The Legal Aspects of Humanitarian Intervention Based on the Intervention in Somalia: what significance does the intervention in Somalia have for the legal status of humanitarian intervention?

The lawfulness of humanitarian intervention and its position in international law has been highly disputed and debated. This thesis will address the question of whether or not humanitarian intervention is a legal use of force in international law and if the humanitarian intervention in Somalia was a lawful humanitarian intervention. The thesis will also look at what significance the intervention in Somalia has had for the legal status of humanitarian intervention and for later interventions. The thesis will present the legal material dealing with humanitarian intervention, where the UN Charter plays a significant role, and show that the Charter permits authorized humanitarian interventions. Furthermore, the thesis will discuss the intervention in Somalia and demonstrate that the intervention was in fact a lawful humanitarian intervention. Finally, the thesis will address the question of whether or not the intervention in Somalia has had any significance for the legal status of humanitarian intervention and later interventions. In regards to the legal status of humanitarian intervention, the emphasis is on the practice of the Security Council under Chapter VII of the Charter. In regards to the significance for later interventions, the thesis will state the significance the intervention in Somalia had for the lack of timely interference in the genocide in Rwanda.Master i rettsvitenskapJUS399MAJU

The Legal Aspects of Humanitarian Intervention Based on the Intervention in Somalia: what significance does the intervention in Somalia have for the legal status of humanitarian intervention?

The lawfulness of humanitarian intervention and its position in international law has been highly disputed and debated. This thesis will address the question of whether or not humanitarian intervention is a legal use of force in international law and if the humanitarian intervention in Somalia was a lawful humanitarian intervention. The thesis will also look at what significance the intervention in Somalia has had for the legal status of humanitarian intervention and for later interventions. The thesis will present the legal material dealing with humanitarian intervention, where the UN Charter plays a significant role, and show that the Charter permits authorized humanitarian interventions. Furthermore, the thesis will discuss the intervention in Somalia and demonstrate that the intervention was in fact a lawful humanitarian intervention. Finally, the thesis will address the question of whether or not the intervention in Somalia has had any significance for the legal status of humanitarian intervention and later interventions. In regards to the legal status of humanitarian intervention, the emphasis is on the practice of the Security Council under Chapter VII of the Charter. In regards to the significance for later interventions, the thesis will state the significance the intervention in Somalia had for the lack of timely interference in the genocide in Rwanda

Magnetisk resonanstomografi i multisenterstudier. Objektiv og subjektiv evaluering av bildekvalitet

Background: Magnetic resonance imaging (MRI) is a technically vulnerable acquisition method. Sequence optimization across equipment increase image quality and reproducibility of multicenter data. Comparisons of scanner-related performance are scarce, mainly due to few guidelines on assessing image quality. Aim: Test and compare image quality and performance in different MRI scanners, independent of vendor and model. Material and methods: A phantom and a healthy volunteer's brain were scanned in the head coil of eight MRI machines (field strength 1.5 Tesla) from three different vendors, with sequences standardized for comparability. The brain protocol included the following: T1-weighted 3D-volume, T2-weighted fluid attenuated inversion recovery (FLAIR)-sequence, dual echo (proton density (PD)- and T2-weighted) turbo spin-echo (TSE)-sequence, and T2*-weighted gradient-echo (GRE)-sequence. Phantom scans were repeated in each scanner after 4-6 months. The phantom protocol included a dual echo TSE- and spin echo (SE)-sequence, and a T1-weighted SE-sequence. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), T2-values, ghosting and geometric accuracy were measured in phantom- and brain images. Spatial resolution, low contrast object detectability, image intensity uniformity, slice thickness accuracy and slice position accuracy were measured in phantom images. Three radiologists visually evaluated the brain images on a five-point scale, focused on tissue conspicuity, artifacts and overall image quality. Results: A majority of tested quality aspects were significantly different between scanners. Different tests accentuated different scanners positively and negatively. Results were stable over time. Conclusion: Scanner-specific features reveal little about image quality without testing. Keywords: magnetic resonance imaging, multicenter study, image quality control, phantom, healthy volunteer

Prediction of outcome from MRI and general movements assessment after hypoxic-ischaemic encephalopathy in low-income and middle-income countries: data from a randomised controlled trial

Objective To evaluate the accuracy of neonatal MRI and general movements assessment (GMA) in predicting neurodevelopmental outcomes in infants with hypoxic-ischaemic encephalopathy (HIE). Design Secondary analyses of a randomised controlled trial (RCT). Setting Tertiary neonatal intensive care unit in India. Methods Fifty infants with HIE were included in an RCT of therapeutic hypothermia (25 cooled and 25 non-cooled). All infants underwent brain MRI at day 5, GMA at 10–15 weeks and outcome assessments including Bayley Scales of Infant and Toddler Development, third edition, at 18 months. Associations between patterns of brain injury, presence/absence of fidgety movements (FMs) and outcomes were assessed. Results Seventeen of 47 (36%) had adverse outcome (5 (21%) cooled vs 12 (52%) non-cooled, p=0.025). Eight infants died (four before an MRI, another three before GMA). Two developed severe cerebral palsy and seven had Bayley-III motor/cognitive composite score <85. Twelve (26%) had moderately/severely abnormal MRI and nine (23%) had absent FMs. The positive predictive value (95% CI) of an adverse outcome was 89% (53% to 98%) for moderate/severe basal ganglia and thalami (BGT) injury, 83% (56% to 95%) for absent/equivocal signal in the posterior limb of the internal capsule (PLIC) and 67% (38% to 87%) for absent FMs. Negative predictive values (95% CI) were 85% (74% to 92%) for normal/mild BGT injury, 90% (78% to 96%) for normal PLIC and 86% (74% to 93%) for present FMs. Conclusion(s) Neonatal MRI and GMA predicted outcomes with high accuracy in infants with HIE. The GMA is a feasible low-cost method which can be used alone or complementary to MRI in low-resource settings to prognosticate and direct follow-up. Trial registration number CTRI/2013/05/003693

Therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy in India (THIN study): a randomised controlled trial

OBJECTIVE: To evaluate the neuroprotective effect of therapeutic hypothermia (TH) induced by phase changing material (PCM) on MRI biomarkers in infants with hypoxic-ischaemic encephalopathy (HIE) in a low-resource setting. DESIGN: Open-label randomised controlled trial. SETTING: One neonatal intensive care unit in a tertiary care centre in India. PATIENTS: 50 term/near-term infants admitted within 5 hours after birth with predefined physiological criteria and signs of moderate/severe HIE. INTERVENTIONS: Standard care (n=25) or standard care plus 72 hours of hypothermia (33.5°C±0.5°C, n=25) induced by PCM. MAIN OUTCOME MEASURES: Primary outcome was fractional anisotropy (FA) in the posterior limb of the internal capsule (PLIC) on neonatal diffusion tensor imaging analysed according to intention to treat. RESULTS: Primary outcome was available for 22 infants (44%, 11 in each group). Diffusion tensor imaging showed significantly higher FA in the cooled than the non-cooled infants in left PLIC and several white matter tracts. After adjusting for sex, birth weight and gestational age, the mean difference in PLIC FA between groups was 0.026 (95% CI 0.004 to 0.048, p=0.023). Conventional MRI was available for 46 infants and demonstrated significantly less moderate/severe abnormalities in the cooled (n=2, 9%) than in the non-cooled (n=10, 43%) infants. There was no difference in adverse events between groups. CONCLUSIONS: This study confirmed that TH induced by PCM reduced brain injury detected on MRI in infants with moderate HIE in a neonatal intensive care unit in India. Future research should focus on optimal supportive treatment during hypothermia rather than looking at efficacy of TH in low-resource settings. TRIAL REGISTRATION NUMBER: CTRI/2013/05/003693

Serum biomarkers identify critically ill traumatic brain injury patients for MRI

Funder: Academy of Medical Sciences; doi: http://dx.doi.org/10.13039/501100000691Funder: the Health FoundationAbstract Background Magnetic resonance imaging (MRI) carries prognostic importance after traumatic brain injury (TBI), especially when computed tomography (CT) fails to fully explain the level of unconsciousness. However, in critically ill patients, the risk of deterioration during transfer needs to be balanced against the benefit of detecting prognostically relevant information on MRI. We therefore aimed to assess if day of injury serum protein biomarkers could identify critically ill TBI patients in whom the risks of transfer are compensated by the likelihood of detecting management-altering neuroimaging findings. Methods Data were obtained from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Eligibility criteria included: TBI patients aged ≥ 16 years, Glasgow Coma Score (GCS) &lt; 13 or patient intubated with unrecorded pre-intubation GCS, CT with Marshall score &lt; 3, serum biomarkers (GFAP, NFL, NSE, S100B, Tau, UCH-L1) sampled ≤ 24 h of injury, MRI &lt; 30 days of injury. The degree of axonal injury on MRI was graded using the Adams-Gentry classification. The association between serum concentrations of biomarkers and Adams-Gentry stage was assessed and the optimum threshold concentration identified, assuming different minimum sensitivities for the detection of brainstem injury (Adams-Gentry stage 3). A cost–benefit analysis for the USA and UK health care settings was also performed. Results Among 65 included patients (30 moderate-severe, 35 unrecorded) axonal injury was detected in 54 (83%) and brainstem involvement in 33 (51%). In patients with moderate-severe TBI, brainstem injury was associated with higher concentrations of NSE, Tau, UCH-L1 and GFAP. If the clinician did not want to miss any brainstem injury, NSE could have avoided MRI transfers in up to 20% of patients. If a 94% sensitivity was accepted considering potential transfer-related complications, GFAP could have avoided 30% of transfers. There was no added net cost, with savings up to £99 (UK) or $612 (US). No associations between proteins and axonal injury were found in intubated patients without a recorded pre-intubation GCS. Conclusions Serum protein biomarkers show potential to safely reduce the number of transfers to MRI in critically ill patients with moderate-severe TBI at no added cost. </jats:sec