Limiting sovereignty and legitimising intervention

International law’s elevated focus on the protection of human rights has resulted in a shift from a purely state-centered body of law to one that is increasingly focused on individual rights. This has been accompanied by a shift away from the concept of sovereignty as protection against external interference, to one of sovereignty as responsibility. According to Anne Peters, sovereignty can no longer be regarded as the “first principle” of international law; rather “it should be seen to exist only in function of humanity.” While this is desirable, this article argues that it presents a rather utopian and unrealistic understanding of international law as it is currently formulated. To what extent has sovereignty been limited by human rights and what are the implications of this for non-intervention

Rationale and recommendations on decolonising the pedagogy and curriculum of the Law School at the University of Exeter

This report outlines the rationale behind and recommendations on the steps that need to be taken towards decolonising the Law School's pedagogy and curriculum. The reason is that we see decolonisation as not something that can be achieved but as an ongoing process. It concludes a two-year process of research and discussions involving a joint effort between staff and students. A rationale for a change in approach to both pedagogy and curriculum is presented together with recommendations and practical examples of how this might be achieved in modular teaching in the Law School

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Effects of a low‐energy diet with and without oat bran and olive oil supplements on body mass index, blood pressure, and serum lipids in diabetic women: A randomized controlled trial

Abstract Type 2 diabetes is an epidemic public health issue worldwide. It is common among adults and is more severe among overweight and obese subjects. This study was conducted to evaluate the effects of a low‐energy diet with and without oat bran and olive oil supplements on body mass index, blood pressure, and serum lipids in women with diabetes. It was conducted for three months among 78 participants after dividing them into six groups. Groups 2 to 6 were received low‐energy diet (1,600 kcal/day), with or without oat bran (10 g/day) and olive oil (5 g/day) supplements. Weight, height, blood pressure, and serum lipids were measured. A low‐energy diet with and without oat bran and olive oil supplements lowers body mass index in subjects by 0.9%–6.0% on average. It also lowers systolic and diastolic blood pressure by 1.0%–9.0% and 4.8%–12.6%, respectively. Serum triglycerides were declined in groups 2, 3, and 4 by 27.2%, 17.3%, and 1.7%, respectively, but not significantly. Total cholesterol was dropped significantly by 8.3% only when the low‐energy diet was used with oat bran supplement among obese subjects, while LDL cholesterol was dropped significantly by 20.0% only when it was used with oat bran and olive oil supplements among subjects with high serum triglycerides. Proper control of type 2 diabetes among overweight and obese adults is needed to control cardiovascular complications. This could be accomplished by following a low‐energy diet and incorporating healthy foods such as oat and olive oil into the usual diet

Short-term effect of soluble fiber in saturated and unsaturated fat diets on plasma glucose and lipids in patients with non-insulin dependent diabetes mellitus

In order to see the effect of high carbohydrate high soluble fiber diet with different or unsaturated fatty acids fat, in patients with non-insulin-dependent diabetes mellitus (NIDDM), twelve female patients were divided into two groups. For ten days the first group received a high carbohydrate high soluble fiber diet rich in unsaturated fatty acids (HCHFU) diet and the second group received a high carbohydrate high soluble fiber saturated fatty acids (HCHFS) diet. The study showed that both diets caused significant (p<0.05) reduction in the patients' weight, but there were no significant differences between the two diets in refer to their effects in the patients weight reduction. HCHFS and HCHFU diets reduced the level of fasting plasma glucose by 20.3% and 22.4% respectively. The effect of the HCHFS diets on fasting glucose level was significantly (p<0.05) higher than the effect of the HCHFU diets. The HCHFU and HCHFS diets reduced the plasma triglyceride level by 7.6% and 23.5% respectively. The level of triglyceride reduction was related to the starting level of triglyceride in the patients more than to the type of diet. Although, there were some effects of the diets on the different types of lipids and cholesterol, the study was unable to confirm any significant difference between the HCHFU and HCHFS diets in their effect on the plasma cholesterol, LDL-Cholesterol and HDL-Cholesterol

Phospholipase A2 receptor 1 promotes lung cell senescence and emphysema in obstructive lung disease

International audienceBackground Cell senescence is a key process in age-associated dysfunction and diseases, notably chronic obstructive pulmonary disease (COPD). We previously identified phospholipase A2 receptor 1 (PLA2R1) as a positive regulator of cell senescence acting via Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signalling. Its role in pathology, however, remains unknown. Here, we assessed PLA2R1-induced senescence in COPD and lung emphysema pathogenesis. Methods We assessed cell senescence in lungs and cultured lung cells from patients with COPD and controls subjected to PLA2R1 knockdown, PLA2R1 gene transduction and treatment with the JAK1/2 inhibitor ruxolitinib. To assess whether PLA2R1 upregulation caused lung lesions, we developed transgenic mice overexpressing PLA2R1 ( PLA2R1 -TG) and intratracheally injected wild-type mice with a lentiviral vector carrying the Pla2r1 gene (LV- PLA2R1 mice). Results We found that PLA2R1 was overexpressed in various cell types exhibiting senescence characteristics in COPD lungs. PLA2R1 knockdown extended the population doubling capacity of these cells and inhibited their pro-inflammatory senescence-associated secretory phenotype (SASP). PLA2R1-mediated cell senescence in COPD was largely reversed by treatment with the potent JAK1/2 inhibitor ruxolitinib. Five-month-old PLA2R1 -TG mice exhibited lung cell senescence, and developed lung emphysema and lung fibrosis together with pulmonary hypertension. Treatment with ruxolitinib induced reversal of lung emphysema and fibrosis. LV- PLA2R1 -treated mice developed lung emphysema within 4 weeks and this was markedly attenuated by concomitant ruxolitinib treatment. Conclusions Our data support a major role for PLA2R1 activation in driving lung cell senescence and lung alterations in COPD. Targeting JAK1/2 may represent a promising therapeutic approach for COPD

Situación

La revista Cuadernos LIRICO publica hoy su número 20. Como para marcar ese hito representativo en términos simbólicos, el comité que la dirige decidió alterar, de manera excepcional, su estructura y su tipo de funcionamiento. En lugar de presentar un monográfico organizado gracias a un concepto, fenómeno o autor, hicimos una convocatoria alrededor de las principales características de la producción literaria y crítica contemporáneas en el Río de la Plata, fijando como único requisito el de diseñar un mapa de tendencias artísticas y críticas actuales. Es decir que propusimos un número misceláneo sobre una situación, usando el viejo término que organizó en algún momento las reflexiones literarias de Jean-Paul Sartre. Uno de los objetivos de este formato fue el de abrir la revista a otros investigadores y darle la palabra a colegas que no habían podido publicar previamente en Cuadernos LIRICO. Sin tener la pretensión de un panorama, el resultado es revelador de ciertas características de la producción actual pero también de los temas en discusión en la crítica: género, edición, animalidad, memoria, límites de la literatura, distopías, aprehensiones laterales de la tradición, escrituras del yo. Lamentamos el lugar escaso que ocupan la poesía y la literatura uruguaya en el número, así como la ausencia de la producción teatral, pero la falta de exhaustividad es una de las consecuencias de las reglas del juego elegidas. A diferencia de los otros números de la revista (que son tomados a cargo en términos tanto científicos como editoriales por responsables de edición), llevamos a cabo aquí un trabajo colectivo de selección y corrección, dejando una máxima libertad a los autores. Mantuvimos la sección traducción con sus criterios habituales (o sea que integramos en ella textos críticos inéditos en castellano, en principio publicados en francés, que prolongan, desde el contraste o la profundización, los presupuestos teóricos elegidos para cada número). En este caso, proponemos cuatro textos franceses sobre la escritura contemporánea, escritos por cuatro figuras que nos parecen ser relevantes intelectualmente en el campo de la crítica literaria

Risdiplam treatment has not led to retinal toxicity in patients with spinal muscular atrophy

International audienceObjective: Evaluation of ophthalmologic safety with focus on retinal safety in patients with spinal muscular atrophy (SMA) treated with risdiplam (EVRYSDI®), a survival of motor neuron 2 splicing modifier associated with retinal toxicity in monkeys. Risdiplam was approved recently for the treatment of patients with SMA, aged ≥ 2 months in the United States, and is currently under Health Authority review in the EU.Methods: Subjects included patients with SMA aged 2 months-60 years enrolled in the FIREFISH, SUNFISH, and JEWELFISH clinical trials for risdiplam. Ophthalmologic assessments, including functional assessments (age-appropriate visual acuity and visual field) and imaging (spectral domain optical coherence tomography [SD-OCT], fundus photography, and fundus autofluorescence [FAF]), were conducted at baseline and every 2-6 months depending on study and assessment. SD-OCT, FAF, fundus photography, and threshold perimetry were evaluated by an independent, masked reading center. Adverse events (AEs) were reported throughout the study.Results: A total of 245 patients receiving risdiplam were assessed. Comprehensive, high-quality, ophthalmologic monitoring assessing retinal structure and visual function showed no retinal structural or functional changes. In the youngest patients, SD-OCT findings of normal retinal maturation were observed. AEs involving eye disorders were not suggestive of risdiplam-induced toxicity and resolved with ongoing treatment.Interpretation: Extensive ophthalmologic monitoring conducted in studies in patients with SMA confirmed that risdiplam does not induce ophthalmologic toxicity in pediatric or adult patients with SMA at the therapeutic dose. These results suggest that safety ophthalmologic monitoring is not needed in patients receiving risdiplam, as also reflected in the United States Prescribing Information for risdiplam