Adapting Human Rights to Privatised Infrastructure Projects

As the planning for South America's largest natural gas project, the Camisea Project, in Peru progressed, meanwhile at over fifty universities in the United States students were holding demonstrations to protest the involvement of Citigroup, the commercial and investment bank, in this and other infrastructure projects. Natural gas extraction and distribution was a surprising lightning rod for non-violent action. However, perhaps the alleged potential negative impact of the project on the rainforest and indigenous groups of the region goes some way to explain things. Such protests were a part of a larger movement to target public and private financial institutions involved in financing infrastructure projects. This and other protests targeting the Camisea Project have succeeded in eliciting concessions and policy changes by the major players who underwrite and participate in the project. However, despite successes and mutual agreements between protesters and project planners about how an infrastructure project should be carried out, questions still persist as to what is the appropriate human rights standard and also how should a human rights standard be implemented in the context of a specific project. This article seeks to provide an institutional solution as an answer to these outstanding questions' the creation of a United Nations-based Human Rights Unit for infrastructure projects that will set standards for projects and monitor compliance with those standards

Factors associated with stroke or death after carotid endarterectomy in Northern New England

ObjectiveThis study investigated risk factors for stroke or death after carotid endarterectomy (CEA) among hospitals of varying type and size participating in a regional quality improvement effort.MethodsWe reviewed 2714 patients undergoing 3092 primary CEAs (excluding combined procedures or redo CEA) at 11 hospitals in Northern New England from January 2003 through December 2007. Hospitals varied in size (25 to 615 beds) and comprised community and teaching hospitals. Fifty surgeons reported results to the database. Trained research personnel prospectively collected >70 demographic and clinical variables for each patient. Multivariate logistic regression models were used to generate odds ratios (ORs) and prediction models for the 30-day postoperative stroke or death rate.ResultsAcross 3092 CEAs, there were 38 minor strokes, 14 major strokes, and eight deaths (5 stroke-related) ≤30 days of the index procedure (30-day stroke or death rate, 1.8%). In multivariate analyses, emergency CEA (OR, 7.0; 95% confidence interval [CI], 1.8-26.9; P = .004), contralateral internal carotid artery occlusion (OR, 2.8; 95% CI, 1.3-6.2; P = .009), preoperative ipsilateral cortical stroke (OR, 2.4; 95% CI, 1.1-5.1; P = .02), congestive heart failure (OR, 1.6; 95% CI, 1.1-2.4, P = .03), and age >70 (OR, 1.3; 95% CI, 0.8-2.3; P = .315) were associated with postoperative stroke or death. Preoperative antiplatelet therapy was protective (OR, 0.4; 95% CI, 0.2-0.9; P = .02). Risk of stroke or death varied from <1% in patients with no risk factors to nearly 5% with patients with ≥3 risk factors. Our risk prediction model had excellent correlation with observed results (r = 0.96) and reasonable discriminative ability (area under receiver operating characteristic curve, 0.71). Risks varied from <1% in asymptomatic patients with no risk factors to nearly 4% in patients with contralateral internal carotid artery occlusion (OR, 3.2; 95% CI, 1.3-8.1; P = .01) and age >70 (OR, 2.9; 95% CI, 1.0-4.9, P = .05). Two hospitals performed significantly better than expected. These differences were not attributable to surgeon or hospital volume.ConclusionSurgeons can “risk-stratify” preoperative patients by considering the variables (emergency procedure, contralateral internal carotid artery occlusion, preoperative ipsilateral cortical stroke, congestive heart failure, and age), reducing risk with antiplatelet agents, and informing patients more precisely about their risk of stroke or death after CEA. Risk prediction models can also be used to compare risk-adjusted outcomes between centers, identify best practices, and hopefully, improve overall results

Dual Legal Orders: From Colonialism to High Technology

This article begins by discussing the genesis of a free zone on a small island in the Straits archipelagos, tracing its development from a free port to an export processing zone and most recently to a science park. Throughout its life as a free zone, this island has comprised a transnational commercial domain of a dual legal order. A dual legal order comprises two domains, a transjurisdictional commercial and local political. Here we focus on a particular type of transjurisdictional commercial domain--the free zone. Three historical forms of zone receive attention, the free port, export processing zone and the science park. Various manifestations geographically and temporally are elaborated. In conclusion, a number of observations are then made concerning dual legal orders and free zones

Should the Poor Foot the Bill

This article looks at the use of privatization to solve urban poverty under the auspices of the United Nations' Millennium Development Goals and the United States Agency for International Development's Urban Strategy. It questions whether the urban poor should be asked to pay their way out of poverty

The Role of Hospitalists in the Acute Care of Stroke Patients

Stroke care has become progressively more complicated with advances in therapies necessitating timely intervention. There are multiple potential providers of stroke care, which traditionally has been the province of general neurologists and primary care physicians. These new players, be they vascular neurologists, neurohospitalists, internal medicine hospitalists, or neurocritical care physicians, at the bedside or at a distance, are poised to make a significant impact on our care of stroke patients. The collaborative model of care may be or become the most prevalent as physicians apply their distinct skill sets to the complex care of inpatients with cerebrovascular disease

Development and Pilot Feasibility Study of a Health Information Technology Tool to Calculate Mortality Risk for Patients with Asymptomatic Carotid Stenosis: The Carotid Risk Assessment Tool (CARAT)

Patients with no history of stroke but with stenosis of the carotid arteries can reduce the risk of future stroke with surgery or stenting. At present, a physicians’ ability to recommend optimal treatments based on an individual’s risk profile requires estimating the likelihood that a patient will have a poor peri-operative outcomes and the likelihood that the patient will survive long enough to gain benefit from the procedure. We describe the development of the CArotid Risk Assessment Tool (CARAT) into a 2-year mortality risk calculator within the electronic medical record, integrating the tool into the clinical workflow, training the clinical team to use the tool, and assessing the feasibility and acceptability of the tool in one clinic setting