Mandatory Review Research Articles

Rate of Diagnostic Change in Surgical Pathology Reports after Mandatory Intradepartmental Peer Review in a Tertiary Hospital in the Philippines: A Retrospective Study.

There is a mandatory intradepartmental peer review algorithm in the University of the Philippines - Philippine General Hospital (UP-PGH) Department of Laboratories wherein specific cases are required to be reviewed by another pathologist before the release of results. The main objective of this study was to determine the rate of diagnostic change in surgical pathology reports after undergoing the said review. All surgical pathology cases which underwent the review from 2015 to 2018 were retrieved from the records of the Section of Surgical Pathology. The cases were classified as concordant or discordant. A case was considered concordant if the reviewing pathologist had agreed with the primary pathologist's diagnosis. A case was considered discordant if the reviewing pathologist had disagreed with the primary pathologist's diagnosis. Out of 5,377 cases included in this study, there were 5,209 concordant cases and 168 discordant cases, with the rate of discordance computed to be 3.1%. Out of the 168 discordant cases, 107 were revised for diagnostic change. Rate of diagnostic change was computed to be 2.0% (107 out of 5,377 cases for review). The most common criterion satisfied for meriting a mandatory review is being under the category of biopsies or cytology cases with malignant or borderline diagnoses (49.4%). The most common category of diagnostic change is change in immunohistochemistry recommendations (24.3%). Most of the discordant cases and cases revised for diagnostic change fall under the categories of gastrointestinal, gynecology, and head & neck pathology. The low rate of diagnostic change in our institution might be attributed to good diagnostic accuracy. However, it is also possible that reviewing pathologists tended to agree with the diagnosis made by their colleagues because of the element of peer pressure. Data from the study may imply that special courses/ lectures or institutional standard practice guidelines on interpreting biopsy and cytology cases as well as on the utility of immunohistochemistry studies, especially those focused on gastrointestinal, gynecology, and head & neck pathology are needed by the pathologists and the doctors training to become pathologists in our institution.

2296 Co-developing a qualitative study exploring the determinants of safe anti-coagulation in frail older adults.

Abstract Introduction Despite the knowledge that oral anti-coagulation (OAC) is effective in secondary prevention of stroke, prescribing rates are low in frail older patients with atrial fibrillation (AF), dementia, and high fall risks. A joint decision-making approach between clinicians, patients and carers is needed to negotiate the risk–benefit balance. The aim of this participatory study was to engage with a group of older adults, their carers and healthcare professionals to identify key themes that will inform a planned qualitative study exploring frail older patients’ acceptance of and adherence to OAC. Methods We identified a group of twenty-eight adults (aged >65 years) and carers from community partners: ‘Ageing Well’ platform, Health Watch team, and the University of the Third Age (U3A) in Brighton and Hove, East Sussex, UK. Using two case vignettes of hypothetical OAC decisions, we hosted two virtual focus group meetings with the above cohort, followed by a virtual meeting with four geriatricians, two pharmacists, a GP and a patient champion. Inductive thematic analysis was performed on the group discussions by two researchers independently. Results Five key themes were identified as crucial to include in the future qualitative study discussions: (i) age should not be a barrier to anti-coagulation (ii) individualised, holistic assessment by a specialist is mandatory (iii) annual review of anti-coagulation should be performed, revisiting patients and carers’ understanding of the risks and benefits (iv) patient and carer education should be tailored to their medical and social background, and (v) quality of life should be a key factor in OAC decisions. Conclusion Engaging with a group of older adults in a co-development exercise helped identify key themes for a future study of anti-coagulation in frail older adults with AF.

Advance Directives Change Frequently in Nursing Home Residents

ObjectivesTo describe the rate, timing, and pattern of changes in advance directives (ADs) of do not resuscitate (DNR) and do not hospitalize (DNH) orders among new admissions to nursing homes (NHs). DesignA retrospective cohort study. Setting and ParticipantsAdmissions to all publicly funded NHs in Ontario, Canada, between January 1, 2013, and December 31, 2017. MethodsResidents were followed until discharged from incident NH stay, death, or were still present at the end of study (December 31, 2019). They were categorized into 3 mutually exclusive baseline composite AD groups: Full Code, DNR Only, and DNR+DNH. We used Poisson regression models to estimate the incidence rate ratios of AD change between different AD groups and different decision makers for personal care, adjusted for baseline clinical and sociodemographic variables. ResultsA total of 102,541 NH residents were eligible for inclusion. Residents with at least 1 AD change accounted for 46% of Full Code, 30% of DNR Only, and 25% of DNR+DNH group. Median time to first AD change ranged between 26 and 55 weeks. For Full Code and DNR Only residents, the most frequent change was to an AD 1 level lower in aggressiveness or intervention, whereas for DNR+DNH residents the most frequent change was to DNR Only. About 16% of residents had 2 or more AD changes during their stay. After controlling for covariates, residents with a DNR-only order or DNR+DNH orders at admission and those with a surrogate decision maker were associated with lower AD change rates. Conclusions and ImplicationsMeasuring AD adherence rates that are documented only at a particular time often underestimates the dynamics of AD changes during a resident's stay and results in an inaccurate measure of the effectiveness of AD on resident care. There should be more frequent reviews of ADs as they are quite dynamic. Mandatory review after an acute change in a resident's health would ensure that ADs are current.

Enhancing patient safety in radiotherapy: Implementation of a customized electronic checklist for radiation therapists

IntroductionThe radiotherapy workflow involves the collaboration of multiple professionals and the execution of several steps to results in an effective treatment. In this study, we described the clinical implementation of an electronic checklist, developed to standardize the process of the chart review prior to the first treatment fraction by the radiation therapists (RTTs). Materials and MethodsA customized electronic checklist was developed based on the recommendations of American Association of Physicists in Medicine (AAPM) Task Groups 275 and 315 and integrated into the Record and Verify System (RVS). The checklist consisted of 16 items requiring binary (yes/no) responses, with mandatory completion and review by RTTs prior to treatment. The utility of the checklist and its impact on workflow were assessed by analysing checklist reports, and by soliciting feedback to RTTs through an anonymized survey. ResultsDuring the first trial phase, from June to November 2023, 285 checklists were completed with a 98% compilation rate and 94.4% review rate. Forty errors were detected, mainly due to missing signed treatment plans and absence of Beam’s Eye View documentation. Ninety percent of detected errors were fixed before the treatment start. In 4 cases, the problem could not be fixed before the first fraction, resulting in a suboptimal first treatment. The feedback survey showed that RTTs described the checklist as useful, with minimal impact on workload, and supported its implementation. DiscussionThe introduction of a customized electronic checklist improved the detection and correction of errors, thereby enhancing patient safety. The positive response from RTTs and the minimal impact on workflow underscore the value of the checklist as standard practice in radiotherapy departments.

Problems of Occupational Injuries and Ways of Its Reduction on Example of Ukraine

Manuscript presents a study of the causes of accidents on the example of Ukraine in recent years, considering the peculiarities of the modern period. The relevance of this study is due to the high level of industrial injuries in Ukraine compared to the industrialized countries of the European Union. Data on the dynamics of the causes of accidents for the period from 2015 to 2022 are presented. Data for the study were taken from open sources of information. The most trauma-dangerous industries of the national economy are considered. Proposed measures to reduce the level of injury in Ukraine. The analysis of the obtained results showed a certain dependence of the causes of accidents on the coronavirus infection. An unchanging leading position in the organizational causes of accidents has been established. According to the results of the study, regularities were established regarding the most traumatic sectors of the economy in the presented years. The predominance of organizational causes of industrial injuries due to the low motivational component of occupational safety is shown. The need to improve training on occupational health and safety issues for employees at all levels was noted. It was established that the reduction of industrial injuries is impossible without the teaching of labor protection issues in institutions of higher education by future heads of structural divisions and leading specialists. Mandatory review and re-approval of the instructions, the violation of which led to an accident, is proposed. It is recommended to apply mandatory professional selection and more thorough control over periodic preventive medical examinations.

The ATLAS Alarm Helper

The Detector Safety System is the last line of defence to protect the ATLAS detector against abnormal and potentially even unforeseen situations. It is designed to return the detector to a safe state based on predefined actions triggered by alarms which are triggered on their part by specific sets of conditions. Every alarm whether it results in an action taken or not is followed up by the operations team that assesses the criticality, takes countermeasures and identifies the point of failure. From experience abnormal situations can result either from faults or from side effects of planned interventions which were either not properly identified despite the mandatory planning and review or where a mistake during execution occurred. In many cases there are multiple interventions ongoing simultaneously in order to profit from shutdown periods. The rapid analysis of alarms while the incident is ongoing is often complicated due to the complexity of the ATLAS detector and its infrastructure and the large number of responsible groups and experts. A new Alarm Helper tool was designed to assist the operation team, particularly the operator in the control room responsible for infrastructure and safety (SLIMOS – Shift Leader in Matters of Safety), by providing real-time information about ongoing interventions and the possible related causes of failure. The new tool will combine historical events, documentation, and limited knowledge about ongoing interventions. It extends the Expert System which visualizes and simulates infrastructure inter-dependencies and allows to trace faults or alarms to a list of potential points of failure. The new tool also proposes which experts should be contacted in the particular circumstances.

Best practice: quality assessment outcomes of the Practice Enhancement Program among family physicians in Saskatchewan, Canada.

Increased family physician workloads have strained primary care. The objective of this study was to describe the frequency and types of quality concerns identified among Saskatchewan's family physicians, changes in these concerns over time, associated physician characteristics, and recommendations made for improvement. In this repeated cross-sectional study (1997-2020), we examined family physician assessment reports from the Saskatchewan Practice Enhancement Program, a mandatory practice review strategy, for quality concerns on three outcomes: care, medical record, and facility. We recorded demographic and practice characteristics, the presence or absence of quality concerns, and the type of recommendations made. Concern incidence was calculated both overall and across subperiods, and three outcome-specific multiple logistic regression models were developed. Recommendations made were quantified, and their nature was evaluated using thematic analysis. Among 824 assessments, 20.8% identified concerns, with a statistically significant increase in 2015-20 over earlier years (14.2% versus 43.4%, P < .001). Corresponding proportions also significantly increased within each quality outcome (6.0%-37.1%, P < .001 for care concerns; 12.7%-19.6%, P = .03 for medical record concerns; 3.9%-21.0%, P < .001 for facility concerns). We found statistically significant adjusted associations between care concerns and both urban location [odds ratio (OR): 2.2; 95% confidence interval (CI): 1.30, 3.8] and international medical training (OR: 2.4; 95% CI: 1.34, 4.2); facility concerns and solo practice (OR: 2.5 95% CI: 1.10, 5.7); and medical record concerns and male gender (OR: 1.88; 95% CI: 1.09, 3.3), solo practice (OR: 1.67; 95% CI: 1.01, 2.7), and increased age. Reflecting a statistically significant interaction found between age as a continuous covariate and time period, older physicians were more likely to have a medical record concern in later years (OR: 1.072; 95% CI: 1.026, 1.120) compared to earlier ones (OR: 1.021; 95% CI: 1.001, 1.043). Among physicians where a concern was identified, recommendations most frequently pertained to documentation (91.2%), chronic disease management (78.2%), cumulative patient profiles (62.9%), laboratory investigations (53.5%), medications (51.8%), and emergency preparedness (51.2%). A concerning and increasing proportion of family physicians have quality gaps, with identifiable factors and recurring recommendations. These findings provide direction for strategic support development.

Ethics review of artistic research: challenging the boundaries and appealing for care

In 2019, a new national Ethics Review Authority (Etikprövningsmyndigheten, EPM) was created in Sweden. In 2020, Sweden’s Ethical Review of Research Involving Humans Act was revised, tightening this legislation, and increasing penalties for its infraction. This article draws on empirical material generated by artistic research conducted with a norm-critical contemporary music ensemble. Two of the musicians who collaborated with this research identify as disabled. Consequently, in accordance with EPM, my artistic research was subject to mandatory ethics review. Reflecting critically on my own experience of seeking ethical approval for this artistic research project, I show how EPM’s process of ethics review enacts scientific boundary work in Sweden that privileges the interests of academic disciplines that are already well-established. As a corrective to EPM’s scientific boundary work I propose the application of an ethics of care that recognises the complex relationalities that exist between research institutions, researchers and research participants.

Evaluating the policy response to curb the opioid prescribing behaviour of physicians in the United States

PurposeIn 2017, the opioid epidemic was declared a public health emergency in the United States. The federal and state governments are still struggling to contain the crisis through various legislations and to stem the tide of overdoses and deaths. This paper looks specifically at the issue of high prescriptions of opioids disbursed to patients by physicians.Design/methodology/approachThis paper evaluates this evolving policy issue through a critical review and synthesis of academic literature, government policy documents (at states and national levels) and articles in the popular press.FindingsOver-prescription is a legal problem because it inevitably leads to diversion of these substances for non-medical usage. The Prescription Drug Monitoring Program (PDMP) laws have been passed by all 50 states and the main policy responses are covered. However, there are hindrances to their effectiveness, which have to be addressed. Two state level policy alternatives are discussed as potential solutions — PDMP mandates and Pain Management Clinic Laws (PMCLs). After a comparative evaluation, it is recommended that all states should pass the mandatory PDMP review and usage laws urgently.Originality/valueThis is the first detailed policy evaluation on the specific and time-sensitive aspect of physician over-prescribing, within the larger opioid abuse problem. Moreover, critique on the public health leadership issue is raised.

Editorial

This issue is one of two that spotlight Francophone West Africa, a long-planned project. Here, all the papers are in French, an editorial decision informed by the need to increase further the visibility and readership of the journal in French speaking countries worldwide. To be sure, this has been the case in the past decades as revealed in our analysis of downloads of papers in French following increased submission and published peer review of such papers. Yet, as the journal became swamped with submissions in French, we feel we must not relent in ensuring that they do not lag behind those in English. The second of the two issues will be in English with, of course, all papers focusing on Francophone West Africa. It will focus on different socio-economic aspects of some of the countries the authors chose for their respective research and analyses. Dr Hélène V Quashie, of LARTES-IFAN Université Cheikh Anta Diop / Institut des Mondes Africains Senegal was charged with the responsibility of co-ordinating all the papers for this special issue, in terms of getting them ready after the mandatory blind review. She titled the issue which is essentially a monograph given its specialised focus.

Promoting Reproducibility and Integrity in Observational Research: One Approach of an Epidemiology Research Community.

To increase research reproducibility, sharing of study data, analysis code, and use of standardized reporting are increasingly advocated. However, beyond reproducibility, few initiatives have addressed the integrity of how research is conducted before manuscripts are submitted. We describe a decades-long experience with a comprehensive approach based in an academic research community around prospective cohort studies that is aimed at promoting a culture of integrity in observational research. The approach includes prespecifying hypotheses and analysis plans, which are discussed in the research community and posted; presentation and discussion of analysis results; mandatory analysis code review by a programmer; review of concordance between analysis output and manuscripts by a technical reviewer; and checks of adherence to the process, including compliance with institutional review board requirements and reporting stipulations by the National Institutes of Health. The technical core is based in shared computing and analytic environments with long-term archiving. More than simply a list of rules, our approach promotes research integrity through integrated educational elements, making it part of the "hidden curriculum," by fostering a sense of belonging, and by providing efficiency gains to the research community. Unlike reproducibility checklists, such long-term investments into research integrity require substantial and sustained funding for research personnel and computing infrastructure. Our experiences suggest avenues for how institutions, research communities, and funders involved in observational research can strengthen integrity within the research process.

1316O Improved nationwide survival of sarcoma patients 10 years after establishment of the NETSARC+ reference center network

Treatment of sarcomas within networks of reference center is associated with improved outcome. We report on the nationwide impact of the NETSARC+ network on sarcoma survival since 2010 in France. NETSARC+ is a national network of 26 reference sarcoma centers with multidisciplinary tumor boards (MDTB) active since 2010, in charge of mandatory pathology review, and collection of patients characteristics in the netsarc.org nationwide database. Exhaustivity of cases collection was reached since 2013. The characteristics of patients with follow-up are presented, as well as the management procedures and overall survival in 3 periods:2010-12 (Period 1, non-exhaustive), 2013-15 (period 2), and 2016-20 (period 3). Patient series is considered exhaustive in periods 2 and 3. 43,975 patients with sarcomas and tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n=9,266 [2010-12], n=12,247 [2013-15], n=22,435 [2016-20]). Median age is 59 years, 50.5% are women, 13.2% were metastatic at diagnosis. The 3 most frequent histotypes were liposarcomas, leiomyosarcomas, and UPS. Over the 3 periods, the percentage of patients 1) biopsied before surgery increased from 63% to 76%, 2) presented to the MDTB before the 1st treatment increased from 32% to 45%, 3) operated in reference centers increased from 55% to 59%, 4) re-operated after 1st surgery decreased from 13% to 9% (p<0.0001 for all tests across the 3 periods, and for comparisons between the 2 exhaustive periods 2 vs 3). With a median follow-up of 14 months in the whole series, the overall survival was significantly superior in the series of patients operated in the period 2017-20 vs 2013-2016 vs 2010-12 (p<0.0001). Comparison of survival in the two most recent exhaustive periods showed a superior survival for patients in 2016-20 vs 2013-15 periods (HR=0.82) in patients aged >18 (HR=0.81), both metastatic (HR=0.68) and non-metastatic (HR=0.82) (p<0.0001 for all). A 24% reduction of the relative risk of death at 12 months was observed in the 2016-20 period. The implementation of the NETSARC+ national reference network since 2010 in France is associated with an improvement of the overall survival nationwide in sarcoma patients.

Activity of Cabazitaxel in Metastatic or Inoperable Locally Advanced Dedifferentiated Liposarcoma

Treatment options for patients with unresectable and/or metastatic dedifferentiated liposarcoma (DDLPS) are limited. New drugs are required. To assess whether cabazitaxel demonstrated sufficient antitumor activity in patients with metastatic or inoperable locally advanced DDLPS to justify further investigation in a phase 3 setting. This international multicenter, open-label single-arm phase 2 trial was conducted at 10 institutions in 4 European countries from March 2015 to March 2019. Eligible patients had to have metastatic or locally advanced histologically proven DDLPS with evidence of disease progression within the past 6 months and had to have received no more than 1 previous line of chemotherapy. After mandatory central review of tumor blocks, if the DDLPS diagnosis was confirmed, patients started treatment within 72 hours after registration. Cabazitaxel was administered at a dose of 25 mg/m2 IV infusion over 1 hour every 21 days until intolerance, progression, or withdrawal of consent. The primary end point was progression-free survival (PFS) rate at 12 weeks per RECIST 1.1. Based on a Simon 2-stage design, at least 4 of 17 (stage 1) and 11 of 37 (stage 2) eligible and evaluable patients who were progression free at 12 weeks were needed. The final analysis report was completed on November 17, 2021. Forty patients were registered, with 2 patients being ineligible. The number of cycles ranged from 1 to 30, with a median of 5; 26 patients (65%) received at least 4 cycles of cabazitaxel. Progression-free survival at 12 weeks was 55%, achieving the primary study end point. At a median follow-up of 21.6 months, median PFS was 6 months and median OS 21 months. Response rate (RR) was 8% with 1 clinical response (CR) and 2 partial responses (PR). Twenty-three (60.5%) patients had a stable disease (SD). Disease control (PR+SD) was achieved in 26 patients (68%). This nonrandomized phase 2 clinical trial met its primary end point, with 21 of 38 patients (55%) being progression free at 12 weeks. These results suggest important activity of cabazitaxel in patients with metastatic or inoperable locally advanced DDLPS. The drug is worth being further studied in these tumors in a phase 3 setting.

Hertfordshire Partnership NHS Trust - Improving VTE Risk Assessments in an Older Adult Psychiatric Inpatient Unit

AimsVTE-related deaths are a leading cause of preventable mortality amongst all hospital inpatients. Psychiatric inpatients are at greater risk of this, due to administration of antipsychotic medication and longer inpatient stay. This is particularly significant during the COVID-19 pandemic, not least as it is a disease known to cause hypercoagulability, but also due to an increase in mental illness and extended admission, resulting from an overwhelmingly run social service. The objective is to analyse VTE risk assessments performed for the 23 patients at Lambourn Grove, a continuing care unit for old age psychiatric inpatients, diagnosed with dementia. The aims are to assess; the frequency at which VTE risk assessments are performed, the accuracy of each assessment and the subsequent management and appropriateness of preventative measures taken.MethodsA retrospective study was conducted of 23 service users. Data were collected from the VTE assessment form on the local electronic patient record system, and analysed to assess compliance with local guidance. GP records were consulted to cross check data and ensure accuracy of information inputted. Improvement measures include presenting at the local teaching session and implementing a mandatory monthly review onto the ward round proforma. A second cycle will be carried out to assess the success of these interventions in improving best medical practice.ResultsOf the 23 service users, 20 patients had their VTE risk assessment completed on admission and there was a delay of over a month with the remaining 3 patients. Of significance is that of all initial VTEs, 6 out of 23 contained inaccurate details, such as omission of comorbidities or a subjective assessment of mobility, indicating the need to use a standardized tool which allows for comparison across time. The mean admission duration for all 23 inpatients, as of February 2022 was calculated to be 16.2 months, with a range of 2 and 59 months. 15 patients did not have their VTE risk assessment repeated during admission, and of these 2 did have a change in their risk profile, indicating non-adherence with NICE guidelines.ConclusionThis study has identified significant areas for improvement, specifically the need for clear timing for repeated VTE assessments, consistent sources of patient's medical history and documentation of mobility status. The project has highlighted the need for a more robust VTE assessment protocol which is currently being developed, to improve patient mortality and outcomes.

Complaints Review and Remedies Mechanisms under the Ethiopian Public Procurement System: A Critical Review of the State of Law &amp; Selected Practices

The Ethiopian Public Procurement &amp; Property Administration Proclamation No. 649/2009 is the primary legislation regulating public procurement procedures, complaint review mechanisms, remedies, administration and disposal of public property. It is supplemented with a Procurement Directive aiming at operationalizing the principles and rules embodied in it. This Public Procurement system has largely modeled itself from the 1994 UNCITRAL Model Law on Procurement of Goods, Construction and Services which features a complaints review mechanism with compulsory hierarchical complaint review mechanisms. The procuring public bodies assume mandatory first instance review jurisdiction on complaints lodged against their own decisions. The complaints review board and the courts are respectively the higher levels of review bodies. It has been 12 years since this law has been put in action and this work aspires to examine and analyze the state of law and practice on suppliers’ complaints, review mechanisms and remedies by drawing relevant insights from the 1994 &amp; 2011 UNCITRAL Model Laws. It is focused on the analysis of the rights of suppliers to file complaints, the complaint review bodies and their scope of competence, the powers of the courts and the award of remedies. It has been established that the Ethiopian public procurement complaints review system is constrained by obstacles that the law opted to include prohibitive clauses on the amenability of major procurement decisions which practically impairs the effectiveness of the review system. The prohibitions on the reviewability of procurement decisions limit the availability of review to be at the later stage of the procurement procedure and result in far fewer remedies. Moreover, the review board’s features of independence and requirements of professionalism are fundamentally compromised. Review jurisdiction by the courts has been very uncertain until the cassation interpretation by the Federal Supreme Court in the Jedaw case made a settling judgment.

Qualified laws as actors of the separation of powers

Abstract Over the last few decades, several countries have entrenched a special subcategory of law, which is adopted by stricter procedural rules than the requirements of the ordinary legislative process. These laws are enacted by qualified majority, by the consent of the two chambers of the legislation, and are subject to mandatory constitutional review before their promulgation, or additional safeguards are implemented in the ordinary legislative process. It is beyond doubt that this legal instrument influences the prevalence of the separation of powers and the constitutional principle of democracy in a remarkable way; therefore, it might be an important tool for populist politicians to concrete their preferences for the long term. In this study, my aim is to conceptualize the most highly contested issues regarding the legal nature of qualified laws, and to provide a deeper understanding of the interdependence between qualified laws and the separation of powers. This analysis might also clarify how qualified laws may serve the ambitions of populist political groups in certain specific circumstances. My contribution provides general theoretic considerations, and does not outline the particular constitutional frameworks in detail. I would rather just use the specific examples to demonstrate how the mechanism of qualified law works in practice as an instrument of constitutional law.

Conventional and constitutional regulations of lawful detention of a person without a court decision: criminal procedure aspect

The article compares the requirements for the lawful application of detention without a court decision as a criminal procedure established in Article 5 § 1 (c) of the Convention for the Protection of Human Rights and Fundamental Freedoms and in the second sentence of Article 29 part 3 of the Constitution of Ukraine. In particular, the content of the concept of "detention" of a person is studied, the list of subjects who have the right to detain a person without a court decision and the legal content and list of legitimate grounds for detention of a person without a court decision as a criminal procedure are studied and compared. Conventional, constitutional and criminal-procedural norms are also studied, as well as the necessity of mandatory further judicial review of the legality of the detention of a person, including the terms of such review.&#x0D; Based on a detailed analysis of these provisions of the Convention for the Protection of Human Rights and Fundamental Freedoms, the Constitution of Ukraine, relevant decisions of the European Court of Human Rights and the Criminal Procedure Code of Ukraine, it is established that the grounds for the detention of a person by a general entity, defined by paragraph 2 of Article 207 of the Criminal Procedure Code of Ukraine, and a special entity, defined by subparagraphs 1 and 2 (except subparagraph 3) of paragraph 1 of Article 208 of the Criminal Procedure Code of Ukraine, in general, correspond to the grounds for lawful detention of a person enshrined in Article 5 § 1 (c) of the Convention for the Protection of Human Rights and Fundamental Freedoms. Therefore, it cannot be qualified as unlawful interference with the human right to liberty and security of person. At the same time, proposals are formulated to make changes and additions to subparagraph 3 of paragraph 1 of Article 208 of the Criminal Procedure Code of Ukraine.&#x0D; It is also proved that the provisions of paragraph 2 of Article 12 and Articles 209 and 211 of the Criminal Procedure Code of Ukraine are critical provisions of the current legislation of Ukraine regarding the lawful application of detention of a person without a court decision. These provisions actually eliminate some shortcomings and establish the necessary legal and procedural grounds for the clarified application of the provision of the second sentence of part 3 of Article 29 of the Constitution of Ukraine, in accordance with the provisions of paragraph 3 of Article 5 of the European Convention for the Protection of Human Rights and Fundamental Freedoms, as well as the practice of their application developed by the European Court of Human Rights.

Saddam Hussein’s role in the gassing of Halabja

Iraq’s use of chemical weapons against Iraqi Kurdish civilians in 1987 and 1988 is among the most morally troubling events in the latter half of the twentieth century. Most of the questions surrounding the attack, including why, when, and how, have been addressed in path-breaking research by Joost Hiltermann and other researchers from Human Rights Watch. However, even as more records and internal documents from the period have come to light, one question remains unresolved: Did Saddam Hussein, Iraq’s leader, directly order the gassing of Iraqi Kurds? This study reassesses the Halabja attack of 1988—in particular, Saddam’s thinking and behavior relating to the attack—in light of the post-2003 evidence. It synthesizes insights from the Iraqi records at the Conflict Records Research Center and Stanford University; debriefings of Iraqi principals, which the authors obtained in response to Mandatory Declassification Review requests; recent memoirs of Iraqi and US officials; and other previously unexplored sources. Although these records provide no direct proof that Saddam Hussein issued an explicit order to gas Halabja, it is clear he created a command environment in which the indiscriminate gassing of Iraqi Kurds was considered permissible and even desirable.

The UK's proposed new national security regime: a sledgehammer to crack a nut

On 11 November 2020, the UK Government published the National Security and Investment Bill (NSI Bill), which, if approved by Parliament, would allow the Secretary of State for Business, Energy and Industrial Strategy (Secretary of State) to screen and prohibit ‘potentially hostile’ investments that threatened UK national security. The proposed system would represent the most significant change in the UK regulatory environment since the Government ceded the power to approve or prohibit mergers on competition grounds to an independent agency in 2002. The envisaged regime would be among the most wide-ranging and onerous in the world, adding a new layer of mandatory review and imposing non-trivial costs on investments in any company with UK activity. This article describes the UK's existing public interest intervention regime, explains the background to the Government's proposed new regime, including similar initiatives elsewhere in the world, summarizes the principal features of the proposed new UK regime, and considers its potential implications for investments in the UK.

COVID-19 and the Vascular Laboratory: Decreasing Exposure Risk

During times of medical normalcy (nonpandemic), overtesting by the vascular laboratory, while never excusable, can be tolerated. When the performance of a test may have dire consequences, illness or death either of the person performing the examination or the patient receiving the examination, more stringent criteria need to be instituted. Early in the COVID-19 crisis, a policy of mandatory review of all vascular laboratory study requests at our hospital for inpatients or emergency department patients was initiated.