Constitutional Courts and Legislatures: Institutional Terms of Engagement

The debate about the legitimacy of judicial review has arguably been misframed. The question is not whether judicial review can be justified, but how judicial institutions need to be designed and how the relationship between the judicial and the legislative branches must be structured in order for it to be legitimate. After briefly describing the point of judicial review and introducing a normative standard for its legitimate institutionalization, the article analyzes a number of variables that, taken together, determine whether or not such standard is met. A third part briefly illustrates the usefulness of the established framework by analyzing and assessing the institutionalization of judicial review in the US and in the UK. As will become clear, both are problematic outlier cases: In the US the institutional position of the Supreme Court is too strong in its relationship the legislature, effectively enabling juristocracy. In the UK the position of the courts is too weak, effectively enabling electoral authoritarianism.debate sobre a legitimidade da justiça constitucional tem sido porventura mal colocado. A questão não é a de saber se é possível legitimar a justiça constitucional, mas a de como arquitetar as instituições judiciais e como estruturar as relações entre os poderes judicial e legislativo de forma a assegurar essa legitimidade. Após uma breve referência ao valor da justiça constitucional e articulação de um parâmetro normativo para sua institucionalização legítima, o artigo percorre um conjunto de variáveis que determinam a observância ou não desse parâmetro. A terceira parte ilustra sucintamente a utilidade deste modelo através da análise e do exame da institucionalização da justiça constitucional nos Estados Unidos e no Reino Unido. Como se tornará claro no decurso dessa análise, ambos consubstanciam casos peculiares e problemáticos: nos Estados Unidos a posição institucional do Supremo Tribunal é demasiado forte na sua relação com o poder legislativo, o que permite a implantação de uma juristocracia. No Reino Unido a posição dos tribunais é demasiado débil, o que permite a implantação de um autoritarismo eleitoral

Liigeskudede molekulaarsed markerid põlveliigese varase osteoartroosi korral: rahvastikupõhine longitudinaalne uuring keskealistel isikutel

Väitekirja elektrooniline versioon ei sisalda publikatsioone.Osteoartroosi (OA) globaalne levik loob vajaduse detailsema teabe järgi haiguse varastest faasidest. Kaua on OA peetud vananeva liigeskõhre „kulumiseks“. Tänapäeval käsitletakse OA metaboolselt aktiivse protsessina, mis võib alata kõikidest liigeskudedest: kõhrest, luust või pehmetest kudedest. OA preradioloogilise faasi hindamiseks on uute diagnostiliste ja prognostiliste vahenditena rakendust leidmas seerumist ja uriinist määratavad liigeskudede päritoluga molekulaarsed markerid. Siiani puuduvad süsteemsed uurimused liigeskudede sünteesi ja lammutamist peegeldavate biomarkerite väärtuse kohta OA varases faasis. Selle uurimuse eesmärkideks oli hinnata: (i) põlveliigese röntgenoloogilise OA levimust keskealistel põlvekaebustega isikutel ning progresseerumist 6 a. jooksul, (ii) liigeskudede biomarkerite diagnostilist ja ennustavat väärtust OA progresseerumise korral. Enam kui pooltel põlvevaevustega keskealistest inimestest esinesid OA röntgenoloogilised tunnused. Kuue jälgimisaasta jooksul süvenes haigus enamasti progresseeruva osteofütoosina. Põlveliigese OA röntgenoloogiline kulg oli heterogeenne ja mittepidev, hõlmates vahelduvalt haiguse stabiliseerumise ja süvenemise perioode. Käesoleva uurimusega õnnestus esmakordselt näidata kõhre-, luu- ja pehmete kudede aine¬-vahetuse samaaegset aktiveerumist OA varases faasis. Kõigil 3 uuritud kõhrekoe markeril (COMP, CTx-II, PIIANP) oli diagnostiline väärtus progresseeruva osteofütoosi suhtes, ning kahel neist (COMP ja CTx-II) oli ka ennustav roll OA väljendunud progressiooni suhtes. Kolmel uuritud luumarkeril (PINP, OC, MidOC) oli diagnostiline väärtus progresseeruva osteofütoosi suhtes, ja ühel neist (PINP) ka ennustavat roll, kui tegu OA laialdasema progressiooniga liigeses. Selgus, et vähemalt OA algfaasis võib luukoe ainevahetus intensiivistuda enamgi võrreldes kõhrekoega. Uus luukoe biomarker – osteokaltsiini keskfragment (MidOC) osutus tugevaimaks riski ennustajaks progresseeruva osteofütoosi suhtes. Biomarkerite väärtuste muutused demonstreerisid liigeskudedes toimuvate ainevahetuslike nihete kindlat mustrit varase OA progresseeruvatel juhtudel. Käesolev uurimus selgitas liigeskudede mitmete biomarkerite diagnostilist ja prognostilist väärtust OA varases faasis.The globally increasing prevalence of osteoarthritis (OA) calls for more detailed knowledge of the early phases of the disease. OA has long been considered to be a “wear and tear” disease of ageing articular cartilage. Nowadays, OA is viewed as a metabolically active process that may arise from any joint tissue: cartilage, bone or soft tissues. It progresses through molecular and radiographic stages. The investigation of pre-radio¬graphic phases is dependent on serum and/or urinary biomarkers originating from articular tissues as new diagnostic and prognostic tools for early OA management. So far, the systemic evaluation of biomarkers reflecting the synthesis and degradation of cartilage and bone has not been simultaneously addressed. The main objectives of the study were to determine: (i) the prevalence and six-year progression of radiographic knee OA in middle-aged subjects with chronic knee joint complaints, and (ii) the diagnostic and prognostic value of biomarkers for progressive radiographic knee OA. More than half of the middle-aged subjects with chronic knee complaints had early radiographic signs of knee OA. In the majority of cases, the six-year OA progression was based on osteophytosis. The radiographic course of knee OA was heterogeneous and non-continuous, with intermittent periods of progression and stabilization. The changes in biomarker values revealed a certain pattern of metabolic shifts in joint tissues in progressive knee OA. All three studied cartilage markers (COMP, CTx-II and PIIANP) had diagnostic value for progressive osteophytosis, and two of them (COMP and CTx-II) also had prognostic value for progressive osteophytosis and joint space narrowing. At the same time, three of the studied bone markers (PINP, OC and MidOC) had diagnostic value for progressive osteophytosis, and one of them, PINP, demonstrated a predictive value for extensive OA progression. Unexpectedly, the activation of bone metabolism seemed to dominate over that of cartilage. The novel bone marker urinary mid-fragments of osteocalcin (MidOC) turned out to be the strongest risk predictor for progressive osteophytosis. The present study proposed a possible sequence of metabolic events in joint tissues during early OA. We discovered the diagnostic and prognostic potential of several biomarkers for progressive OA