The Hole in the Whole: Sovereignty, Shared Sovereignty, and International Law

Ideally, a body of law comprises a set of coherent and consistent rules. These rules contribute to the creation of an environment that is predictable, efficacious, and just. Most international lawyers hope, expect, or believe that such a body of law can exist for the international system. This is a fool\u27s errand

Power and Constraint

John Bolton raises two distinct sets of questions about global governance: the first involves the creation of supranational authority structures; the second, the penetration of the American domestic political process, especially by transnational non-governmental organizations ( TNGOs ). Neither of these involves international legal sovereignty, the right of the United States, or any state, to freely enter into agreements with other states. Both do involve issues associated with the nature and autonomy of domestic authority structures, the ability of political actors to determine the kinds of political institutions within which they will function, and the decisions that emerge from these institutions. The rule that one state should not interfere in the internal affairs of another, first articulated by the international jurist Emer de Vattel at the end of the 18th century, has become one of the defining norms of sovereignty. It is, however, a norm that has been frequently violated, sometimes as a result of coercion, for example the Soviet Union\u27s invasion of Czechoslovakia in 1968 and the American occupation of Panama in 1989, and sometimes as a result of voluntary agreements, such as the 1957 Treaty of Rome and subsequent accords that have created the European Union. Moreover, some political structures are inherently more open to official or unofficial external influence either because there are multiple avenues of access, as is the case with the United States, or because they are weakly institutionalized, as is the case in several African countries. Although domestic autonomy is a widely recognized rule it might, or might not, serve the interests of a specific state. John Bolton worries that the permeability of the American political process may be a threat to the United States. I suggest instead that, given the inordinate international power of the United States, the ability of external actors, including TNGOs, to involve themselves in American decision-making may make it easier to accomplish American objectives by reducing the temptation to balance against, rather than cooperate with, the United States

CAUSAS ESTRUTURAIS E CONSEQUÊNCIAS DOS REGIMES INTERNACIONAIS: REGIMES COMO VARIÁVEIS INTERVENIENTES

Os regimes internacionais são definidos como princípios, normas, regras e procedimentos de tomada dedecisões ao redor dos quais as expectativas dos atores convergem em uma dada área-tema. Como ponto departida, os regimes são conceituados como variáveis intervenientes, estando entre fatores causais básicose os resultados e comportamentos relacionados. Há três visões a respeito da importância dos regimes: asorientações estruturais convencionais desvalorizam os regimes como sendo, na melhor das hipóteses,ineficazes; as orientações grocianas vêem os regimes como componentes íntimos do sistema internacional;as perspectivas estruturalistas modificadas vêem os regimes como significativos somente em certas condiçõesrestritas. Para os argumentos grociano e estruturalista modificado – que concordam com a visão de que osregimes podem influenciar resultados e comportamentos –, o desenvolvimento de regimes é visto como umafunção de cinco variáveis causais básicas: auto-interesse egoísta; poder político; normas e princípiosdifusos; usos e costumes; conhecimento

Propofol Inhibits Glioma Stem Cell Growth and Migration and Their Interaction with Microglia via BDNF-AS and Extracellular Vesicles

Glioblastoma (GBM) is the most common and aggressive primary brain tumor. GBM contains a small subpopulation of glioma stem cells (GSCs) that are implicated in treatment resistance, tumor infiltration, and recurrence, and are thereby considered important therapeutic targets. Recent clinical studies have suggested that the choice of general anesthetic (GA), particularly propofol, during tumor resection, affects subsequent tumor response to treatments and patient prognosis. In this study, we investigated the molecular mechanisms underlying propofol\u27s anti-tumor effects on GSCs and their interaction with microglia cells. Propofol exerted a dose-dependent inhibitory effect on the self-renewal, expression of mesenchymal markers, and migration of GSCs and sensitized them to both temozolomide (TMZ) and radiation. At higher concentrations, propofol induced a large degree of cell death, as demonstrated using microfluid chip technology. Propofol increased the expression of the lncRNA BDNF-AS, which acts as a tumor suppressor in GBM, and silencing of this lncRNA partially abrogated propofol\u27s effects. Propofol also inhibited the pro-tumorigenic GSC-microglia crosstalk via extracellular vesicles (EVs) and delivery of BDNF-AS. In conclusion, propofol exerted anti-tumor effects on GSCs, sensitized these cells to radiation and TMZ, and inhibited their pro-tumorigenic interactions with microglia via transfer of BDNF-AS by EVs

Centerscope

Centerscope, formerly Scope, was published by the Boston University Medical Center "to communicate the concern of the Medical Center for the development and maintenance of improved health care in contemporary society.

Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study.

BACKGROUND: Ethical challenges are common in end of life care; the uncertainty of prognosis and the ethically permissible boundaries of treatment create confusion and conflict about the balance between benefits and burdens experienced by patients. OBJECTIVE: We asked physician trainees in internal medicine how they reacted and responded to ethical challenges arising in the context of perceived futile treatments at the end of life and how these challenges contribute to moral distress. DESIGN: Semi-structured in-depth qualitative interviews. PARTICIPANTS: Twenty-two internal medicine residents and fellows across three American academic medical centers. APPROACH: This study uses systematic qualitative methods of data gathering, analysis and interpretation. KEY RESULTS: Physician trainees experienced significant moral distress when they felt obligated to provide treatments at or near the end of life that they believed to be futile. Some trainees developed detached and dehumanizing attitudes towards patients as a coping mechanism, which may contribute to a loss of empathy. Successful coping strategies included formal and informal conversations with colleagues and superiors about the emotional and ethical challenges of providing care at the end of life. CONCLUSIONS: Moral distress amongst physician trainees may occur when they feel obligated to provide treatments at the end of life that they believe to be futile or harmful.This study was funded by the Health Resources and Service Administration T32 HP10025-20 Training Grant, the Gates Cambridge Scholarship, Society of General Internal Medicine Founders Grant, and the Ho-Chiang Palliative Care Research Fellowship at the Johns Hopkins School of Medicine.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s11606-015-3505-

International Nonregimes: A Research Agenda1

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146934/1/j.1468-2486.2007.00672.x.pd