Responsible agricultural investment: is there a significant role for the law to promote sustainability?

The world food situation is back in the headlines as price levels surpass 2008 peaks, confirming the rising trend in food markets. Higher prices pose challenges to both food importing and exporting countries. One serious barrier to increasing food output remains the lack of necessary capital and technology in countries that have the potential to increase production rapidly. To avoid a food crisis, international organizations and several governments have increasingly turned to promoting foreign direct investment (FDI) by multinational enterprises (MNEs) in agriculture. This may be an effective solution, but some obstacles stand in the way of the establishment of such projects and, more importantly, their long-term sustainability

Um espaço para pensar em alternativas? A academia latino-americana de Direito Internacional Econômico frente à ordem econômica global

Esta contribuição tem por objetivo analisar o papel da academia latino-americana de direito internacional econômico frente à ordem econômica global. Grande parte dos problemas que hoje enfrentam os latino-americanos está ligada à globalização econômica. Condições de trabalho, acesso a medicamentos, uso de recursos naturais, entre outros, estão intimamente ligados à ordem econômica global. No debate sobre estes problemas, não obstante, poucas vezes reconhece-se o papel fundamental que tem a academia de direito internacional econômico. Embora seja certo que o conhecimento articulado pela academia não é suficiente para explicar por que os Estados atuam de certa forma, talvez seja suficiente para entender por que não atuam de outra maneira. Neste contexto, o argumento central desta contribuição é que a academia de direito internacional econômico tem um papel chave na manutenção e na reprodução da atual ordem econômica global. Se isto está correto, a academia regional pode fazer mais pela América Latina que servir de apoio às necessidades estatais, tanto de assessoria como de defesa de seus interesses em controvérsias legais. Ao tomar consciência de seu papel constitutivo da ordem econômica global, a academia regional pode ser um meio fundamental para articular alternativas que permitam à América Latina e a sua população encontrar seu lugar na globalização

负责任的农业投资：可持续发展促进法是否至关重要

随着粮食价格超过2008年高位，粮食问题重新占据各大媒体的头条，反过来支撑粮价继续攀升。价格走高给粮食出口国和进口国都带来了挑战。阻碍粮食增产的重要障碍依然是潜在产出增长国对必要资本和技术的缺乏。为避免粮食短缺危机，国际组织及多国政府已越来越多的致力于促进跨国公司在农业部门的外国直接投资。这或许是一种有效的解决方式，不过这些项目的设立存在一些障碍，其中最重要的是检验其是否具有长期可持续性

Pathways to Just, Equitable and Sustainable Trade and Investment Regimes

In this report we discuss what a Fair, Just and Equitable approach to the global, liberalized and hyper-competitive system of global trade and investments should be. The global market for goods and capital affect the life of producers and workers, stimulates the run towards cheaper products and puts farmers and workers against each other. The current vision of trade and investments is based on the silencing of gendered and reproductive labour and is responsible for the increase in inequality and relative poverty. Furthermore, it stimulates the extraction of commodities and contributes to the degradation of the planet, it has a significant impact on greenhouse gas emissions (GHG) due to transportation representing above 7% of the world total GHG, and it is closely linked with the appropriation of nature through patenting and the shift towards capital-intensive forms of production.In light of this, our report claims that the Fair Trade Movement shall not play ‘outside the market’ nor accept that the existing narrative and mechanisms will provide a solution that addresses the root causes of the problem. If the Fair Trade Movement was to play outside the market, it would create islands of fairness in a sea of degradation and violence, which sooner or later would also swallow those few bubbles (unless they can be reproduced thanks to the support of an elite interested in fair and sustainable products). This is because the global market is characterized by an inherent expansionist tendency and needs to stretch its frontiers, compete for resources and ensure a larger shares of consumers. If the approach was that of tweaking with current mechanisms and narratives, it would accept the historical violence and inequality of colonialism and uneven development that are at the basis of the global system of trade, it would dismiss the role that global trade has in piercing the planetary boundaries, and it would accept that contemporary social problems shall be addressed by making the pie larger rather than adequately redistributing what is already available.Given that the aim is that of implementing justice, equity and sustainability, we thus suggest ten principles/recommendations to be utilized by the Fair Trade movement when thinking about its approach to trade, its campaigns and where does it stand vis-à-vis concrete issues. The adoption of an intersectional and systemic approach to justice, equity and sustainability has concrete implications on the approach that the Fair Trade movement should adopt with regards to a set of trade and investments issues that are prominent in the contemporary international and regional debate. In the last part of this report we engage with five of these topics and present the main elements of a renew policy approach that follows the indications contained in our analysis

MDRD or CKD-EPI study equations for estimating prevalence of stage 3 CKD in epidemiological studies: which difference? Is this difference relevant?

Background: Prevalence of stage 3 chronic kidney disease (CKD) is increasing according to the NHANES study. Prevalence has been calculated using the MDRD study equation for estimating glomerular filtration rate (GFR). Recently, a new estimator based on creatinine, the CKD-EPI equation, has been proposed which is presumed to better perform in normal GFR ranges. The aim of the study was to measure the difference in prevalence of stage 3 CKD in a population using either the MDRD or the CKD-EPI study equations. Methods: CKDscreening is organized in the Province of Liège, Belgium. On a voluntary basis, people aged between 45 and 75 years are invited to be screened. GFR is estimated by the MDRD study equation and by the "new" CKD-EPI equations. Results: The population screened consisted in 1992 people (47% of men). Mean serum creatinine was 0.86 ± 0.20 mg/dl. The prevalence of stage 3 CKD in this population using the MDRD or the CKD-EPI equations was 11.04 and 7.98%, respectively. The prevalence of stage 3 CKD is significantly higher with the MDRD study equation (p <0,0012). Conclusions: Prevalence of stage 3 CKDvaries strongly following the method used for estimating GFR, MDRD or CKDEPI study equations. Such discrepancies are of importance and must be confirmed and explained by additional studies using GFR measured with a reference method

Surrogate endpoints for overall survival in digestive oncology trials: which candidates? A questionnaires survey among clinicians and methodologists

<p>Abstract</p> <p>Background</p> <p>Overall survival (OS) is the gold standard for the demonstration of a clinical benefit in cancer trials. Replacement of OS by a surrogate endpoint allows to reduce trial duration. To date, few surrogate endpoints have been validated in digestive oncology. The aim of this study was to draw up an ordered list of potential surrogate endpoints for OS in digestive cancer trials, by way of a survey among clinicians and methodologists. Secondary objective was to obtain their opinion on surrogacy and quality of life (QoL).</p> <p>Methods</p> <p>In 2007 and 2008, self administered sequential questionnaires were sent to a panel of French clinicians and methodologists involved in the conduct of cancer clinical trials. In the first questionnaire, panellists were asked to choose the most important characteristics defining a surrogate among six proposals, to give advantages and drawbacks of the surrogates, and to answer questions about their validation and use. Then they had to suggest potential surrogate endpoints for OS in each of the following tumour sites: oesophagus, stomach, liver, pancreas, biliary tract, lymphoma, colon, rectum, and anus. They finally gave their opinion on QoL as surrogate endpoint. In the second questionnaire, they had to classify the previously proposed candidate surrogates from the most (position #1) to the least relevant in their opinion.</p> <p>Frequency at which the endpoints were chosen as first, second or third most relevant surrogates was calculated and served as final ranking.</p> <p>Results</p> <p>Response rate was 30% (24/80) in the first round and 20% (16/80) in the second one. Participants highlighted key points concerning surrogacy. In particular, they reminded that a surrogate endpoint is expected to predict clinical benefit in a well-defined therapeutic situation. Half of them thought it was not relevant to study QoL as surrogate for OS.</p> <p>DFS, in the neoadjuvant settings or early stages, and PFS, in the non operable or metastatic settings, were ranked first, with a frequency of more than 69% in 20 out of 22 settings. PFS was proposed in association with QoL in metastatic primary liver and stomach cancers (both 81%). This composite endpoint was ranked second in metastatic oesophageal (69%), colorectal (56%) and anal (56%) cancers, whereas QoL alone was also suggested in most metastatic situations.</p> <p>Other endpoints frequently suggested were R0 resection in the neoadjuvant settings (oesophagus (69%), stomach (56%), pancreas (75%) and biliary tract (63%)) and response. An unexpected endpoint was metastatic PFS in non operable oesophageal (31%) and pancreatic (44%) cancers. Quality and results of surgical procedures like sphincter preservation were also cited as eligible surrogate endpoints in rectal (19%) and anal (50% in case of localized disease) cancers. Except for alpha-FP kinetic in hepatocellular carcinoma (13%) and CA19-9 decline (6%) in pancreas, few endpoints based on biological or tumour markers were proposed.</p> <p>Conclusion</p> <p>The overall results should help prioritise the endpoints to be statistically evaluated as surrogate for OS, so that trialists and clinicians can rely on endpoints that ensure relevant clinical benefit to the patient.</p

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P &lt;0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation