the goals and targets were not new, when endorsed by world leaders in 2000. Upon further consideration, especially of documents related to the implementation of the MDGs a second characteristic emerged: the integrated approach that relevant documents adopt towards development, often accompanied by the assertion that the MDGs embody basic human rights. The first characteristic – not new – prompted me to engage in some archeological research. The findings of that research led to the following question. Why have we not done better, given that the MDGs have been part of human rights law for six decades? This essay points to the fragmented nature of the international institutional framework – or international governance structure – as a factor that has contributed to our failure. This fragmented institutional setting – also not new – has led to a fragmented approach to international law. Finally, this essay considers how international law, despite its fragmented nature, might further the integrated approach evident from the MDGs. In this essay I assume that the fragmented nature of the international institutional framework is unlikely to undergo significant change in the near future, given the limited outcome of the 2005 World Summit in this respec

Introduction: The Possibilities of Comparative Law Methods for Research on the Rule of Law in a Global Context

Since its rise at the beginning of the twentieth century, comparative legal research has gained an influential place in legal research concerning national legal systems. Comparative legal methodology is used to acquire insight into foreign legal systems, to find solutions for problems of a specific legal system, or to promote the unifi cation of law between national legal systems. Its methods consist of a comparison of different legal systems or legal traditions (external comparison), or of fields of law within national legal systems (internal comparison). With the proliferation of regulatory regimes at the international level (e.g. in the context of the United Nations or the WTO), comparative legal research has expanded its focus to include international law. Consensus, however, has not been reached on the most suitable way of applying comparative law methods to the global context. Can the concepts and methods developed to conduct comparative legal research of national legal systems be transposed to study the international legal system? In this issue of Erasmus Law Review, a number of scholars with different legal backgrounds reflect on these questions

Introduction: Public Values and Public Participation in Decision-Making in Times of Privatisation

__Abstract__ Privatisation poses challenges to the manner in which public values, such as accessibility, affordability, reliability, safety and sustainability, can be secured. In liberal societies the state, legitimised through democratic elections (input legitimacy) and the rule of law upheld by courts (output legitimacy), was traditionally regarded as the entity responsible for securing such values – although these values were perceived rather thinly. During the second half of the 20th century, with the role of the state expanding and public values conceived more thickly, the perception emerged that democratic elections and courts upholding the rule of law were not sufficient for legitimising the exercise of public power by states and that concerned members of the public should play a direct role in securing public values. As a result, public participation in the national context – here defined as consisting of the following elements: transparency (including access to information), public participation in decision-making, and access to courts or court-like institutions – emerged as a tool for securing public values, as well as checking, and thereby legitimising (input legitimacy), the exercise of public power by the state

Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes

Background The first epidemic wave of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over one-third of care homes reported an outbreak, while there was limited testing of hospital patients discharged to care homes. Aim To investigate patients discharged from hospitals as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. Methods A clinical review was performed for all patients discharges from hospitals to care homes from 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease 2019 (COVID-19) test history, clinical assessment at discharge, whole-genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis using Cluster Investigation and Virus Epidemiological Tool software. Patient timelines were obtained using electronic hospital records. Findings In total, 787 patients discharged from hospitals to care homes were identified. Of these, 776 (99%) were ruled out for subsequent introduction of SARS-CoV-2 into care homes. However, for 10 episodes, the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data were available. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission, leading to 10 positive cases in their care home. Conclusion The majority of patients discharged from hospitals were ruled out for introduction of SARS-CoV-2 into care homes, highlighting the importance of screening all new admissions when faced with a novel emerging virus and no available vaccine

SARS-CoV-2 Omicron is an immune escape variant with an altered cell entry pathway

Vaccines based on the spike protein of SARS-CoV-2 are a cornerstone of the public health response to COVID-19. The emergence of hypermutated, increasingly transmissible variants of concern (VOCs) threaten this strategy. Omicron (B.1.1.529), the fifth VOC to be described, harbours multiple amino acid mutations in spike, half of which lie within the receptor-binding domain. Here we demonstrate substantial evasion of neutralization by Omicron BA.1 and BA.2 variants in vitro using sera from individuals vaccinated with ChAdOx1, BNT162b2 and mRNA-1273. These data were mirrored by a substantial reduction in real-world vaccine effectiveness that was partially restored by booster vaccination. The Omicron variants BA.1 and BA.2 did not induce cell syncytia in vitro and favoured a TMPRSS2-independent endosomal entry pathway, these phenotypes mapping to distinct regions of the spike protein. Impaired cell fusion was determined by the receptor-binding domain, while endosomal entry mapped to the S2 domain. Such marked changes in antigenicity and replicative biology may underlie the rapid global spread and altered pathogenicity of the Omicron variant

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