Pre-emption against terror : just war pacifist approach

Having soberly reflected upon the tragedy of September 11, 2001, the author observed that though international law and treaties restrict pre-emptive war, they do allow for war in self-defense. Consequently, some powerful nations have used this as a justification for launching pre-emptive strikes. The threats posed by the powerful nations using self-defense as a justification for pre-emptive strikes and the inability of weaker nations to do the same, greatly account for the unprecedented explosion of global terrorism. The author thinks that confronting terrorism therefore requires a pro-pacifist ethical framework whose principles have to be applied with international law to narrow the legitimacy of self-defense wars. Hence, he proposes "Moral Consistency" as a required condition for launching pre-emptive strikes with two main aims - to reduce violent conflicts and to draw a substantial distinction between reason and justification, and between crime and criminal justice

Exploring Graduated Court Diversion Clients\u27 Experience of Psychotherapy in Their Community Reintegration

Court Diversion Program (CDP) seeks to reduce the criminalization and reoffending among people living with mental illness to ensure their community reintegration (Schneider, 2010). The complex nature of achieving this goal calls for a comprehensive strategy, which requires a collaborative effort of legal, health care, and allied professionals including psychotherapists. However, because most CDP clients frequently receive medication treatment, not much is known about how CDP clients find psychotherapy services even though psychotherapy is effective for addressing mental illnesses and offending behaviors (Feingold & Fox, 2018; Feucht & Holt, 2016), To gain more insight into the issue, this study applied the postmodern framework and adopted a comparative case study design to explore the experiences of 5 CDP clients who received psychotherapy as part of their treatment with other 5 CDP clients who received pharmacotherapy treatment. Specifically, this research investigated why the clients chose their preferred treatment, how they experienced their participation in this form of treatment, and the role their treatment modality played in their community reintegration after encountering the criminal justice system. The researcher used qualitative interview techniques to collect data from the 10 participants who were living in the City of Toronto. Data were analyzed for patterns that revealed group differences in the experience and outcomes of these treatments

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications