From Genocide to Cultural Genocide, Ethnocide, Ethnic Cleansing (and Denazification)

This paper discusses the complexity of the legal debate that arises defining geno-cide, cultural genocide, ethnocide, or ethnic cleansing. The definitions will differ depending on the discipline from where they are taken, even within the law itself, resulting in conceptual chaos. Cultural genocide appeared in the legal discourse, after the definition given to genocide by the 1948 Convention, followed by ethnocide in the context of the struggle of Indigenous peoples for their rights and that of ethnic cleansing in the context of the conflict in the former Yugoslavia. This expression is incorporated into the law because of its use as an expression in colloquial language, devoid of a technical meaning. This has given rise to clarifications by jurisprudence. Together with these locutions, similar terms make their reappearance, such as dena-zification, the meaning of which – for the time being – has not yet been clarified by the law.El presente trabajo tiene como objetivo traer al debate jurídico la complejidad surgida al definir las categorías jurídicas de genocidio, genocidio cultural, etnocidio o limpieza étnica. Las definiciones difieren según la disciplina de la que procedan, incluso dentro del propio Derecho, lo que da lugar confusiones. El genocidio cultural apareció en el discurso legal tras la definición dada al genocidio por la Convención de 1948, la de etnocidio reapareció en el marco de la lucha de los pueblos indígenas por sus derechos y la de limpieza étnica, con el conflicto en la ex Yugoslavia. Esta locución ha sido incorporada al Derecho como expresión del lenguaje coloquial carente de significado técnico, dando lugar a precisiones por parte de la jurisprudencia que la alejan y la acercan a la del genocidio. Junto a ellos, aparece hoy la de des-nazificación, cuyo significado aún no ha sido precisado por el Derecho

Los pueblos indígenas y la protección del medioambiente: la indigenización del derecho internacional, derechos bioculturales y derechos de la naturaleza

En el presente trabajo se analiza la relación “pueblos indígenas y medio ambiente” desde la perspectiva de la aportación de estos pueblos a la protección y cuidado de aquel y al reconocimiento de este hecho, tanto en los textos internacionales de medio ambiente como en la jurisprudencia. Se exponen, así, tanto los cuerpos normativos que constatan la contribución a aquella, como aquellas sentencias que resaltan positivamente que el respeto a sus derechos redunda en beneficio del medio, al comprobarse el papel que realizan como guardianes de la naturaleza. Esto ha conducido a que en el debate jurídico se trate la cuestión de los derechos bioculturales y, más allá, de los derechos de la naturaleza, donde aparece con fuerza el complejo dilema antropocentrismo y ecocentrismo

The use (and abuse) of indigenous peoples' ancestral lands for economic reasons: between human rights violations and international crimes

The expression "serious human rights violations" is frequently used in connection with "international crimes" in both doctrine and jurisprudence. Indigenous peoples and communities have been, and are, victims of actions brought before international bodies and courts for the protection of human rights, but in the International Criminal Court, however, to date, and despite the fact that there has been no lack of actions, no response has been issued regarding the possibility of land grabbing for economic reasons constituting crimes against humanity as they have been qualified in the communications sent on the basis of Article 15 of the Rome Statute. The objective of this paper is not so much to analyze whether they constitute a crime as to analyze why after eight years there has been no response. That is, whether the necessary requirements for the Court to act have been met, which we consider from the perspective of both the Court and the indigenous communities. Thus, beyond the fact that it can be qualified as such, are the criteria set by the Court's policy regarding the selection and prioritization of cases in place?La expresión “graves violaciones de derechos humanos” aparece frecuentemente conectada con la de “crímenes internacionales” tanto en la doctrina como en la jurisprudencia. Los pueblos y comunidades indígenas han sido y son sujetos de acciones llevadas a cabo en instancias internacionales y tribunales de protección de derechos humanos, pero en el ámbito de la Corte Penal Internacional, sin embargo, hasta la fecha, y pese a que no han faltado acciones, no ha se ha emitido respuesta respecto a la posibilidad de que los acaparamientos de tierra por razones económicas constituyan crímenes de lesa humanidad tal y como han sido calificados en los escritos enviados en base al artículo 15 del Estatuto de Roma. El objetivo de este trabajo no es tanto el analizar si constituyen un determinado crimen sino el por qué transcurridos ocho años no existe respuesta alguna. Esto es, si se dan o no los requisitos necesarios para que la Corte actúe, lo que planteamos desde la perspectiva de la Corte como de las comunidades indígenas. Así, más allá de que pueda calificarse como tal, ¿se dan los criterios marcados por la política de la Corte en cuanto a la selección y priorización de casos

Globalización, globalización jurídica, global law y derecho internacional privado = Globalization, legal globalization, global law and private international law

Resumen: Globalización, Globalización jurídica y Global Law son conceptos y fenómenos frecuentes en el discurso jurídico actual. La diversidad y multiplicidad de las definiciones proporcionadas por la doctrina han provocado una confusión conceptual que dificulta precisar los términos del discurso, especialmente entre la teoría del Global Law y la de la Globalización jurídica. En este trabajo se tratan las dificultades existentes en torno a la creación de un Global Law, especialmente cuando se afirma el desgaste de relevancia del Derecho internacional público en razón de la pérdida del poder del Estado en favor de unos entes supuestamente creadores de un Derecho al margen de aquél. Además, la inevitable conexión entre Derecho y cultura e incluso la creación de esta idea desde el mundo jurídico occidental nos llevan a la conclusión de la inexistencia de un Derecho global. Se trata asimismo, finalmente, la cuestión de la Globalización jurídica en la Unión Europea y en especial respecto a su Derecho internacional privado. Palabras clave: cultura y derecho, Derecho Internacional Privado, Derecho de la Unión Europea, Global Law, globalización jurídica. Abstract: Globalization, legal globalization and Global Law are frequent concepts and phenomena in the current legal discourse. The diversity and the multiplicity of the definitions provided by the schol-ars have led to a conceptual confusion which arise of the difficulty specifiyng the terms of the discourse, especially between the theory of the Global Law and legal globalization. In this work, we study the difficulties surrounding the creation of a Global Law, especially when they argue a down-turn of the public international lawbased on the loss of the power of the State in favour of a few supposed entities making Law on the fringes of the states. In addition, the inevitable connection between law and culture and even the creation of this idea from the Western legal world lead us to the conclusion of the absence of a Global Law. Finally, we analyze the question of the legal globalization in the European Union and in particular with respect to its private international law.Keywords: culture and law, Private International Law, European Union Law, Global Law, legal globalization.do: https://doi.org/10.20318/cdt.2017.361

Effect of viral storm in patients admitted to intensive care units with severe COVID-19 in Spain: a multicentre, prospective, cohort study

Background: The contribution of the virus to the pathogenesis of severe COVID-19 is still unclear. We aimed to evaluate associations between viral RNA load in plasma and host response, complications, and deaths in critically ill patients with COVID-19. Methods: We did a prospective cohort study across 23 hospitals in Spain. We included patients aged 18 years or older with laboratory-confirmed SARS-CoV-2 infection who were admitted to an intensive care unit between March 16, 2020, and Feb 27, 2021. RNA of the SARS-CoV-2 nucleocapsid region 1 (N1) was quantified in plasma samples collected from patients in the first 48 h following admission, using digital PCR. Patients were grouped on the basis of N1 quantity: VIR-N1-Zero ([removed]2747 N1 copies per mL). The primary outcome was all-cause death within 90 days after admission. We evaluated odds ratios (ORs) for the primary outcome between groups using a logistic regression analysis. Findings: 1068 patients met the inclusion criteria, of whom 117 had insufficient plasma samples and 115 had key information missing. 836 patients were included in the analysis, of whom 403 (48%) were in the VIR-N1-Low group, 283 (34%) were in the VIR-N1-Storm group, and 150 (18%) were in the VIR-N1-Zero group. Overall, patients in the VIR-N1-Storm group had the most severe disease: 266 (94%) of 283 patients received invasive mechanical ventilation (IMV), 116 (41%) developed acute kidney injury, 180 (65%) had secondary infections, and 148 (52%) died within 90 days. Patients in the VIR-N1-Zero group had the least severe disease: 81 (54%) of 150 received IMV, 34 (23%) developed acute kidney injury, 47 (32%) had secondary infections, and 26 (17%) died within 90 days (OR for death 0·30, 95% CI 0·16–0·55; p<0·0001, compared with the VIR-N1-Storm group). 106 (26%) of 403 patients in the VIR-N1-Low group died within 90 days (OR for death 0·39, 95% CI 0·26–0·57; p[removed]11 página

Effect of viral storm in patients admitted to intensive care units with severe COVID-19 in Spain: a multicentre, prospective, cohort study

Background: The contribution of the virus to the pathogenesis of severe COVID-19 is still unclear. We aimed to evaluate associations between viral RNA load in plasma and host response, complications, and deaths in critically ill patients with COVID-19. Methods: We did a prospective cohort study across 23 hospitals in Spain. We included patients aged 18 years or older with laboratory-confirmed SARS-CoV-2 infection who were admitted to an intensive care unit between March 16, 2020, and Feb 27, 2021. RNA of the SARS-CoV-2 nucleocapsid region 1 (N1) was quantified in plasma samples collected from patients in the first 48 h following admission, using digital PCR. Patients were grouped on the basis of N1 quantity: VIR-N1-Zero (2747 N1 copies per mL). The primary outcome was all-cause death within 90 days after admission. We evaluated odds ratios (ORs) for the primary outcome between groups using a logistic regression analysis. Findings: 1068 patients met the inclusion criteria, of whom 117 had insufficient plasma samples and 115 had key information missing. 836 patients were included in the analysis, of whom 403 (48%) were in the VIR-N1-Low group, 283 (34%) were in the VIR-N1-Storm group, and 150 (18%) were in the VIR-N1-Zero group. Overall, patients in the VIR-N1-Storm group had the most severe disease: 266 (94%) of 283 patients received invasive mechanical ventilation (IMV), 116 (41%) developed acute kidney injury, 180 (65%) had secondary infections, and 148 (52%) died within 90 days. Patients in the VIR-N1-Zero group had the least severe disease: 81 (54%) of 150 received IMV, 34 (23%) developed acute kidney injury, 47 (32%) had secondary infections, and 26 (17%) died within 90 days (OR for death 0·30, 95% CI 0·16-0·55; p<0·0001, compared with the VIR-N1-Storm group). 106 (26%) of 403 patients in the VIR-N1-Low group died within 90 days (OR for death 0·39, 95% CI 0·26-0·57; p<0·0001, compared with the VIR-N1-Storm group). Interpretation: The presence of a so-called viral storm is associated with increased all-cause death in patients admitted to the intensive care unit with severe COVID-19. Preventing this viral storm could help to reduce poor outcomes. Viral storm could be an enrichment marker for treatment with antivirals or purification devices to remove viral components from the blood.This work was supported by grants from the Instituto de Salud Carlos III (FONDO-COVID19, COV20/00110, CIBERES, 06/06/0028; AT), Proyectos de Investigación en Salud (PI19/00590; JFB-M), Miguel Servet (CP20/00041; DdG-C), Sara Borrell (CD018/0123; APT), and Predoctorales de Formación en Investigación en Salud (FI20/00278; AdF). We also received funds from Programa de Donaciones Estar Preparados, UNESPA (Madrid, Spain), and from the Canadian Institutes of Health Research (CIHR OV2–170357; DJK and JFB-M), Research Nova Scotia, Li-Ka Shing Foundation (DJK), and finally by a Research Grant 2020 from ESCMID (APT). COV20/00110, PI19/00590, CP20/00041, CD018/0123, FI20/00278 were co-funded by European Regional Development Fund and European Social Fund (A way to make Europe, and Investing in your future). We thank the IRB-Lleida Biobank 119 (B.0000682) and Plataforma Biobancos PT17/0015/0027 in Lleida, the Hospital Clinic Barcelona (HCB)-IDIBAPS biobank in Barcelona, and the National DNA Bank and the Hospital Universitario de Salamanca biobank (both in Salamanca) for their logistical support with sample processing and storage. We are indebted to the Fundació Glòria Soler for its contribution and support to the COVIDBANK of HCBIDIBAPS Biobank. This work was not supported by any pharmaceutical company or other agency.S

Plan gallego de hospitalización a domicilio. Estrategia HADO 2019-2023

Documento estratéxico que pretende potenciar e consolidar a hospitalización a domicilio como un modelo asistencial do Servizo Galego de Saúde e garantir o seu desenvolvemento nos próximos seis anos, establecendo criterios homoxéneos de atención coa finalidade de normalizar os modelos asistenciais, carteira de servizos e fluxos de traballo para asegurar una asistencia sanitaria de calidadeDocumento estratégico que pretende potenciar y consolidar la hospitalización a domicilio como un modelo asistencial del Servicio Gallego de Salud y garantizar su desarrollo en los próximos seis años, estableciendo criterios homogéneos de atención con la finalidad de normalizar los modelos asistenciales, cartera de servicios y flujos de trabajo para asegurar una asistencia sanitaria de calida

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio