Introductory Remarks: Panel On Internal Conflicts

Welcome. The purpose of our panel this morning is to look at some difficult questions related to nature and the role of international law applicable in non-international conflicts. Most of the world\u27s conflicts today are not international

Joint Study Panel On transparency In International Commercial Arbitration

Thanks to Professor Louise Ellen Teitz, and to the ILA and ASIL for initiating this joint study panel. Our topic brings to mind the tale of the blind men and the elephant

Symposium on the ILC\u27s State Responsibility Articles: Introduction and Overview

In August 2001, the International Law Commission (ILC) adopted its “Draft Articles on the Responsibility of States for Internationally Wrongful Acts,” bringing to completion one of the Commission\u27s longest running and most controversial studies. On December 12, 2001, the United Nations General Assembly adopted Resolution 56/83, which “commend[ed the articles] to the attention of Governments without prejudice to the question of their future adoption or other appropriate action.” The ILC articles address the fundamental questions: when does a state breach an international obligation and what are the legal consequences? Rather than attempting to define particular “primary” rules of conduct, the articles set forth more general “secondary” rules of responsibility and remedies for breaches of a primary rule. Important issues include: - What is an “internationally wrongful act”? - When does a “breach” of an international obligation occur? - When can a state be held responsible for acts (or omissions) of nonstate actors or of another state? - What circumstances justify otherwise wrongful conduct? - What must a state do to remedy an internationally wrongful act (render compensation, restitution, satisfaction, etc.)? - Which states have standing to complain? - What kinds of countermeasures are permitted and under what circumstances? At the outset, the ILC\u27s first special rapporteur on state responsibility noted, “[I]t would be difficult to find a topic beset with greater confusion and uncertainty.” And throughout the ILC\u27s consideration of the subject, skepticism and controversy abounded, particularly among those trained in the common law, to whom the abstract treatment of “responsibility,” as such, is unfamiliar. Some see the articles as “a bland gruel not likely to upset the most dyspeptic government official,” others as perhaps the ILC\u27s most important product. Whatever one\u27s view of the articles, however, their adoption by the ILC doubtless represents a significant moment in the continuing development of international law. That is the motivation for this symposium

Groups of Galaxies in the Two Micron All-Sky Redshift Survey

We present the results of applying a percolation algorithm to the initial release of the Two Micron All-Sky Survey Extended Source Catalog, using subsequently measured redshifts for almost all of the galaxies with K < 11.25 mag. This group catalog is based on the first near-IR all-sky flux-limited survey that is complete to |b| = 5 deg. We explore the dependence of the clustering on the length and velocity scales involved. The paper describes a group catalog, complete to a limiting redshift of 10,000 km/s, created by maximizing the number of groups containing 3 or more members. A second catalog is also presented, created by requiring a minimum density contrast of 80 to identify groups. We identify known nearby clusters in the catalogs and contrast the groups identified in the two catalogs. We examine and compare the properties of the determined groups and verify that the results are consistent with the UZC-SSRS2 and northern CfA redshift survey group catalogs. The all-sky nature of the catalog will allow the development of a flow-field model based on the density field inferred from the estimated cluster masses.Comment: Accepted for publication in ApJ (29 pages including 13 figures). A version with high-resolution figures is available at http://www.cfa.harvard.edu/~acrook/preprints

Genetic counseling and testing practices for late-onset neurodegenerative disease: a systematic review

ObjectiveTo understand contemporary genetic counseling and testing practices for late-onset neurodegenerative diseases (LONDs), and identify whether practices address the internationally accepted goals of genetic counseling: interpretation, counseling, education, and support.MethodsFour databases were systematically searched for articles published from 2009 to 2020. Peer-reviewed research articles in English that reported research and clinical genetic counseling and testing practices for LONDs were included. A narrative synthesis was conducted to describe different practices and map genetic counseling activities to the goals. Risk of bias was assessed using the Qualsyst tool. The protocol was registered with PROSPERO (CRD42019121421).ResultsSixty-one studies from 68 papers were included. Most papers focused on predictive testing (58/68) and Huntington's disease (41/68). There was variation between papers in study design, study population, outcomes, interventions, and settings. Although there were commonalities, novel and inconsistent genetic counseling practices were identified. Eighteen papers addressed all four goals of genetic counseling.ConclusionContemporary genetic counseling and testing practices for LONDs are varied and informed by regional differences and the presence of different health providers. A flexible, multidisciplinary, client- and family-centered care continues to emerge. As genetic testing becomes a routine part of care for patients (and their relatives), health providers must balance their limited time and resources with ensuring clients are safely and effectively counseled, and all four genetic counseling goals are addressed. Areas of further research include diagnostic and reproductive genetic counseling/testing practices, evaluations of novel approaches to care, and the role and use of different health providers in practice

Whole-genome sequencing shows that patient-to-patient transmission rarely accounts for acquisition of Staphylococcus aureus in an intensive care unit

BACKGROUND  Strategies to prevent Staphylococcus aureus infection in hospitals focus on patient-to-patient transmission. We used whole-genome sequencing to investigate the role of colonized patients as the source of new S. aureus acquisitions, and the reliability of identifying patient-to-patient transmission using the conventional approach of spa typing and overlapping patient stay. METHODS Over 14 months, all unselected patients admitted to an adult intensive care unit (ICU) were serially screened for S. aureus. All available isolates (n = 275) were spa typed and underwent whole-genome sequencing to investigate their relatedness at high resolution. RESULTS Staphylococcus aureus was carried by 185 of 1109 patients sampled within 24 hours of ICU admission (16.7%); 59 (5.3%) patients carried methicillin-resistant S. aureus (MRSA). Forty-four S. aureus (22 MRSA) acquisitions while on ICU were detected. Isolates were available for genetic analysis from 37 acquisitions. Whole-genome sequencing indicated that 7 of these 37 (18.9%) were transmissions from other colonized patients. Conventional methods (spa typing combined with overlapping patient stay) falsely identified 3 patient-to-patient transmissions (all MRSA) and failed to detect 2 acquisitions and 4 transmissions (2 MRSA). CONCLUSIONS Only a minority of S. aureus acquisitions can be explained by patient-to-patient transmission. Whole-genome sequencing provides the resolution to disprove transmission events indicated by conventional methods and also to reveal otherwise unsuspected transmission events. Whole-genome sequencing should replace conventional methods for detection of nosocomial S. aureus transmission

Decline of meticillin-resistant Staphylococcus aureus in Oxfordshire hospitals is strain-specific and preceded infection-control intensification

Background In the past, strains of Staphylococcus aureus have evolved, expanded, made a marked clinical impact and then disappeared over several years. Faced with rising meticillin-resistant S aureus (MRSA) rates, UK government-supported infection control interventions were rolled out in Oxford Radcliffe Hospitals NHS Trust from 2006 onwards. Methods Using an electronic Database, the authors identified isolation of MRS among 611 434 hospital inpatients admitted to acute hospitals in Oxford, UK, 1 April 1998 to 30 June 2010. Isolation rates were modelled using segmented negative binomial regression for three groups of isolates: from blood cultures, from samples suggesting invasion (eg, cerebrospinal fluid, joint fluid, pus samples) and from surface swabs (eg, from wounds). Findings MRSA isolation rates rose rapidly from 1998 to the end of 2003 (annual increase from blood cultures 23%, 95% CI 16% to 30%), and then declined. The decline accelerated from mid-2006 onwards (annual decrease post-2006 38% from blood cultures, 95% CI 29% to 45%, p=0.003 vs previous decline). Rates of meticillin-sensitive S aureus changed little by comparison, with no evidence for declines 2006 onward (p=0.40); by 2010, sensitive S aureus was far more common than MRSA (blood cultures: 2.9 vs 0.25; invasive samples 14.7 vs 2.0 per 10 000 bedstays). Interestingly, trends in isolation of erythromycin-sensitive and resistant MRSA differed. Erythromycin-sensitive strains rose significantly faster (eg, from blood cultures p=0.002), and declined significantly more slowly (p=0.002), than erythromycin-resistant strains (global p&lt;0.0001). Bacterial typing suggests this reflects differential spread of two major UK MRSA strains (ST22/36), ST36 having declined markedly 2006-2010, with ST22 becoming the dominant MRSA strain. Conclusions MRSA isolation rates were falling before recent intensification of infection-control measures. This, together with strain-specific changes in MRSA isolation, strongly suggests that incompletely understood biological factors are responsible for the much recent variation in MRSA isolation. A major, mainly meticillin-sensitive, S aureus burden remains