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This article aims at reviewing the practice of ‘initiatives’ by Intergovernmental Organizations (igo s) when responding to crises or the unforeseen needs of their respective memberships. It forms part of a broader research project on the role of igo s in international law where more than 100 initiatives were identified so far, focusing on 14 igo s. The notion of an igo’s initiative, conceptualised as activities of the Executive Heads and the secretariat’s staff that enhance the remit of an organization beyond those functions initially or formally envisaged by its constituent instrument, is examined. A descriptive analysis of over 30 initiatives indicate that they may be successful in addressing modern unforeseen challenges, whether they stem from international emergencies, climate change, dynamic technological advancements, or global health crises such as the covid-19 pandemic- especially when such initiatives are accepted and supported by igo s’ members. more...

L’invocation par les États membres de l’Organisation mondiale du commerce (OMC) de l’exception de sécurité prévue par l’Accord général sur les tarifs douaniers et le commerce (GATT) de 1994 constitue l’un des enjeux les plus pressants au sein de l’Organe de règlement des différends (ORD). La conclusion du Groupe spécial dans l’affaire Russie – Trafic en transit constitue une première interprétation de cette mesure d’exception prévue à l’article XXI du GATT, dont la portée met en relief le délicat équilibre entre la libéralisation du commerce international et celui de la protection des intérêts essentiels de sécurité. Compte tenu notamment de l’invocation répétée de cette exception dans des contentieux en lien avec l’acier et l’aluminium, opposant les États-Unis à sept autres membres, ce premier jalon interprétatif doit être étudié dans sa dimension politique. Il s’agit en effet d’un moyen pour le Groupe spécial de favoriser la stabilité et l’effectivité du système, et ce en refusant aux membres invoquant l’article XXI une pleine autonomie de jugement. L’importance du rapport du Groupe spécial réside dans sa construction visant à limiter un recours abusif à l’exception de sécurité de la part des membres dans un contexte d’instabilité internationale. Afin de bien apprécier la portée de ce rapport, le présent article propose trois analyses. Dans un premier temps, un retour sur les arguments des parties et des tierces parties dans l’affaire Russie – Trafic en transit permettra de contextualiser les conclusions du Groupe spécial pour traiter, dans un second temps, de la politique interprétative propre à l’ORD. Finalement, les notions d’activisme judiciaire et de la charge persuasive du rapport sont examinées à l’aune des différends en cours dans lesquels l’exception de sécurité a été invoquée. Cet exposé doit permettre d’appréhender la question des exceptions de sécurité dans le contexte plus global des défis auquel est confrontée aujourd’hui l’OMC, notamment en lien avec la paralysie de l’Organe d’appel à compter du 11 décembre 2019., One of the most pressing issues affecting the Dispute Settlement Body (DSB) of the World Trade Organization (WTO) is the growing number of invocations by Members of the security exceptions enshrined in Article XXI of the 1994 General Agreement on Tariffs and Trade (GATT). The conclusions brought forward by the Panel in the dispute Russia—Traffic in Transit constitute the first WTO interpretation of the GATT security exceptions. The Panel managed to draw a fine line between the imperative of trade liberalization and the protection of Members’ essential security interests. In turn, considering amongst others the invocations of the exception to justify tariffs on steel and aluminium by the United States, this first interpretative milestone needs to be examined in its political dimension. Indeed, in reaction to the current instability of the multilateral trading system, the Panel endorsed a stabilizing function, aiming to guarantee the efficiency of the system. As such, the Panel in Russia—Traffic in Transit denied Members full discretion as regards security exceptions, explicitly rejecting a “non-justiciability” scenario. The importance of the Panel’s report lies in the argumentative and textual construction thereof, which aims to limit potential abuse as regards Member’s invocation of the exceptions at times of instability. To fully appreciate the significance of the report, the article will proceed in three steps. First, an analysis of the arguments brought forward by disputing and third parties in Russia—Traffic in Transit will help to contextualize the conclusions reached by the Panel, which will accordingly highlight the political mechanisms of interpretation underlying the interpretative practice of the DSB’s organs. Finally, the notions of judicial activism and the legal weight to be given to the Panel’s conclusions in Russia—Traffic in Transit will be examined in relation to ongoing disputes. The growing invocation by Members of security exceptions takes place against the backdrop of numerous challenges affecting the WTO, one of the direst being the paralysis of the Appellate Body as of December 2019., La invocación por los Estados Miembros de la Organización Mundial del Comercio (OMC) acerca de las excepciones relativas a la seguridad halladas en el Acuerdo General sobre Aranceles Aduaneros y Comercio (GATT) de 1994, constituye uno de los desafíos más importantes al que el Órgano de Solución de Diferencias (OSD) debe enfrentarse. La conclusión del Grupo especial en el caso Rusia – Tráfico en tránsito constituye la primera interpretación de las excepciones de seguridad consagradas en el artículo XXI del GATT. La interpretación por el Grupo especial de tales excepciones es muestra del sutil equilibrio entre la liberalización del comercio y los imperativos de protección de los intereses esenciales de seguridad de los Miembros de la OMC. Para apreciar plenamente el alcance de las excepciones de seguridad del GATT y la dimensión política del informe del Grupo especial en el caso Rusia – Trafico en tránsito, este artículo se focalizará en las nuevas diferencias que surgieron entre Estados Unidos y otros siete Miembros de la OMC relativas a tarifas estadounidenses sobre productos de acero y de aluminio. El reciente informe constituyó una oportunidad para el Grupo especial de apostar por la eficiencia y la estabilidad del mecanismo de solución de diferencias de la OMC, tras negar a los Miembros de invocar el artículo XXI con una plena discreción. La importancia del informe del Grupo especial reside en su constitución, que expresa claramente el objetivo de limitar recursos abusivos por los Miembros de la excepción de seguridad. Para entender el alcance de dicha decisión, el presente análisis se dividirá en tres partes. Primero, se examinarán los argumentos de las partes y de las terceras partes frente a las excepciones a fin de contextualizar las conclusiones del Grupo especial. Posteriormente, se explicará la política interpretativa del OSD, para finalmente examinar las nociones de activismo jurídico y el futuro peso interpretativo del informe en el caso Rusia – Trafico en tránsito en las diferencias vigentes en las que las excepciones de seguridad han sido invocadas. De esta forma, este artículo tiene como objetivo demostrar la pasmosa evolución de la “vida” de las excepciones de seguridad, sobre todo frente al difícil contexto afectando a la OMC, especialmente en relación con la inoperatividad de su Órgano de Apelación desde el 11 diciembre 2019. more...

Objective The purpose of this review was to compare the efficacy of motor control exercises (MCEs) to strengthening exercises for adults with upper- or lower-extremity musculoskeletal disorders (MSKDs). Methods Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL, and CINAHL. Randomized controlled trials were identified on the efficacy of MCEs compared to strengthening exercises for adults with upper- or lower-extremity MSKDs. Data were extracted with a standardized form that documented the study characteristics and results. For pain and disability outcomes, pooled mean differences (MDs) and standardized mean differences (SMDs) were calculated using random-effects inverse variance models. Results Twenty-one randomized controlled trials (n = 1244 participants) were included. Based on moderate-quality evidence, MCEs lead to greater pain (MD = −0.41 out of 10 points; 95% CI = −0.72 to −0.10; n = 626) and disability reductions (SMD = −0.28; 95% CI = −0.43 to −0.13; n = 713) when compared to strengthening exercises in the short term; these differences are not clinically important. When excluding trials on osteoarthritis (OA) participants and evaluating only the trials involving participants with rotator cuff–related shoulder pain, shoulder instability, hip-related groin pain, or patellofemoral pain syndrome, there is moderate quality evidence that MCEs lead to greater pain (MD = −0.74 out of 10 points; 95% CI = −1.22 to −0.26; n = 293) and disability reductions (SMD = −0.40; 95% CI = −0.61 to −0.19; n = 354) than strengthening exercises in the short term; these differences might be clinically important. Conclusions MCEs lead to statistically greater pain and disability reductions when compared to strengthening exercises among adults with MSKDs in the short term, but these effects might be clinically important only in conditions that do not involve OA. Inclusion of new trials might modify these conclusions. Impact These results suggest that MCEs could be prioritized over strengthening exercises for adults with the included non-OA MSKDs; however, results are unclear for OA disorders. more...

Objective To compare the efficacy of region-specific exercises to general exercises approaches for adults with spinal or peripheral musculoskeletal disorders (MSKDs). Data Sources Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health. Study Selection Randomized control trials (RCTs) on the efficacy of region-specific exercises compared to general exercises approaches for adults with various MSKDs. Data Extraction Mean differences and standardized mean differences were calculated using random-effects inverse variance modeling. Eighteen RCTs (n=1719) were included. Cohorts were composed of participants with chronic neck (n=313) or low back disorders (n=1096) and knee osteoarthritis (OA) (n=310). Data Synthesis Based on low-quality evidence in the short-term and very low-quality in the mid- and long-term, there were no statistically significant differences between region-specific and general exercises in terms of pain and disability reductions for adults with spinal disorders or knee OA. Secondary analyses for pain reduction in the short-term for neck or low back disorders did not report any statistically significant differences according to very low- to low-quality of evidence. Conclusions The difference in treatment effect remains uncertain between region-specific and general exercises approaches. Based on very low- to low-quality evidence, there appear to have no differences between both types of exercise approaches for pain reduction or disability for adults with spinal disorders. Future trials may change the current conclusions. More evidence is needed for region-specific exercises compared to general exercises for other peripheral MSKDs including knee OA. more...

In patients suffering from knee osteoarthritis awaiting knee arthroplasty, to measure associations between several selected determinants and pain, disability, health-related quality of life and physical performance.Validated self-reported measures were collected: (1) Western Ontario and McMaster Universities Osteoarthritis Index, (2) Lower Extremity Functional Scale (LEFS) and (3) Short-Form 36 (SF-36). Physical performance was also assessed with four validated performance tests. Demographic, socioeconomic, psychosocial and clinical characteristics of the participants were also measured. Multivariate regression analyses were used to evaluate potential associations.Higher fear-avoidance beliefs, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse pain, function or HRQOL (p 0.05) and explained 12%-35% of the variances of the self-reported measure scores. Pretest pain and change in pain during posttest, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse performance on the physical tests (p 0.05) and explained 41%-59% of the variances of the different physical tests results.Several determinants were significantly associated with worse pain, disability, health-related quality of life or physical performance. Several of these associations may be considered clinically important, including psychosocial determinants in relation to self-reported measures, but to physical performance as well. Implications for rehabilitation Knee osteoarthritis is a highly prevalent and disabling condition incurring important socioeconomic costs. Several modifiable determinants have been shown to contribute to pain and disability in individuals suffering from knee OA awaiting TKA. Recent studies demonstrated the efficacy of education and rehabilitation (prehabilitation) in individuals awaiting TKA. more...

Clinicians often rely on physical examination tests to guide them in the diagnostic process of knee disorders. However, reliability of these tests is often overlooked and may influence the consistency of results and overall diagnostic validity. Therefore, the objective of this study was to systematically review evidence on the reliability of physical examination tests for the diagnosis of knee disorders. A structured literature search was conducted in databases up to January 2016. Included studies needed to report reliability measures of at least one physical test for any knee disorder. Methodological quality was evaluated using the QAREL checklist. A qualitative synthesis of the evidence was performed. Thirty-three studies were included with a mean QAREL score of 5.5 ± 0.5. Based on low to moderate quality evidence, the Thessaly test for meniscal injuries reached moderate inter-rater reliability (k = 0.54). Based on moderate to excellent quality evidence, the Lachman for anterior cruciate ligament injuries reached moderate to excellent inter-rater reliability (k = 0.42 to 0.81). Based on low to moderate quality evidence, the Tibiofemoral Crepitus, Joint Line and Patellofemoral Pain/Tenderness, Bony Enlargement and Joint Pain on Movement tests for knee osteoarthritis reached fair to excellent inter-rater reliability (k = 0.29 to 0.93). Based on low to moderate quality evidence, the Lateral Glide, Lateral Tilt, Lateral Pull and Quality of Movement tests for patellofemoral pain reached moderate to good inter-rater reliability (k = 0.49 to 0.73). Many physical tests appear to reach good inter-rater reliability, but this is based on low-quality and conflicting evidence. High-quality research is required to evaluate the reliability of knee physical examination tests. more...

The objective of this study was to compare the sensitivity and specificity of 2- and 4-film x-ray series when interpreted by pediatric emergency medicine physicians in the diagnosis of skull fracture in children.A noninferiority crossover study was performed. The skull radiographs of the 50 most recent cases of skull fracture for which a 4-film radiography series was available and 50 controls matched for age were reviewed. Two modules, containing a random sequence of 2- and 4-film series of each child, were constructed to have all children evaluated twice (once with 2 films and once with 4 films). Pediatric emergency physicians evaluated both modules 2 to 4 weeks apart. The interpretation of the 4-film series by a pediatric radiologist served as the criterion standard. The sensitivity and specificity of the 2-film versus the 4-film skull x-ray series, in the identification of fracture, were compared.Thirteen pediatric emergency physicians participated in the study. For sensitivity, the mean difference between the 2- and 4-view series was higher than the noninferiority margin of 0.055 with an absolute mean difference of 0.060 (4-view minus 2-view series) and a 1-sided 95% higher confidence limit of 0.099. However for specificity, the mean difference was within the margin with an absolute mean difference of 0.011 and a 1-sided 95% higher confidence limit of 0.033.For children sustaining a head trauma, the 2-film skull radiography series is not as sensitive as the 4-film series in the detection of fracture, when interpreted by pediatric emergency physicians. more...

Introduction More evidence on diagnostic validity of physical examination tests for knee disorders is needed to lower frequently used and costly imaging tests. Objective To conduct a systematic review of systematic reviews (SR) and meta-analyses (MA) evaluating the diagnostic validity of physical examination tests for knee disorders. Methods A structured literature search was conducted in five databases until January 2016. Methodological quality was assessed using the AMSTAR. Results Seventeen reviews were included with mean AMSTAR score of 5.5 ± 2.3. Based on six SR, only the Lachman test for ACL injuries is diagnostically valid when individually performed (Likelihood ratio (LR+):10.2, LR-:0.2). Based on two SR, the Ottawa Knee Rule is a valid screening tool for knee fractures (LR-:0.05). Based on one SR, the EULAR criteria had a post-test probability of 99% for the diagnosis of knee osteoarthritis. Based on two SR, a complete physical examination performed by a trained health provider was found to be diagnostically valid for ACL, PCL and meniscal injuries as well as for cartilage lesions. Conclusion When individually performed, common physical tests are rarely able to rule in or rule out a specific knee disorder, except the Lachman for ACL injuries. There is low-quality evidence concerning the validity of combining history elements and physical tests. more...

This paper explores the Multi-party Interim Appeal Arbitration Arrangement Pursuant to Article 25 of the Dispute Settlement Understanding (hereafter the “ MPIA”), aimed at overcoming the paralysis of the Appellate Body of the World Trade Organization. Following a brief historical overview, the MPIA and its annexes will first be outlined. Subsequently, the MPIA will be analyzed in the light of “ classic” dispute settlement, and some questions of judicial policy raised by this provisional arrangement will be identified. Albeit mirroring in many ways the proceedings before the Appellate Body, the MPIA incorporates recommendations from the Walker process, which envisaged various solutions to the complaints of certain Members against the Appellate Body., Le présent article porte sur l’Arrangement multipartite concernant une procédure arbitrale d’appel provisoire conformément à l’article 25 du Mémorandum d’accord sur le règlement des différends (ci-après, l'AMPA), visant à pallier la paralysie de l’Organe d’appel de l’Organisation mondiale du commerce. Suivant un bref rappel historique, l’AMPA et ses annexes seront, dans un premier temps, étudiés. Dans un second temps, l’AMPA sera analysé à l’aune du règlement des différends «classique » , et quelques questions de politique judiciaire suscitées par cet arrangement provisoire seront relevées. Bien qu’il calque à maints égards les procédures ayant cours devant l’Organe d’appel, l’AMPA intègre certaines innovations entre autres issues du Walker process, lequel proposait diverses solutions aux récriminations de certains Membres envers l’Organe d’appel., Este artículo aborda el Procedimiento Arbitral Multipartito de Apelación Provisional de conformidad con el artículo 25 del Entendimiento sobre Solución de Diferencias (en adelante, el “ mecanismo”), destinado a superar la actual parálisis del Órgano de Apelación de la Organización Mundial del Comercio. Luego de una breve reseña histórica, primero se estudiará el mecanismo y sus anexos. Posteriormente, se analizará el mecanismo a la luz de los procedimientos de solución de controversias “ clásicos” y se identificarán algunas cuestiones de política judicial planteadas por este mecanismo provisional. Aunque refleja de muchas maneras los procedimientos ante el Órgano de Apelación, veremos que el mecanismo incorpora ciertas recomendaciones del Walker process, identificando varias soluciones a las quejas de ciertos Miembros en contra del Órgano de Apelación., Gervais Nicolas, Ouellet André-Philippe. L’échapper belle : AMPA ou MPIA. Quatre lettres au secours du système de règlement des différends à l’OMC. In: Revue Québécoise de droit international, volume 32-2, 2019. pp. 29-57. more...