Carbon Outlasts the Law: States Walk the Constitutional Line

State carbon policies to control climate warming and our energy future are under legal attack. A successful barrage of litigation now invokes the dormant Commerce Clause and the Federal Power Act as interpreted through the Filed Rate Doctrine, as well as the Supremacy Clause of the U.S. Constitution, to challenge the legal validity and sustainability of these state carbon-based laws. California and other states have survived these legal challenges sparingly, and then often only by prevailing with procedural defenses that dismiss the case before a decision on the legal merits of their state energy regulation. This Article examines and analyzes the multiple legal dimensions of challenges on carbon control and sustainable energy in a constellation of states, comparing them to California’s particular legal challenges. The Constitution is not changeable by simple legislation; its requirements and restrictions endure, and state action on energy can be ruled unconstitutional. The now-forming precedent will construct and limit the U.S. carbon-control future as states labor to achieve a legally sustainable economy. This Article navigates these recent challenges to state carbon control and sustainable energy statutory and regulatory law. How the judiciary is resolving each challenge, and the precedent created, will chart the future of U.S. sustainable energy policy

The Failure of International Global Warming Regulation to Promote Needed Renewable Energy

Renewable power generation technologies exist today and comprise the foundation for the bridge to a sustainable international power generation infrastructure. However, the Kyoto Protocol (Kyoto) has failed to utilize these technologies. Kyoto also missed the forest for the trees: it disallowed forest preservation to count in its carbon currency. It also missed including the correct chemical base in developing countries. This Article examines what led international law not to focus on development in renewable power alternatives where they are most required in the international order: developing nations. It analyzes the critical role of international multilateral organizations to create the new architecture of carbon control before it is too late. This Article concludes by highlighting a little-noticed template for renewable power and carbon mitigation success that has been demonstrated in several developing countries. It highlights the changes to Kyoto and international law that are necessary to construct a bridge to the development of sustainable power generation infrastructure

Características clínicas de pacientes con complicaciones maternas trasladadas al Hospital Bertha Calderón Roque, Managua, Enero del 2011

El objetivo de este estudio fue determinar las características clínicas de las pacientes con complicaciones maternas trasladas de las diferentes unidades de salud al Hospital Bertha Calderón Roque, Managua, durante Enero del 2011. El estudio fue de corte transversal y la población período de estudio fue el total de pacientes embarazadas trasladadas de las diferentes unidades de salud del país al servicio de emergencia del hospital Bertha Calderón Roque durante enero del 2011. La fuente de información fue primaria y secundaria. El software usado fue SPSS versión 18.0. Se solicitó autorización a la dirección del hospital y consentimiento informado verbal a las pacientes. La información fue confidencial y anónima. Las normas y protocolos para la atención de pacientes con complicaciones maternas no se cumplieron en 70% de los casos, y las condiciones del traslado fueron malas en 58.8%. Las principales indicaciones de los traslados fueron síndrome hipertensivo gestacional, ruptura prematura de membranas y amenaza de parto prematuro. Los eventos adversos se presentaron en casi una quinta parte de los casos, y los principales servicios donde fueron derivadas las pacientes fueron ARO, UCI y quirófano. La tasa de letalidad materna y perinatal fue de 2.5% y 25.1%, respectivamente. Se recomienda diseminar los resultados al MINSA para evaluar la calidad en el traslado y manejo de pacientes embarazadas. Así como realizar estudio sobre el conocimiento y cumplimiento de las normas y protocolos del Ministerio de Salud por parte del personal involucrado. Palabras claves: normas y protocolos de atención, traslado de pacientes, calidad de atención, complicaciones maternas

Torquing the Levers of International Power

The world is now at its climate’s “tipping point” at a precipice to redress global warming; after which our ability to halt a climate temperature rise below 2 degrees Centigrade (3.4 degrees Fahrenheit) is deemed unreachable. How to arrest the fast-accelerating accumulation of long-term carbon in the atmosphere is the legal and environmental challenge of the 21st century. It involves intelligent implementation of legal mechanisms, not technical fixes. Governments must quickly torque the levers of international power, but U.S. courts are finding some of these levers unconstitutional. This Article identifies, compares, contrasts, and torques the levers of international power. Sustainable development and continuation of world civilization in the manner we know it depend on effective and intelligent regulatory use of these comparative levers of power, and creation of legal space to do so. Part II of this Article explores why electric power forms the critical crucible in which climate, policy and law now mix. Part III examines the legal implications of feed-in tariffs, which European and other world nations employ to promote renewable electric power. Comparing U.S. to international experience, Part III then analyzes why these same techniques have been held unconstitutional in the U.S. when implemented by states. And even though legal in Europe, Part III examines the financial loss that has resulted from Germany’s, Italy’s, and Spain’s misaligned positioning of this lever of power. Part IV examines the alternative levers employed in the majority of U.S. states to promote renewable energy deployment: renewable portfolio standards and net metering. These are legal if carefully designed. However, the specific programs in several states have been found by federal Circuit Courts to violate the Constitution. A series of recent legal challenges has resulted in states having to legally remake their programs. Part V strategically manipulates these key international levers of power for the developed and developing countries of the world

A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting with Gastroenteritis and Developing Severe Pulmonary Disease.

Novel coronavirus disease 2019 (COVID-19) is a highly infectious, rapidly spreading viral disease with an alarming case fatality rate up to 5%. The risk factors for severe presentations are concentrated in patients with chronic kidney disease, particularly patients with end-stage renal disease (ESRD) who are dialysis dependent. We report the first US case of a 56-year-old nondiabetic male with ESRD secondary to IgA nephropathy undergoing thrice-weekly maintenance hemodialysis for 3 years, who developed COVID-19 infection. He has hypertension controlled with angiotensin receptor blocker losartan 100 mg/day and coronary artery disease status-post stent placement. During the first 5 days of his febrile disease, he presented to an urgent care, 3 emergency rooms, 1 cardiology clinic, and 2 dialysis centers in California and Utah. During this interval, he reported nausea, vomiting, diarrhea, and low-grade fevers but was not suspected of COVID-19 infection until he developed respiratory symptoms and was admitted to the hospital. Imaging studies upon admission were consistent with bilateral interstitial pneumonia. He was placed in droplet-eye precautions while awaiting COVID-19 test results. Within the first 24 h, he deteriorated quickly and developed acute respiratory distress syndrome (ARDS), requiring intubation and increasing respiratory support. Losartan was withheld due to hypotension and septic shock. COVID-19 was reported positive on hospital day 3. He remained in critical condition being treated with hydroxychloroquine and tocilizumab in addition to the standard medical management for septic shock and ARDS. Our case is unique in its atypical initial presentation and highlights the importance of early testing