The Effect of Globalization on Domestic Legal Services

Globalization, in the context of this panel, refers to international, trans-border processes which are not regulated by the international legal framework, either private law or public international law. These processes, these unregulated influences, are having both positive and negative effects and affecting aspects of culture and society which had previously been considered domestic or wholly domestic concerns. This is creating a tension within both the domestic and international environments, and it is this particular tension that this panel seeks to address. E. Clinton Bamberger, Emeritus Professor of Law, University of Maryland Law School, will speak about how domestic systems in one country can serve as surrogates or supplements, providers of access to justice, for persons denied access to justice in their own country. Lucie White, Professor of Law, Harvard will talk about how legal aid is affected when different cultures and different communities immigrate or immigrant communities are set up in a country. Filipe Gonzalez Morales, Director, Public Interest Action Program, Deigo Portales University, Chile, will talk about how globalization and other forces are coming together and affecting developing economies of scale in providing legal aid across national borders. Dorchen Leidholdt, Director, Center for Battered Women's Legal Services, Sanctuary for Families, New York will talk about how globalization and enlarging immigrant communities in New York City have affected her work in providing protection for battered women

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

The Effect of Globalization on Domestic Legal Services

Globalization, in the context of this panel, refers to international, trans-border processes which are not regulated by the international legal framework, either private law or public international law. These processes, these unregulated influences, are having both positive and negative effects and affecting aspects of culture and society which had previously been considered domestic or wholly domestic concerns. This is creating a tension within both the domestic and international environments, and it is this particular tension that this panel seeks to address. E. Clinton Bamberger, Emeritus Professor of Law, University of Maryland Law School, will speak about how domestic systems in one country can serve as surrogates or supplements, providers of access to justice, for persons denied access to justice in their own country. Lucie White, Professor of Law, Harvard will talk about how legal aid is affected when different cultures and different communities immigrate or immigrant communities are set up in a country. Filipe Gonzalez Morales, Director, Public Interest Action Program, Deigo Portales University, Chile, will talk about how globalization and other forces are coming together and affecting developing economies of scale in providing legal aid across national borders. Dorchen Leidholdt, Director, Center for Battered Women\u27s Legal Services, Sanctuary for Families, New York will talk about how globalization and enlarging immigrant communities in New York City have affected her work in providing protection for battered women

Roots and rhizomes of wild Asparagus: Nutritional composition, bioactivity and nanoencapsulation of the most potent extract

The nutritional composition and bioactive properties of roots and rhizomes of Asparagus stipularis were evaluated. Antioxidant activity of extracts obtained by infusion was evaluated using free radicals scavenging and reducing power methods. Porcine liver primary cell was used to check the hepatotoxicity of infusions. Results revealed that Asparagus samples are likely a source of nutrients, such as dietary fibre and essential fatty acids. HPLC-DAD-ESI/MS characterization of infusions allowed the identification and quantitation of 7 phenolic compounds, all hydroxycinnamoyl derivatives, with caffeic acid as the most abundant. Roots infusion contained the highest amounts of these compounds. It also exhibited the highest antioxidant activity in all assays, with EC50 values of 0.44 ± 0.01, 0.98 ± 0.03 and 0.64 ± 0.01 mg/mL for DPPH, ABTS and FRAP assays, respectively, with no toxicity towards PLP2 primary cell cultures (GI50 > 400 μg/mL). PLGA nanoparticles loaded with root extract were prepared using solvent-evaporation double emulsion method. Nanoparticles size was about 260 nm and a polydispersity index around 0.1, with a zeta potential of about -36 mV, as well as a good encapsulation efficiency of approximately 83%. Their morphology was analysed by SEM and spherical polymeric nanoparticles with a smooth surface were observed. FTIR and DSC were also performed, which allowed corroborating the efficacy of the encapsulation and to confirm the production of a stable and robust system to load Asparagus extracts. The developed nanoparticles are expected to be used as delivery systems for bioactive compounds of A. stipularis and they could be used as an innovative dietary supplement

Assessing changes in global fire regimes

Human activity has fundamentally altered wildfire on Earth, creating serious consequences for human health, global biodiversity, and climate change. However, it remains difficult to predict fire interactions with land use, management, and climate change, representing a serious knowledge gap and vulnerability. We used expert assessment to combine opinions about past and future fire regimes from 98 wildfire researchers. We asked for quantitative and qualitative assessments of the frequency, type, and implications of fire regime change from the beginning of the Holocene through the year 2300. Respondents indicated that direct human activity was already influencing wildfires locally since at least ~12,000 years BP, though natural climate variability remained the dominant driver of fire regime until around 5000 years BP. Responses showed a ten-fold increase in the rate of wildfire regime change during the last 250 years compared with the rest of the Holocene, corresponding first with the intensification and extensification of land use and later with anthropogenic climate change. Looking to the future, fire regimes were predicted to intensify, with increases in fire frequency, severity, and/or size in all biomes except grassland ecosystems. Fire regime showed quite different climate sensitivities across biomes, but the likelihood of fire regime change increased with higher greenhouse gas emission scenarios for all biomes. Biodiversity, carbon storage, and other ecosystem services were predicted to decrease for most biomes under higher emission scenarios. We present recommendations for adaptation and mitigation under emerging fire regimes, concluding that management options are seriously constrained under higher emission scenarios