Reparation and enforcement of judgments : a comparative analysis of the European and Inter-American human rights systems

The inter-American human rights system has been conceived following the example of the European system under the European Convention on Human Rights (ECHR) before it was modified by Protocol No 11. However, two important differences exist. First, the authority of the European Court of Human Rights (ECtHR) to order reparation has been strictly limited by the principle of subsidiarity. Thus, the ECtHR's main function is to determine whether the ECHR has been violated. Beyond the declaratory effect of its judgments, according to Article 41 ECHR, it may only "afford just satisfaction to the injured party". The powers of the Inter-American Court of Human Rights (IACtHR) were conceived in a much broader fashion in Article 63 of the American Convention on Human Rights (ACHR), giving the Court the authority to order a variety of individual and general measures aimed at obtaining restitutio in integrum. The first main part of this thesis shows how both Courts have developed their reparation practice and examines the advantages and disadvantages of each approach. Secondly, the ECtHR's rather limited reparation powers have, interestingly, been combined with an elaborate implementation system that includes several of the Council of Europe's organs, principally the Committee of Ministers. In the Inter-American System, no dedicated mechanism was implemented to oversee compliance with the IACtHR's judgments. The ACHR limits itself to inviting the Court to point out in its annual reports the cases that have not been complied with and to propose measures to be adopted by the General Assembly of the Organization of American States. The General Assembly, however, hardly ever took action. The IACtHR has therefore filled this gap by developing a proper procedure to oversee compliance with its judgments. Both the European and the American solutions to ensure compliance are presented and compared in the second main part of this thesis. Finally, based on the results of both main parts, a comparative analysis of the reparation practice and the execution results in both human rights systems is being provided, aimed at developing proposals for the improvement of the functioning of either human rights protection system.

Comparison of implant stability by means of resonance frequency analysis for flapless and conventionally inserted implants

Background: Resonance frequency analysis (RFA) is a noninvasive technique for the quantitative assessment of implant stability. Information on the implant stability quotient (ISQ) of transmucosally inserted implants is limited. Purpose: The aim of this investigation was to compare the ISQ of conventionally inserted implants by raising a muco-periostal flap with implants inserted using a flapless procedure. Materials and Methods: Forty elderly patients with complete edentulous maxilla were consecutively admitted for treatment with implant-supported prostheses. A computer tomography was obtained for the computer-assisted implant planning. One hundred ten implants were placed conventionally in 23 patients (flap-group) and 85 implants in 17 patients by means of the flapless method (flapless-group) using a stereolithographic template. RFA measurements were performed after implant placement (baseline) and after a healing time of 12 weeks (reentry). Results: All implants exhibited clinically and radiographically successful osseointegration. Bone level did not change significantly neither for genders nor type of surgical protocol. Mean ISQ values of the flapless-group were significantly higher at baseline (p < .001) and at reentry (p < .001) compared with the flap-group. The ISQ values were significantly lower at reentry compared with baseline for the flap-group (p = .028) but not for the flapless-group. This group showed a moderate, but insignificant increase. RFA measurements of males resulted in ISQ values that were thoroughly higher as compared with females at both time-points in both groups. Correlation between RFA and bone level was not found. Conclusions: The flapless procedure showed favorable conditions with regard to implant stability and crestal bone level. Some changes of the ISQ values that represent primary (mechanical) and secondary (bone remodeling) implant stability were observed in slight favor of the flapless method and male patients. In properly planned and well-selected cases, the minimal invasive transmucosal technique using a drill-guide is a safe procedure.

Post-mortem radiological CT identification based on classical ante-mortem X-ray examinations

Radiological identification is important in forensic medicine. Identification using comparison of individualising structures with ante- and post-mortem conventional radiographs has been known for a long time. New radiological procedures such as computed tomography (CT) and magnetic resonance imaging (MRI) are being increasingly used for identification. In this paper, a new comparative approach using various radiological methods is described and its application demonstrated. This new approach is the comparison of ante-mortem conventional radiographs with projected images calculated from post-mortem CT data. The identification procedure will be illustrated with reference to the frontal sinus and the pelvis.

Whole-body motion discrimination in the visually impaired

Visually impaired people show superior abilities in various perception tasks such as auditory attention, auditory temporal resolution, auditory spatial tuning, and odor discrimination. However, with the use of psychophysical methods, auditory and olfactory detection thresholds typically do not differ between visually impaired and sighted participants. Using a motion platform we investigated thresholds of passive whole-body motion discrimination in nine visually impaired participants and nine age-matched sighted controls. Participants were rotated in yaw, tilted in roll, and translated along the y-axis at two different frequencies (0.3 Hz and 2 Hz). An adaptive 3-down 1-up staircase procedure was used along with a two-alternative direction (leftward vs. rightward) discrimination task. Superior performance of visually impaired participants was found in the 0.3 Hz roll tilt condition. No differences between the visually impaired and controls were observed in all other types of motion. The superior performance in the 0.3 Hz roll tilt condition could reflect differences in the integration of extra-vestibular cues and increased sensitivity towards changes in the direction of the gravito-inertial force. In the absence of visual information, roll tilts entail a more pronounced risk of falling, and this could eventually account for the group difference. It is argued that differences in experimental procedures (i.e. detection vs. discrimination of stimuli) explain the discrepant findings across perceptual tasks comparing blind and sighted participants.

Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke

Background Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome. Methods We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group). Patients had confirmed occlusions in the proximal anterior intracranial circulation and an absence of large ischemic-core lesions. The primary outcome was the severity of global disability at 90 days, as assessed by means of the modified Rankin scale (with scores ranging from 0 [no symptoms] to 6 [death]). Results The study was stopped early because of efficacy. At 39 centers, 196 patients underwent randomization (98 patients in each group). In the intervention group, the median time from qualifying imaging to groin puncture was 57 minutes, and the rate of substantial reperfusion at the end of the procedure was 88%. Thrombectomy with the stent retriever plus intravenous t-PA reduced disability at 90 days over the entire range of scores on the modified Rankin scale (P<0.001). The rate of functional independence (modified Rankin scale score, 0 to 2) was higher in the intervention group than in the control group (60% vs. 35%, P<0.001). There were no significant between-group differences in 90-day mortality (9% vs. 12%, P=0.50) or symptomatic intracranial hemorrhage (0% vs. 3%, P=0.12). Conclusions In patients receiving intravenous t-PA for acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, thrombectomy with a stent retriever within 6 hours after onset improved functional outcomes at 90 days.

Impact of case-relevant and case-irrelevant communication within the surgical team on surgical-site infection

BACKGROUND Surgical-site infections (SSIs) are the most common complications after surgery. An influence from talking and distractions during surgery on patient outcomes has been suggested, but there is limited evidence. The aim of this prospective observational study was to assess the relationship between intraoperative communication within the surgical team and SSI, and between intraoperative distractions and SSI. METHODS This prospective observational study included patients undergoing elective, open abdominal procedures. For each procedure, intraoperative case-relevant and case-irrelevant communication, and intraoperative distractions were observed continuously on site. The influence of communication and distractions on SSI after surgery was assessed using logistic regressions, adjusting for risk factors. RESULTS A total of 167 observed procedures were analysed; their mean(s.d.) duration was 4·6(2·1) h. A total of 24 SSIs (14·4 per cent) were diagnosed. Case-relevant communication during the procedure was independently associated with a reduced incidence of organ/space SSI (propensity score-adjusted odds ratio 0·86, 95 per cent c.i. 0·77 to 0·97; P = 0·014). Case-irrelevant communication during the closing phase of the procedure was independently associated with increased incidence of incisional SSI (propensity score-adjusted odds ratio 1·29, 1·08 to 1·55; P = 0·006). Distractions had no association with SSI. CONCLUSION More case-relevant communication was associated with fewer organ/space SSIs, and more case-irrelevant communication during wound closure was associated with incisional SSI.

Percutaneous closure of the patent foramen ovale, easy does it.

Closure of the patent foramen ovale does not benefit from echocardiographic guidance in the majority of cases. Guiding these procedures with fluoroscopy only reduces procedure time, radiation exposure, and amount of contrast medium. There is a clear trend to abandon echocardiographic guidance for this procedure over time and with growing experience.

SYNTHETIC PROBES FOR STUDYING TUFTSIN-RECEPTOR INTERACTIONS ON HUMAN POLYMORPHONUCLEAR LEUKOCYTES

Tuftsin is an immunopotentiating tetrapeptide of the sequence L-Thr-L-Lys-L-Pro-L-Arg with anti-microbial and anti-tumor enhancing capabilities. These enhancing functions are manifested through the host's granulocytes and monocytes. In delineating tuftsin's mechanism of action, both radiolabeled and fluorescent probes were synthesized. The radiolabeled probe of tuftsin, L-proly-3,4-('3)H(N) -tuftsin, was obtained through the synthesis and subsequent catalytic hydrogenation of L-3,4-dehydroprolyl ('3)-tuftsin using tritium gas. This procedure yielded a probe with a specific activity of 44.9 Ci/mmole. This radiolabeled probe of tuftsin was used in competitive inhibition studies with tuftsin, the tuftsin analogues Lys-Pro-Arg, Thr-Lys-Pro-Arg(NO(,2)) and (DELTA)('3)-pro('3) -tuftsin as well as with the chemotactic peptide f-Met-Leu-Phe. From the competitive binding curves, the K(,D) for tuftsin was estimated to be 80 nM, a value that approaches the concentration of tuftsin that evokes a half maximal biological response. The approximate Ki's for the tuftsin analogues (33 nM) approached that of tuftsin itself (40 nM). On the other hand, approximately a two log difference in the Ki was seen with the chemotactic tripeptide, indicating that tuftsin may indeed be acting through the chemotactic peptide receptor. This conclusion is further strengthened by studies using an N-terminal derivitized mono-fluoresceinated tuftsin probe and image intensification microscopy. These studies showed that like the chemotactic peptide, tuftsin initially binds to diffusely distributed receptors on the surface of human granulocytes. The tuftsin-receptor complexes then rapidly redistribute to form patches (5 min @ 37(DEGREES)C) which are then internalized. Whether redistribution and internalization of tuftsin-receptor complexes is crucial in effecting a biological response, or simply an intermediary point leading ultimately to degradation, is still not clear. This process, however, may provide the target cell with an early time point in modulating the biological effects of tuftsin through down-regulation of cell surface receptor sites. ^

Women in Eighteenth Century London: Female Coming of Age in Frances Burney’s Evelina, Cecilia, and The Witlings

The late eighteenth-century author Frances Burney is best known for popularizing the “comedy of manners,” a literary style later adopted by Jane Austen. Burney’s novels, journals, and plays offer an intriguing commentary on contemporary social customs and etiquette. In particular, she voices the concerns and desires of women, leading scholars to focus on the feminist overtones of her writing. Although she carefully examined female roles in the household and family structure, Burney also provided an insider’s perspective into London high life. As an acclaimed author and member of the royal court, Burney offers a rare insight into the lives of the urban elite. For these reasons, I have chosen to examine three of her works within the context of their London setting. In Evelina, Cecilia, and The Witlings, Burney examines women’s struggle for independence against the backdrop of the city. These works offer a new interpretation of the female Bildungsroman, or coming of age story. Burney shows how London life influences her heroines’ expectations, ambitions and desires. Evelina’s coming of age centers around the quest for family and social acceptance, while the two Cecilias of Cecilia and The Witlings confront the financial pressures that accompany their inheritance. Ultimately, the three protagonists learn important lessons that are specific to city life. Although Burney concludes each story with the heroine’s marriage, her focus is not on romance, as has been suggested, but on the cultural landscape of the city. Coming of age in her stories is inextricably connected to the diverse challenges and opportunities presented to urban women.

Healthcare provider perspectives on parental refusal of medical interventions: A qualitative study

Background. Healthcare providers in pediatrics are faced with parents making medical decisions for their children. Refusal to consent to interventions can have life threatening sequelae, yet healthcare workers are provided little training in handling refusals. The healthcare provider's experience in parental refusal has not been well described, yet is an important first step in addressing this problem. ^ Specific aims. Describe: (1) the decision-making processes made by healthcare providers when parents refuse medical interventions for their children, (2) the source of healthcare workers' skills in handling situations of refusal, and (3) the perspectives of healthcare workers on parental refusals in the inpatient setting. ^ Methods. Nurses, physicians and respiratory therapists (RT) were recruited via e-mail at Texas Children's Hospital (TCH). Interview questions were developed using Social Cognitive Theory constructs and validated. One-on-one in-depth, one hour semi-structured interviews were held at TCH, audio recorded and transcribed. Coding and analysis were done using ATLAS ti. The constant comparative method was applied to describe emergent themes that were reviewed by an independent expert. ^ Results. Interviews have been conducted with nurses (n=6), physicians and practitioners (n=6), social workers (n=3) and RT (n=3) comprising 13 females and 5 males with 3–25 years of experience. Decision-making processes relate to the experience of the caregiver, familiarity with the family, and the acuity of the patient. Healthcare workers' skills were obtained through orientation processes or by trial-and-error. Themes emerged that related to the importance of: (1) Communication, where the initial discussion about a medical procedure should be done with clarity and an understanding of the parents' views; (2) Perceived loss of control by parents, a key factor in their refusal of interventions; and (3) Training, the need for skill development to handle refusals. ^ Conclusions. Effective training involving clarity in communication and a preservation of perceived control by parents is needed to avoid the current trial-and-error experience of healthcare workers in negotiating refusal situations. Such training could lessen the more serious outcomes of parental refusal. ^

Diversidad de focalizaciones y unidad de sentido en Minotauroamor de Abelardo Arias

Minotauroamor, obra favorita de Abelardo Arias, es una novela que se presenta ante el lector organizada en dos planos. Esta estructura ha sido claramente marcada ya desde el nivel tipográfico: la mayor parte de la obra está escrita en un tipo normal y algunos párrafos, en bastardilla o cursiva. Precisamente estos párrafos son los que se separan, aparentemente, del relato principal, narrando otra historia, con otros personajes, acciones y ejes espacio-temporales. Por muchos años fue común que los lectores eligieran ignorar este otro relato, de menor extensión, ya que el texto principal resulta perfectamente legible sin él. Sin embargo, esta lectura empobrece la obra, razón por la cual este trabajo se propone demostrar, a partir del análisis de los rasgos que unen y diferencian estos dos planos de la novela, que el significado total es más que la suma del significado de cada parte y, evidentemente, más que el significado de una parte.

¿Porque funciona o por qué funciona? Los argumentos de fiscales y abogados defensores en causas por delitos sexuales [Buenos Aires, 1863-1921]

Las agresiones sexuales producen, habitualmente, una enorme cantidad de discursos no sólo jurídicos, médicos y académicos sino también periodísticos e incluso de simple divulgación o informales. En ellos se cuelan cotidiana y casi desapercibidamente ideas respecto de las conductas sexuales esperables -o inaceptables- tanto en hombres como mujeres antes, durante y después del ataque. En el presente trabajo propongo estudiar un conjunto de discursos particular donde pueden verse estas mismas cuestiones: los argumentos que fiscales y abogados defensores produjeron en el contexto de su participación en casos por delitos sexuales durante la segunda mitad del siglo XIX y principios del XX llevados adelante en Buenos Aires. La contienda judicial obliga, si se quiere, a que los juristas involucrados en el proceso deban siempre armar historias "creíbles" en tanto "factibles" de acuerdo a los hechos que la investigación del ilícito denunciado va revelando, y aunque cada caso tenga características particulares, siempre existirán similitudes que permitan el desarrollo de estrategias legales comunes para aplicar en ocasiones análogas. Aquí entonces, se busca mostrar cuáles fueron algunas de las estrategias discursivas en los juicios por los delitos particulares que trabajo, independientemente del éxito final de la estrategia en el expediente concreto. En este sentido, si bien debe tenerse en cuenta que los alegatos siempre son un relato armado que responde a una meta particular -ganar el caso-, y por tanto, su estudio requiere de especiales cuidados es factible utilizarlos para rastrear ideas socio-sexuales que se cuelan en ellos así como pensar las distintas formas en que se construye o discute a la víctima. Al analizar casos que tuvieron por víctimas a mujeres y a hombres se busca poner en juego las diferentes construcciones discursivas que se dieron para cada uno de ellos mostrando los diferentes argumentos que se produjeron de acuerdo al sexo biológico de la persona agredida y tensionando entonces las ideas de lo esperable y aceptable para cada uno de ellos no sólo en el terreno de la sexualidad sino de los lugares asignados en la sociedad

Justicia y evaluación en el Carmen 64 de Catulo

En la historia de la interpretación del carmen 64 de Catulo pueden observarse algunas constantes, que tienen que ver principalmente con discusiones acerca del género, la estructura, la unidad y diversidad del poema. En este artículo se retoman diversas propuestas de acuerdo con estos ejes, revisando ciertas consideraciones y preguntándose una vez más por su sentido. La elección de los personajes, por ejemplo, y las alteraciones deliberadas en los detalles de la historia respecto de la tradición, al tiempo que desorientan y siembran la duda, revelan la compleja dimensión axiológica del texto, que parece involucrarnos más de lo esperado

Justicia y evaluación en el Carmen 64 de Catulo

En la historia de la interpretación del carmen 64 de Catulo pueden observarse algunas constantes, que tienen que ver principalmente con discusiones acerca del género, la estructura, la unidad y diversidad del poema. En este artículo se retoman diversas propuestas de acuerdo con estos ejes, revisando ciertas consideraciones y preguntándose una vez más por su sentido. La elección de los personajes, por ejemplo, y las alteraciones deliberadas en los detalles de la historia respecto de la tradición, al tiempo que desorientan y siembran la duda, revelan la compleja dimensión axiológica del texto, que parece involucrarnos más de lo esperado

¿Porque funciona o por qué funciona? Los argumentos de fiscales y abogados defensores en causas por delitos sexuales [Buenos Aires, 1863-1921]

Las agresiones sexuales producen, habitualmente, una enorme cantidad de discursos no sólo jurídicos, médicos y académicos sino también periodísticos e incluso de simple divulgación o informales. En ellos se cuelan cotidiana y casi desapercibidamente ideas respecto de las conductas sexuales esperables -o inaceptables- tanto en hombres como mujeres antes, durante y después del ataque. En el presente trabajo propongo estudiar un conjunto de discursos particular donde pueden verse estas mismas cuestiones: los argumentos que fiscales y abogados defensores produjeron en el contexto de su participación en casos por delitos sexuales durante la segunda mitad del siglo XIX y principios del XX llevados adelante en Buenos Aires. La contienda judicial obliga, si se quiere, a que los juristas involucrados en el proceso deban siempre armar historias "creíbles" en tanto "factibles" de acuerdo a los hechos que la investigación del ilícito denunciado va revelando, y aunque cada caso tenga características particulares, siempre existirán similitudes que permitan el desarrollo de estrategias legales comunes para aplicar en ocasiones análogas. Aquí entonces, se busca mostrar cuáles fueron algunas de las estrategias discursivas en los juicios por los delitos particulares que trabajo, independientemente del éxito final de la estrategia en el expediente concreto. En este sentido, si bien debe tenerse en cuenta que los alegatos siempre son un relato armado que responde a una meta particular -ganar el caso-, y por tanto, su estudio requiere de especiales cuidados es factible utilizarlos para rastrear ideas socio-sexuales que se cuelan en ellos así como pensar las distintas formas en que se construye o discute a la víctima. Al analizar casos que tuvieron por víctimas a mujeres y a hombres se busca poner en juego las diferentes construcciones discursivas que se dieron para cada uno de ellos mostrando los diferentes argumentos que se produjeron de acuerdo al sexo biológico de la persona agredida y tensionando entonces las ideas de lo esperable y aceptable para cada uno de ellos no sólo en el terreno de la sexualidad sino de los lugares asignados en la sociedad