Criminal procedures and sanctions against seafarers after large-scale ship-source oil pollution accidents: a human rights perspective

The international maritime community is highly concerned about the unfair application of criminal procedures and sanctions against seafarers, particularly after large-scale ship-source oil pollution accidents, because such unfairness may cause severe negative consequences for individual seafarers and the shipping sector in broader terms. A lot of work has already been done towards the elimination of the respective unfairness. Yet, the unfair practice continues. This dissertation attempts to give new ideas as to how to facilitate the fair application of criminal procedures and sanctions against seafarers after large-scale ship-source oil pollution accidents. The dissertation starts with the clear definition and comprehensive explanation of the standard of fair criminal procedures and sanctions against seafarers. The offered standard is – relevant human rights. The dissertation continues with the analysis of whether or not those rules of UNCLOS and MARPOL which can be linked to criminal procedures and sanctions applicable against seafarers after large-scale ship-source oil pollution accidents are clear and comply with human rights. As a result, several deficient rules of UNCLOS and MARPOL are identified and corresponding recommendations on how to interpret these rules are given within the dissertation. Many of these recommendations are innovative, particularly, because when addressing the issue of the unfair application of criminal procedures and sanctions against seafarers after large-scale ship-source oil pollution accidents, the international maritime community, so far, has predominantly focused on criticising particular EU and national laws and practices, instead of looking critically at the relevant rules of UNCLOS and MARPOL as well. After analysing the relevant legal norms of UNCLOS and MARPOL, the dissertation turns to the long-standing discussion on the qualities of EU Directive 2005/35 on ship-source pollution, particularly to the controversy of whether the Directive conflicts with the MARPOL exceptions from liability, or not. The dissertation, inter alia, makes an original conclusion that the root cause of the controversy is the failure of the drafters of MARPOL to agree on the issue as to when, if ever, State Parties to MARPOL may adopt more stringent standards than MARPOL. Some insight into relevant national laws and practices is provided by the dissertation – through the case study of four large-scale ship-source oil pollution accidents: the Erika, Prestige, Tasman Spirit and Hebei Spirit accidents. The case study shows that after all four afore-mentioned accidents seafarers were exposed to unfair criminal procedures and sanctions. After this unfortunate finding, the dissertation analyses whether IMO/ILO Guidelines on Fair Treatment of Seafarers are capable to bring considerable positive change in practice. Conclusion is made that the Guidelines, per se, are not capable to bring such change, however some rules of the Guidelines are good basis for further, more substantial developments. The dissertation ends with revisiting of all research questions and providing user-friendly lists of main recommendations related to these questions. At the very end, a couple of overall conclusions and recommendations, which, at times, reach even further than only large-scale ship-source oil pollution offences, are given. One of such recommendations is the recommendation to develop three new IMO instruments: one binding (the International Convention for the Unification of Certain Rules Relating to Penal Liability in the Maritime Domain) and two non-binding (the Sanctioning Guidelines for Offences in the Maritime Domain and the Guidelines on Penal Proceedings Which Involve Seafarers)

Diphtheritic polyneuropathy : A clinical study and comparison with Guillain-Barré syndrome

Objectives and Methods - Clinical features of 50 adults with diphtheritic polyneuropathy (DP) were studied in Riga, Latvia and compared with 21 patients with Guillain-Barré syndrome (GBS). Results - Neurological complications occurred in 15% of patients admitted to hospital with diphtheria and usually after severe pharyngeal infection. Bulbar dysfunction occurred in 98% of patients with DP and only 10% of patients with GBS. Limb weakness was mild or absent in 30% of patients with DP. Ventilation dependent respiratory failure occurred in 20% of patients with DP. The first symptoms of DP occurred 2-50 days after the onset of local diphtheria infection. Neurological deterioration in DP continued for a median of 49 (range 15-83) days and improvement started 73 (range 20-115) days after onset. In 66% of patients with DP, the neuropathy was biphasic with a secondary worsening after 40 days. By contrast patients with GBS worsened for only 10 days on average (range 2-28 days) and improved after 21 (range 4-49) days. Eight patients with DP died, four from severe cardiomyopathy and four from multiple diphtheritic organ failure. Prolonged distal motor latencies (DMLs) were common to both DP and GBS, and more pronounced than motor conduction slowing. Limb symptoms continued after 1 year in 80% of the patients with DP, 6% were unable to walk independently, but independent respiratory and bulbar function had returned in all survivors. By comparison no patients with GBS died and none were severely disabled after 1 year. No death, in patients with DP occurred after antitoxin on days 1 or 2 after onset of diphtheria symptoms, whereas identical rates of death and peak severity of DP were seen both in those who received antitoxin on days 3-6 and those who did not receive it at all. Conclusion - Diphtheric polyneuropathy is much more likely than GBS to have a bulbar onset, to lead to respiratory failure, to evolve more slowly, to take a biphasic course, and to cause death or long term disability. Antitoxin seems ineffective if administered after the second day of diphtheritic symptoms.publishersversionPeer reviewe

Central Auditory Processing Disorders : Effects of Age and Hearing Loss to Electrophysiological and Behavioral Responses

Introduction. Central auditory processing involve normal sound perception, speech recognition, ability of cognition and memory. Accordingly speech recognition difficulties may manifest due to changes at any segment of auditory processing. Cortical auditory evoked potentials (CAEPs) and behavioral measures provide insight into the neural mechanisms underlying speech recognition. These disorders are observed both in young and elderly population. Aim of the study. To evaluate central auditory processing for subjects of different age and hearing level through the presentation of noise using CAEPs and behavioral measures of speech discrimination. However due to complicated connectivity in auditory pathway it is difficult to identify the central auditory processing damage. Behavioral tests in conjunction with electrophysiological examination will reveal more complicated information for differenciation between peripheral and central auditory processing disorders. Materials and methods. Three groups of subjects participated: young normal hearing, young hearing-impaired and elderly hearing– impaired subjects. To minimaze subject variables, the CAEPs (wave peaks P1,N1,P2,N2,P3,N3 in miliseconds) was investigated using passive listening paradigme. The CAEPs were elicited by 1,1s change in frequency 1000 Hz and 2000 Hz in pure tones presented at 65, 70 and 75 dB SPL. Sentence recognition tests in quite and noise, Digit Pairs (DP) and Word Pairs (WP) were developed in Latvian language prior to investigation. They were presented to all subjects. Results. The most prominent finding was the increased latency of P3, N3 in elderly and also in younger hearing impaired adults groups and highly differed within groups. More prolonged latencies were find of N1, P2 in elderly hearing impaired group than in younger hearing impaired group adults. Conclusions. During this investigation the CAEPs are performed for the first time in our clinic therefore the main standarts are determined for our laboratory. The speech recognition tests (Sentence recognition test, DD, DW) are developed in Latvian. The present findings suggest patterns of CAEP are variable within individuals however shows that auditory perception and cognitive function is not only a result of aging and must be associated with a general slowing of neuronal processing or decreased neuronal synchrony within the central auditory nervous system. Determination of central auditory processing capacity level is of crucial significance to prognose and evaluate the hearing result after hearing prosthetics and to appraise indications for hearing prosthetics, cochlear and middle ear implantation including.publishersversionPeer reviewe

Clinical and Epidemiological Characteristics of Migraine in Latvia

Publisher Copyright: © 2015 by Tatjana Muravska.The aim of this study was to explore clinical-epidemiological characteristics of migraine in Latvia and the disability of migraine patients, to determine the optimal options for care of these patients. Patients selected from three headache centres were asked 40 questions by phone. Among 116 patients, the dominant age group was 25-34 (41.4%) and most patients were women (87.9%). 52.6% of patients were highly educated, and 53.4% had a job involving communication with people. In 56.9% of cases headaches started at the age of 15-24. About 25% migraine attacks lasted for 25-48 hours. The diagnosis "Migraine with aura" was confirmed in 50% of the patients. Headaches were quite frequent: 4-8 times a month or more in 22.4% of patients and 2-4 times a month in 29.3%. As medication, 50.9% used selective serotonin 5-HT (5-hydroxytryptamine) receptor agonists for migraine attacks treatment, 35.3%-nonsteroidal anti-inflammatory drugs (NSAIDs) and 30.2%-acetaminophen-containing medicines. The average quality of life estimated by migraine disability assessment questionnaire (MIDAS) was 13.0, which equates to moderate disability. According to our study clinical characteristics of migraine in Latvia do not differ significantly from that of other European countries. Most of the patients are educated, working women of childbearing age. Migraine diagnosis and treatment seems to be appropriate, but nevertheless, too many sufferers have frequent and persistent headache attacks that require further investigation.publishersversionPeer reviewe

No Definite Evidence for Human Endogenous Retroviral HERV-W and HERV-H RNAS in Plasma of Latvian Patients Suffering from Multiple Sclerosis and Other Neurological Diseases

Publisher Copyright: © 2016 by Jonas Blomberg.Multiple sclerosis (MS) is a neurological disease of unknown aetiology. Several research groups reported an increased level of human endogenous retroviruses HERV-W and HERV-H RNAs in cerebrospinal fluid, plasma and supernatants of cell cultures from MS individuals. To quantify the abundance of extracellular virion-associated HERV, RNAs in blood, plasma samples from Latvian MS patients, patients with other neurological diseases (OND), as well as blood donors (BD), were retrospectively studied by using both our previously published and newly developed quantitative Real-time reverse transcription PCR assays (QPCRs) targeting different polymerase (pol) gene regions of HERV-W and HERV-H. Unspecific signals due to incomplete removal of DNA were monitored by running the assays with and without reverse transcription (RT±) in parallel. According to our score, a few MS, OND and healthy controls gave borderline signals simultaneously with both newly developed HERV-H and HERV-W QPCRs, but the rest were negative. All borderline positive samples also had small amounts of non-retroviral cellular mRNA with possible origin from cell-free circulating RNA fragments, apoptotic bodies or exosomes, which can mimic the previously described virus-like particles. The results do not confirm the previous reports on prevalence of HERV-H or-W virion-associated RNA in plasma of MS patients.publishersversionPeer reviewe

Value of parental concern and clinician's gut feeling in recognition of serious bacterial infections : A prospective observational study

Funding Information: Authors are thankful to State Research programme “BIOMEDICINE”, Project No. 5.6.2. “Research on acute and chronic diseases in children of wide age range to develop diagnostic and therapeutic algorithms to reduce mortality, prolong survival and improve quality of life”. This manuscript was drafted as a part of the project. We thank all the participating clinicians and research team of data collectors. Funding Information: This research was funded by State Research programme “BIOMEDICINE”, Project No. 5.6.2. “Research on acute and chronic diseases in children of wide age range to develop diagnostic and therapeutic algorithms to reduce mortality, prolong survival and improve quality of life”. This manuscript was drafted as a part of the project. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Publisher Copyright: © 2019 The Author(s).Background: Serious bacterial infections (SBI) are a significant cause of mortality worldwide. Parental concern and clinician's gut feeling that there is something wrong has been associated with increased likelihood of developing SBI in primary care studies. The aim of this study is to assess the diagnostic value of parental concern and gut feeling at the emergency department of a tertiary hospital. Methods: This prospective observational study included children with fever attending the emergency department of Children's Clinical University hospital in Riga between October 2017 and July 2018. Data were collected via parental and clinician questionnaires. "Gut feeling" was defined as intuitive feeling that the child may have a serious illness, and "Sense of reassurance" as a feeling that the child has a self-limiting illness. "Parental concern" was defined as impression that this illness is different from previous illnesses. SBI included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, appendicitis, bacterial gastroenteritis, and osteomyelitis. Pearson's Chi-Squared test or Fisher's exact test were used to compare the variables between children with and without SBI. Positive likelihood ratio was calculated for "gut feeling", "sense of reassurance", and parental concern. Results: The study included 162 patients aged 2 months to 17.8 years. Forty-six patients were diagnosed with SBI. "Sense of reassurance" expressed by all clinicians was associated with lower likelihood of SBI (positive likelihood ratio 8.8, 95% confidence interval 2.2-34.8). "Gut feeling" was not significantly predictive of the patient being diagnosed with SBI (positive likelihood ratio 3.1, 95% confidence interval 1.9-5.1), The prognostic rule-in value of parental concern was insignificant (positive likelihood ratio 1.4, 95% confidence interval 1.1-1.7). Conclusion: Sense of reassurance was useful in ruling out SBI. Parental concern was not significantly predictive of SBI.publishersversionPeer reviewe

Interventional pain management using fluoroscopy and ultrasound imaging techniques

Interventional injection therapies play a major role in the management of various pain conditions and are becoming an integral part of the multidisciplinary therapies required to improve and rehabilitate pain patients. Many of these procedures have historically been performed without imaging guidance. Imaging–guided techniques with fluoroscopy or ultrasound increase the precision of these procedures and help confirm needle placement. Imaging–guided techniques should lead to better results and reduced complication rates and they are now becoming more popular. These improvements are probably due in part also to better patient selection by experienced pain physicians.publishersversionPeer reviewe

Coping with febrile illness in children : A qualitative interview study of parents

Funding Information: This study was part of the State Research Programme “Biomedicine”, Project No. 5.6.2. “Research on acute and chronic diseases in children of wide age range to develop diagnostic and therapeutic algorithms to reduce mortality, prolong survival and improve quality of life”. Publisher Copyright: © 2019 Urzula Nora Urbane et al., published by Sciendo 2019.The aim of this study was to investigate parental perception of febrile illness in their children, the most commonly applied management practices, as well as the expectations from clinicians when coping with fever in children. The study included parents of patients admitted to the Emergency and Observation Department of Children's Clinical University Hospital in Ria, Latvia. Data were collected via semi-structured interviews. All interviews were transcribed, and the transcripts analysed by inductive thematic analysis. Thirty-four parental interviews were analysed. Six themes emerged from the study, which were: signs causing concern; beliefs regarding fever; assessment and monitoring of fever; fever management practices; help-seeking behaviour; and expectations from the healthcare personnel. Many parents believed that fever could potentially cause injuries to the nervous system, kidneys, the brain, other internal organs, and even cause death. The perceived threat of fever resulted in frequent temperature measurements and administration of antipyretics. Meeting the emotional and information needs of the parents were considered as equally important to meeting the child's medical needs. The study found that fever phobia exists among parents. Parental misconceptions of fever lead to overly zealous management practices. Parental education initiatives must be organised in order to improve parental knowledge of fever and its management in children.publishersversionPeer reviewe

History of Academic Neurology in Latvia

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