bluuebunny/crossref_metadata_2025 huggingface dataset:
The Rule of Law and International Development
Authors: Chalmers Shane
Published: December 2023

The aim of this chapter is twofold: to provide an overview of the international development project’s ‘rule of law’ agenda, and to do so in a way that shows its mythological character. In 1992 Peter Fitzpatrick published The Mythology of Modern Law, a work that exposed the constitutive relation between Europe’s racialised imperialism and its conception of modern law. In the three decades since, a renewed field of law and development has grown, this time in the name of ‘the rule of law’. This chapter shows how the mythology of modern law endures in this field of rule-of-law development. The analysis shows how the mythology of modern law, in its racialised imperial form, is integral to the work of international rule-of-law promotion. One consequence is the denial of ‘local’ law by a rule of law that obtains its authority by purporting to be responsive to legal pluralism.
Measurement as Development
Authors: Buchanan Ruth , Murphy Caitlin
Published: December 2023

The proliferation of quantitative metrics has been an integral aspect of the project of development from the second half of the twentieth century, with profound effects on how development has both been envisioned and enacted. Measurement is a social process, with a variety of implications for how we conduct ourselves and how institutions govern populations in the world. Over the past several decades the mechanisms and metrics to measure and rank phenomena in the world have proliferated. This chapter examines in particular one global process of measurement and comparison and how it came to be arranged in this way: the Global Indicator Framework for the Sustainable Development Goals. To interrogate this process further, the chapter concludes with a brief case study of NASA’s ‘Worldview’ programme. This is read as illustrative of the complexities and contradictions of the current moment in which both measurement—often conducted via data points—and development are bigger and more entangled than ever.
Direct-Democratic Votes
Authors: Sciarini Pascal , Tresch Anke
Published: December 2023

Although the instruments of direct democracy are increasingly popular in a growing number of democracies, nowhere are they more developed than in Switzerland. Indeed, direct democracy is a fundamental institution of the Swiss political system, and greatly impacts on the legislative process, party competition, and political campaigning. In the last two decades alone (2001–2021), Swiss citizens voted on 166 legislative or constitutional proposals at the federal level. This chapter first describes the use of direct-democratic instruments (compulsory referendum, optional referendum, popular initiative) over time and the evolution of the electorate’s support for the government. Second, it reviews the emerging literature on direct-democratic campaigning, shedding light on the actors involved and varying coalitions, their campaign channels, and their resources, as well as the flux and resonance of their campaign messages. Third, it turns to the individual-level and contextual-level determinants of turnout and highlights the apparent contradiction between low turnout rates at the aggregate level and widespread selective participation at the individual level. Finally, it takes stock of classic and recent studies on opinion formation and voting decisions to assess if and under what circumstances voters can make informed and correct choices. The chapter concludes on a rather optimistic note regarding the quality of direct-democratic decision-making in Switzerland and indicates avenues for future research.
Environmental and Spatial Planning Policies
Authors: Ingold Karin , Nahrath Stéphane
Published: December 2023

This chapter presents the history and development of Swiss policies addressing environmental issues and spatial planning. It runs through the most important events that have led to policy changes and important regulations, emphasizing the major developments in legislation and policy instruments. The chapter shows how environmental and spatial planning policies are embedded in the Swiss institutional setting and it outlines the most important actors and structures involved. The concluding section of the chapter offers an outlook on how these two policy fields, which have taken some parallel and some separate pathways in the past, might evolve in the near future.
Chocolate Democracy
Authors: Bochsler Daniel
Published: December 2023

Swiss citizens take pride in their export industry. Although chocolate figures among those products that the global public most frequently associates with its export industry, Switzerland also stands out thanks to the unique features of its model of democracy. Swiss citizens take pride in their democracy. This is mirrored by scholarly claims that Swiss democracy could offer ‘possible solutions to conflict in multicultural societies’. This chapter asks how four main pillars of Swiss democracy—direct democracy, the consensus-oriented institutions, the consociational democracy model, and federalism—are received abroad, and how they are reflected in the literature on comparative politics. Additionally, it analyses whether and how Swiss democracy promotion abroad builds on these supposed strengths of Swiss democracy. It turns out that the consociational democracy of Switzerland, which is the most relevant aspect to the Swiss democracy promotion and peacebuilding agenda, dates back to the nineteenth and twentieth century, and the cultural divide that was the basis on which the Swiss consociational model was built is no longer relevant. The Swiss promotion of democracy relies primarily on Switzerland’s past. This does no harm for its exports: political history has no expiration date.
Introduction
Authors: Emmenegger Patrick , Fossati Flavia , Häusermann Silja , Papadopoulos Yannis , Sciarini Pascal , Vatter Adrian
Published: December 2023

The introduction sets the scene and explains why Switzerland has become a test case of democracy in divided societies. It shows that Swiss politics are no longer as exceptional as they used to be a few decades ago and that developments in Swiss politics have foreshadowed major trends that mark current European politics. For example, Switzerland has been at the forefront of developments regarding the reconfiguration of the political space that are of transnational relevance, such as partisan realignment with the early emergence of Green, new-left parties and the major electoral successes of the nativist right. The introduction describes Switzerland as an example of the successful formation of a political nation on a multicultural basis that some consider a microcosm and a possible model for Europe but also suggests that this country’s conflict-laden path to power-sharing and to consensus democracy cannot be taken for granted. Beyond the interest in Switzerland as a historical case of political integration, studying the country also offers insights regarding the tensions an increasing number of countries are experiencing between an ever-stronger international economic integration and the preservation of political sovereignty. Such contested dynamics are likely to intensify in many advanced democratic economies. Lastly, Switzerland’s political system is of particular interest regarding the diagnosis of a democratic deficit in established democracies. The political, social, and economic problems in numerous states have aroused interest in Swiss political institutions such as federalism, consociationalism, and direct democracy.
EMDR Therapy and Integrative Approaches with Children
Authors: Beckley-Forest Ann , Lyles Marshall , Monaco Annie
Published: December 2023

EMDR therapy with children requires great developmental sensitivity and creativity to enhance therapeutic safety and engagement in the therapy. Integrating play therapy conceptualizations and interventions can enhance the congruence of the somatic, emotional, and cognitive shifts occurring during EMDR. This chapter will establish the importance of therapeutic play as a tool in clinical work with children and review of some major play therapy models (child-centered play therapy, Adlerian play therapy, synergetic play therapy, Gestalt play therapy, and prescriptive play therapy), their intersection with the Adaptive Information Processing model, and how these play therapy techniques can be integrated within the eight phases of EMDR.
Animals as Commodities
Authors: Cowie Helen
Published: December 2023

Animal commodities have been central to human existence for millennia. As well as supplying human dietary needs in the form of meat, milk, and eggs, they have been used for clothing, ornamentation, dyeing, medicine, fertilizer, and fuel, and as domestic companions. Animal power has also been harnessed to harvest, transport, and process other major global commodities, from silver to teak. The chapter provides an overview of the commodification of animals and explores their changing role within global trade. It examines how the type and quantity of animal commodities shifted over time and emphasises the ecological and ethical issues posed by the commodification of animals. The chapter concludes with a study of the Pacific fur seal (Callorhinus ursinus), which was hunted to the point of extinction in the nineteenth century for its thick fur coat.
Land Use and Commodities
Authors: Chambouleyron Rafael , Fischer Luly , Arenz Karl Heinz
Published: December 2023

This chapter addresses the issue of land use and commodity exploitation, especially in the early-modern period, exploring the way land was appropriated for economic production of commodities and the consequences of this appropriation. The role played by the expansion of commodities is examined in regard to the impact on the environment and on access to land and natural resources. It illustrates this impact with a case study of the exploitation of Amazonian cacao from the mid-seventeenth until the late nineteenth centuries. In the Luso-Brazilian Amazon region, cacao was both gathered as wild fruits as well as cultivated in settlers’ lands. The same commodity thus entailed different forms of land use, which had multiple environmental and territorial consequences.
Commodities, Carbon, and Climate
Authors: Brooke John L. , Herschthal Eric , Kaplan Jed O.
Published: December 2023

Commodities and climate are both deeply connected to carbon, as the stuff of earthly matter and the most significant of the atmosphere greenhouse gases, CO2. Both agricultural land-use and the industrial combustion of fossil fuels produce carbon emissions that pass through the atmosphere. This chapter reviews the long history of climate change and commodities production through the lens of atmospheric CO2 and carbon emissions rising from economic activity. Human derived, or anthropogenic, carbon emissions may have begun in advancing agricultural societies six to seven thousand years ago, and can be measured in early-modern commodity production, most eastly in the Caribbean. The chapter closes with a review of the rise of agricultural and industrial emissions through the ‘Great Acceleration’ after 1945, a discussion of the history of fossil fuels as commodities, and the recent trajectory toward a decarbonization of the energy stream.
Mapping Commodity Histories
Authors: Clifford Jim , MacFadyen Joshua , Castonguay Stéphane
Published: December 2023

Geographic Information Systems (GIS) have evolved from a powerful tool to visualize quantitative census data into an iterative methodology that allows historians to bring together information from historical maps, textual sources, and quantitative data. It allows historians to interrogate historiographical assumptions and develop new questions. It can help answer questions and create maps to better communicate spatial information. This chapter explores the limited use and potential of historical GIS methods in commodity histories. A case study of the Canadian forest-products trade demonstrates the value of GIS for researching the history of commodities. The authors show the iterative process that helped us better understand the early development of export-orientated sawmills in the Quebec City region and then use GIS to map the geography of the timber and firewood trade in the later nineteenth century. The authors hope that open-source software, tutorials, and the potential to reach wider audiences through interactive online maps will prompt more interest in GIS methods in commodity history.
Patterns of Injustice
Authors: Loyle Cyanne E. , Davenport Christian
Published: December 2023

This chapter presents the concept transitional injustice to address some of the important variation in the intentions and aims of governments which choose to adopt transitional justice policies, processes, and institutions. In particular, it raises the issue that many of the normatively “good” outcomes associated with transitional justice (such as the promotion of democracy, human rights, and an end to violence) are not the intended aims of the implementing government. It argues that rather than intending to promote these goals, governments may instead use these same institutional forms and behaviors to strengthen authoritarianism, increase state repression, and foment armed conflict and violence. Despite the importance of the topic, it is clear that it can be extremely challenging to identify and measure the intentions of governments in the creation of new institutions. The chapter outlines the ways in which existing data efforts account and fail to account for potential injustice in their coding protocols and the implication that this omission can have for some of our conclusions about the impact of transitional justice. It then turns to new data on truth commissions to assess the implications of alternative sampling strategies for our understanding of patterns of transitional injustice more broadly.
Defoe and Christianity
Authors: Walker David
Published: December 2023

Daniel Defoe was raised as a Presbyterian, a Dissenter from the established Church of England, at a time when Nonconformists were persecuted for their faith. This chapter explores the intersections of religion and politics in Defoe’s lifetime and as they affected his career and writings. The evidence of Defoe’s early, unpublished poetic ‘Meditations’ (c.1683) is that he took the decision as a young man not to become a clergyman but instead to pursue a career in trade with considerable anguish. From then on, Defoe’s private religious convictions remained prominent in his public writings on theology, as he defended the Toleration Act (1689) and attacked Anglican intolerance in numerous writings, notably his satire The Shortest-Way with the Dissenters (1702). The chapter traces Defoe’s ideas about religion through to his late writings on supernatural and occult topics, demonstrating that he adhered to an orthodox conception of Christianity.
Defoe’s Europe
Authors: Mueller Andreas K. E.
Published: December 2023

This chapter charts the prevailing attitudes to the nations of Europe in Daniel Defoe’s writings, situating these in salient contexts of national identity and state formation, global commerce and conflict, and trade, religion, and cultural exchange. It shows the centrality to Defoe’s international outlook of the theory of the balance of power, the delicate equilibrium that ensured the possibility of coexistence; and it shows how Defoe imputed national characteristics to the personal styles of national rulers. The chapter traces Defoe’s outlook towards the Dutch, French, Spanish, German, and other nationalities. It goes from the aftermath of the 1688 Revolution, when Defoe defended William III’s continental policies, through to his propagandistic writings during the War of the Spanish Succession (1701–14), and on to the often-surprising and ambivalent depictions of non-British individuals in his novels. It demonstrates that Defoe was a European as much as an Englishman in outlook.
Defoe’s Critical Reception, 1731–1945
Authors: Kincade Kit
Published: December 2023

Since his death in 1731, Daniel Defoe has attracted a vast range of responses, both for his literary achievements, wider social ideas, and his personality and actions. This chapter traces Defoe’s reception down to the middle of the twentieth century, by which time he had been canonized as a major author, particularly as a pioneering novelist. The chapter shows that this status has been hard-won. In the generation after his death, Defoe was to a large extent ignored, especially as most of his novels remained anonymous. Certain Romantic-era critics reclaimed Defoe, focusing on Robinson Crusoe. This acclaim continued in the Victorian period but was at that time combined with moralistic disapproval of some of his writings, as well as distaste for Defoe’s political duplicity. Modernist critics recuperated Defoe more ardently, and Defoe has attracted a wave of professional academic scholarship after World War II.
New Memory and the Archive
Authors: Hoskins Andrew
Published: December 2023

User-generated needs and the embrace of the digital values of openness appear to liberate archives from the bounds of space, organizations, and elites, and yet the past is also caught up in the algorithmic narrowing of information, knowledge, and life. The haste for the digitization of everything seems at the expense of a clear understanding of the risks related to ownership, use, access, costs, and finitude of digital data. Suddenly, when every comment and conversation is a publication, the unfolding present seems documented and shared with compulsive abandon. The result is an inverted archive of unmatched complexity and scale that gives up the past to forces beyond our control. This chapter probes the ownership of memory following the digital’s reversal in the idea of archive as something we create to something that archives us.
Schleiermacher and Friedrich Schlegel
Authors: Arndt Andreas
Published: December 2023

Schlegel and Schleiermacher met in Berlin in 1796. Although working independently, they shared much in common, particularly in philosophy. In his later years, Schleiermacher went back to the period of “symphilosophy” with Schlegel in early Romanticism, as shown in the first section. The second section describes briefly the encounter between Schleiermacher and Schlegel, as well as the development of this relationship, and the traces it left on Schleiermacher. The third section demonstrates how Schleiermacher introduced early Romantic philosophy into the epoch dominated by Hegel as well as the post-Hegelian philosophical epoch. He did this by appropriating the store of ideas created in the “symphilosophical” laboratory of ideas in a systematically directed way, and in doing so transforming it into a discursive form beyond the paradoxes of early Romanticism in the fields of hermeneutics, dialectics, and with the translation of Plato’s dialogues. The last section describes the divergent paths Schlegel and Schleiermacher took after their quarrel about their joint project to translate Plato, which was a breaking point in their relationship.
Dialectic
Authors: Schmidt Sarah
Published: December 2023

This contribution explores the genesis of Schleiermacher’s lectures on dialectic (1), its conception and the problem it addresses (2) as well as its position within the system of sciences (3). As a “Kunst der Gesprächsführung” (art of dialogue), Schleiermacher’s dialectic is committed to a dialogic understanding of knowledge and is based on a genesis of knowledge within the constant reciprocity between all forms of thinking. In the first, transcendental part of the Dialectic, the “Analyse der Idee des Wissens” (Analysis of the Idea of Knowledge), the focus is on the question of how knowledge can be established through movement, that is out of the process of its unfolding. Here, Schleiermacher marks out immediate self-consciousness as a form of possessing the transcendental ground of knowledge, but one that cannot be obtained through reflection. The second, technical part of the lecture is intended to guide the emerging knowledge with rules for dispute resolution. Schleiermacher insists here on the importance of a fundamental skeptical attitude as well as a contextualizing “critical process” (“kritischen Verfahren”). As regards the position of dialectic within the system of sciences, the focus is in particular on its relationship to hermeneutics and ethics, or rather, the relationship between thinking and speaking as well as that between thinking and acting, both of which are fundamental to the process of knowing.
Levels of Analysis and Word Classes (Root, Stem, Word)
Authors: Bisang Walter
Published: December 2023

The chapter presents a systematic account of how the morphological levels of root, stem, and word interact with word class. Based on an input–output model for comparing word-class flexibility or rigidity at each level, it develops eight morphological word-class types. These types are established on a maximally broad empirical basis, including typological challenges like omnipredicative and nominalistic languages as they are described in the literature (Classical Nahuatl and Tagalog, respectively). As a result, the chapter confirms Haig’s (2006) and Lehmann’s (2008) generalization that there is a decrease in flexibility from root > stem > word if one only considers the morphological word-class types which can operate (almost) exhaustively in an individual language. Moreover, it shows that a systematic morphological approach comes with challenges for Lexeme Formation Rules and theories like Functional Discourse Grammar, Radical Construction Grammar, and Distributed Morphology.
Word Classes in Salish Languages
Authors: Gerdts Donna B. , Schneider Lauren
Published: December 2023

Word classes have been controversial in Salish language research, but the current consensus among Salishanists is that the concepts of noun and verb, as well as adjective and adverb, are important for constructing insightful grammars of the languages. Drawing on primary data from the Central Salish language Halkomelem as well as discussions of word classes by various scholars, we show that entity-denoting and event-denoting words can clearly be related to nouns and verbs respectively. Nouns and verbs exhibit clear inflectional differences even though some inflectional processes—such as tense, plural, and diminutive marking—pertain to all lexical classes. We also illustrate morphological processes that change the lexical class of a word. Adjectives have been understudied in Salish languages, which have few true adjectives, as modification is also accomplished by means of stative-resultative forms. Adverbs divide into two types—those that must be followed by a linker and those that can occur in many positions. We conclude that categorial distinctions are relevant to the description and analysis of Salish languages at all levels: root, word, phrase, and clause.
Word Classes in Second Language Acquisition
Authors: Lindstromberg Seth , Boers Frank
Published: December 2023

With respect to post-childhood acquisition of an additional language (L2), it has sometimes been suggested that word class is an important co-determinant of ‘word learnability’, defined as the speed and thoroughness with which a once unknown L2 word can be integrated into a learner’s lexicon. This chapter reviews evidence for this suggestion, largely with respect to the open word classes noun, verb, and adjective, since these are the classes that have received the most attention in empirical research. It begins by discussing variables other than word class which empirical researchers have identified as notable co-determinants of word learnability; for example, semantic variables such as concreteness (i.e. the perceptibility of the referent) and degree of polysemy, form variables such as length, the usage-based variable item frequency, and interlingual or partly interlingual variables such as cognateness and pronounceability. Then, with respect to the difficulty of isolating an effect of word class on word learning, the chapter gives examples of how experimental studies which seemed to have revealed a word-class effect are in fact at least as likely to have indicated an effect of some other variable. There seems to be no compelling evidence for an independent word-class effect on word learnability.
Word Classes in Cognitive Grammar
Authors: Broccias Cristiano
Published: December 2023

Unlike most mainstream linguistic theories but similarly to Radical Construction Grammar, Cognitive Grammar provides a conceptual characterization of word classes based on cognitive abilities and models. This chapter first explores how word classes are understood in Cognitive Grammar and then focuses on the dual characterization of nouns and verbs at a prototypical and a schematic level. The discussion of verbs is linked to that of sequential and summary scanning as these two scanning modes play a crucial role in word classification. This also paves the way for a schematic description of adjectives, adverbs, and prepositions. In the final sections of the chapter, the import of distributional evidence is assessed in relation to the schematic characterizations offered previously and some discussion of function words, in particular determiners and modals, is offered.
Mind bomb 2 limits inflammatory dermatitis in Sharpin mutant mice independently of cell death
Authors: Simpson Daniel S , Anderton Holly , Yousef Jumana , Vaibhav Vineet , Cobbold Simon A , Bandala-Sanchez Esther , Kueh Andrew J , Dagley Laura F , Herold Marco J , Silke John , Vince James E , Feltham Rebecca
Published: December 2023

Skin inflammation is a complex process implicated in various dermatological disorders. The chronic proliferative dermatitis (cpd) phenotype driven by the cpd mutation (cpdm) in the Sharpin gene is characterized by dermal inflammation and epidermal abnormalities. Tumour necrosis factor (TNF) and caspase-8-driven cell death causes the pathogenesis of Sharpincpdm mice; however, the role of mind bomb 2 (MIB2), a pro-survival E3 ubiquitin ligase involved in TNF signaling, in skin inflammation remains unknown. Here, we demonstrate that MIB2 antagonizes inflammatory dermatitis in the context of the cpd mutation. Surprisingly, the role of MIB2 in limiting skin inflammation is independent of its known pro-survival function and E3 ligase activity. Instead, MIB2 enhances the production of wound-healing molecules, granulocyte colony-stimulating factor, and Eotaxin, within the skin. This discovery advances our comprehension of inflammatory cytokines and chemokines associated with cpdm pathogenesis and highlights the significance of MIB2 in inflammatory skin disease that is independent of its ability to regulate TNF-induced cell death.
Asking Expresses a Desire to Know
Authors: van Elswyk Peter
Published: December 2023

A speaker's use of a sentence does more than contribute content to a conversation. It also expresses the speaker's attitude. This essay is about which attitude or attitudes are expressed by using an interrogative sentence to ask a question. With reference to eight lines of data about how questions are circulated in conversation, it is argued that a desire to know the question's answer(s) is expressed.
Caenorhabditis elegans as a suitable model to evaluate the toxicity of water from Rolante River, southern Brazil
Authors: Rodrigues Vinícius Bley , Menezes Júlia Machado , da Silva Laura Cé , Müller Isadora , Mallmann Larissa , Hermann Bruna Saraiva , Menezes Charlene , Brucker Natália , da Vida Roselaine L , Picada Jaqueline Nascimento , Boaretto Fernanda Brião Menezes , Schneider Anelise , Linden Rafael , Zanella Renato , Fleck Juliane Deise , Charão Mariele Feiffer
Published: December 2023

Urbanization and agricultural activities increased environmental contaminants. Integrated analysis of water parameters and bioassays represents an essential approach to evaluating aquatic resource quality. This study aimed to assess water quality by microbiological and physicochemical parameters as well as the toxicological effects of water samples on the Ames test and Caenorhabditis elegans model. Samples were collected during (collection 1) and after (collection 2) pesticide application in the upper (S1), middle (S2), and lower (S3) sections of the Rolante River, southern Brazil. Metals were determined by GFAAS and pesticides by UPLC-MS/MS. Bioassays using the Ames test and the nematode C. elegans were performed. Levels of microbiological parameters, as well as Mn and Cu were higher than the maximum allowed limits established by legislation in collection 2 compared to collection 1. The presence of pesticide was observed in both collections; higher levels were found in collection 1. No mutagenic effect was detected. Significant inhibition of body length of C. elegans was found in collection 1 at S2 (P < 0.001) and S3 (P < 0.001) and in collection 2 at S2 (P = 0.004). Comparing the same sampling site between collections, a significant difference was found between the site of collection (F(3,6)=8.75, P = 0.01) and the time of collection (F(1,2)=28.61, P = 0.03), for the S2 and S3 samples. C. elegans model was useful for assessing surface water quality/toxicity. Results suggest that an integrated analysis for the surface water status could be beneficial for future approaches.
Thromboelastography-Guided Correction of Coagulopathy Before Tunneled Central Venous Access in Critically Ill Patients With Liver Disease: A Propensity Score-Matched Study
Authors: Sohail Mohammad A. , Vachharajani Tushar J. , Lane James E. , Huang Shuaiqi , Wang Xiaofeng , Mucha Simon , Kapoor Aanchal , Dugar Siddharth , Hanane Tarik
Published: December 2023

Importance:

Optimal blood product transfusion strategies before tunneled central venous catheter (CVC) placement are required in critically ill coagulopathic patients with liver disease to reduce exposure to allogeneic blood products and mitigate bleeding and thrombotic complications.

Objectives:

This study evaluated the safety and efficacy of a thromboelastography-guided transfusion strategy for the correction of coagulopathy in patients with liver disease compared with a conventional transfusion strategy (using international normalized ratio, platelet count, and fibrinogen) before tunneled CVC insertion.

Design, Setting, and Participants:

A retrospective propensity score-matched single-center cohort study was conducted at a quaternary care academic medical center involving 364 patients with liver disease (cirrhosis and acute liver failure) who underwent tunneled CVC insertion in the ICU. Patients were stratified into two groups based on whether they received blood product transfusions based on a thromboelastography-guided or conventional transfusion strategy.

Main Outcomes and Measures:

Primary outcomes that were evaluated included the volume, units and cost of blood products (fresh frozen plasma, cryoprecipitate, and platelets) when using a thromboelastography-guided or conventional approach to blood transfusions. Secondary outcomes included the frequency of procedure-related bleeding and thrombotic complications.

Results:

The total number of units/volume/cost of fresh frozen plasma (12 U/3,000 mL/$684 vs. 32 U/7,500 mL/$1,824 [p = 0.019]), cryoprecipitate (60 U/1,500 mL/$3,240 vs. 250 U/6,250 mL/$13,500 [p < 0.001]), and platelets (5 U/1,500 mL/$2,610 vs. 13 units/3,900 mL/$6,786 [p = 0.046]) transfused were significantly lower in the thromboelastography-guided transfusion group than in the conventional transfusion group. No differences in the frequency of bleeding/thrombotic events were observed between the two groups.

Conclusions and Relevance:

A thromboelastography-guided transfusion strategy for correction of coagulopathy in critically ill patients with liver disease before tunneled CVC insertion, compared with a conventional transfusion strategy, reduces unnecessary exposure to allogeneic blood products and associated costs without increasing the risk for peri-procedural bleeding and thrombotic complications.
Third-line Treatment for Metastatic Triple-negative Breast Cancer
Authors: Shi Mingqiang , Li Zhoujuan , Wang Tianzhuo , Wang Miaozhou , Liu Zhen , Zhao Fuxing , Ren Dengfeng , Zhao Jiuda
Published: December 2023

Objective:

Metastatic triple-negative breast cancer (mTNBC) is an invasive histologic subtype with a poor prognosis and rapid progression. Currently, there is no standard therapy for the third-line treatment of mTNBC. In this study, we conducted a network meta-analysis to compare regimens and determine treatment outcomes.

Methods:

We performed a systematic search of PubMed, EMBASE, the Cochrane Central Register of Controlled Bases, and the minutes of major conferences. Progression-free survival, overall survival, and objective response rate were analyzed through network meta-analysis using the R software (R Core Team). The efficacy of the treatment regimens was compared using hazard ratios, odds ratios, and 95% CIs.

Results:

We evaluated 15 randomized controlled trials involving 6,010 patients. Compared with the physician’s choice treatment, sacituzumab govitecan showed significant advantages in progression-free survival and overall survival, with hazard ratio values of 0.41 (95% CI: 0.32-0.52) and 0.48 (95% CI, 0.39-0.60). In terms of objective response rate, sacituzumab govitecan is the best-performing therapy (odds ratio: 10.82; 95% CI: 5.58-20.97). Adverse events among grades 3 to 5 adverse reactions, the incidence of neutropenia and leukopenia in each regimen was higher, whereas the incidence of fever, headache, hypertension, and rash was lower.

Conclusion:

Compared with the treatment of the physician’s choice, sacituzumab govitecan appears more efficacious and is the preferred third-line treatment for mTNBC.
Comparison of the Test-negative Design and Cohort Design With Explicit Target Trial Emulation for Evaluating COVID-19 Vaccine Effectiveness
Authors: Li Guilin , Gerlovin Hanna , Figueroa Muñiz Michael J. , Wise Jessica K. , Madenci Arin L. , Robins James M. , Aslan Mihaela , Cho Kelly , Gaziano John Michael , Lipsitch Marc , Casas Juan P. , Hernán Miguel A. , Dickerman Barbra A.
Published: December 2023

Background:

Observational studies are used for estimating vaccine effectiveness under real-world conditions. The practical performance of two common approaches—cohort and test-negative designs—need to be compared for COVID-19 vaccines.

Methods:

We compared the cohort and test-negative designs to estimate the effectiveness of the BNT162b2 vaccine against COVID-19 outcomes using nationwide data from the United States Department of Veterans Affairs. Specifically, we (1) explicitly emulated a target trial using follow-up data and evaluated the potential for confounding using negative controls and benchmarking to a randomized trial, (2) performed case–control sampling of the cohort to confirm empirically that the same estimate is obtained, (3) further restricted the sampling to person–days with a test, and (4) implemented additional features of a test-negative design. We also compared their performance in limited datasets.

Results:

Estimated BNT162b2 vaccine effectiveness was similar under all four designs. Empirical results suggested limited residual confounding by healthcare-seeking behavior. Analyses in limited datasets showed evidence of residual confounding, with estimates biased downward in the cohort design and upward in the test-negative design.

Conclusion:

Vaccine effectiveness estimates under a cohort design with explicit target trial emulation and a test-negative design were similar when using rich information from the VA healthcare system, but diverged in opposite directions when using a limited dataset. In settings like ours with sufficient information on confounders and other key variables, the cohort design with explicit target trial emulation may be preferable as a principled approach that allows estimation of absolute risks and facilitates interpretation of effect estimates.
Can a Machine Ace the Test? Assessing GPT-4.0’s Precision in Plastic Surgery Board Examinations
Authors: Al Qurashi Abdullah A. , Albalawi Ibrahim Abdullah S , Halawani Ibrahim R. , Asaad Alanoud Hammam , Al Dwehji Adnan M. Osama , Almusa Hala Abdullah , Alharbi Ruba Ibrahim , Alobaidi Hussain Amin , Alarki Subhi M. K. Zino , Aljindan Fahad K.
Published: December 2023

Background:

As artificial intelligence makes rapid inroads across various fields, its value in medical education is becoming increasingly evident. This study evaluates the performance of the GPT-4.0 large language model in responding to plastic surgery board examination questions and explores its potential as a learning tool.

Methods:

We used a selection of 50 questions from 19 different chapters of a widely-used plastic surgery reference. Responses generated by the GPT-4.0 model were assessed based on four parameters: accuracy, clarity, completeness, and conciseness. Correlation analyses were conducted to ascertain the relationship between these parameters and the overall performance of the model.

Results:

GPT-4.0 showed a strong performance with high mean scores for accuracy (2.88), clarity (3.00), completeness (2.88), and conciseness (2.92) on a three-point scale. Completeness of the model’s responses was significantly correlated with accuracy (P < 0.0001), whereas no significant correlation was found between accuracy and clarity or conciseness. Performance variability across different chapters indicates potential limitations of the model in dealing with certain complex topics in plastic surgery.

Conclusions:

The GPT-4.0 model exhibits considerable potential as an auxiliary tool for preparation for plastic surgery board examinations. Despite a few identified limitations, the generally high scores on key parameters suggest the model’s ability to provide responses that are accurate, clear, complete, and concise. Future research should focus on enhancing the performance of artificial intelligence models in complex medical topics, further improving their applicability in medical education.
Modified Seki Method for the Treatment of Lymphedema
Authors: Rizaliyana Sitti , Dianti Yuanita Safitri , Bogari Melia
Published: December 2023

Lymphedema is characterized by the abnormal accumulation of lymphatic fluid in the skin and subcutaneous tissue owing to impaired lymph flow. This condition may be primary or secondary to other diseases. Most lymphedema occurs in the lower extremities, which greatly interferes with the activities of the patients, especially walking. Further, it may affect the psychological condition of patients. In Indonesia, several patients with severe lymphedema have visited our clinic. In our center, lymphography is not available. However, as our center is a provincial referral hospital, many patients with lymphedema present with severe conditions. Nonoperative and operative treatment is available, including lymphovenous anastomosis. Herein, we present the rare case of a 33-year-old man with severe lymphedema in his left leg for the past 7 years. The patient was diagnosed with stage III secondary lymphedema of the left lower extremity and underwent lymphaticovenular anastomosis using a modification of the Seki method (Seki 2015). Five large lymphatic vessels were identified using methylene blue, and a transverse incision was made approximately 2–3 cm from the skin to the fatty tissue under the superficial fascia. Lymphaticovenular anastomosis was performed using a microscope. On postoperative day 1, the edema in the leg shrank significantly, and 6 months after surgery, the patient’s foot size began normalizing. The patient could wear pants and became more confident.
Immediate Lymphatic Reconstruction Using a Handheld Fluorescence Imaging Device
Authors: Goel Pedram , Arora Jagmeet S. , Lanier Brock
Published: December 2023

Background:

Immediate lymphatic reconstruction (ILR) has traditionally required a fluorescent-capable microscope to identify lymphatic channels used to create a lymphaticovenous bypass (LVB). Herein, a new alternative method is described, identifying lymphatic channels using a commercially available handheld fluorescence imaging device.

Methods:

This was a single-center study of consecutive patients who underwent ILR over a 1-year period at a tertiary medical center. Intradermal injection of fluorescent indocyanine green dye was performed intraoperatively after axillary or inguinal lymphadenectomy. A handheld fluorescent imaging device (SPY-PHI, Stryker) rather than a fluorescent-capable microscope was used to identify transected lymphatic channels. Data regarding preoperative, intraoperative, and outcome variables were collected and analyzed.

Results:

The handheld fluorescent imaging device was successfully able to identify transected lymphatic channels in all cases (n = 15). A nonfluorescent-capable microscope was used to construct the LVB in 14 cases. Loupes were used in one case. In 13 cases, ILR was unilateral. In two cases, bilateral ILR was performed in the lower extremities. All upper extremity cases were secondary to breast cancer (n = 7). Lower extremity cases (n = 8) included extramammary Paget disease of the penis, ovarian cancer, vulvar squamous cell carcinoma, squamous cell carcinoma of unknown origin, soft tissue sarcomas, cutaneous melanoma, and porocarcinoma.

Conclusions:

ILR, using indocyanine green injection with a handheld fluorescent imaging device, is both safe and effective. This method for intraoperative identification of lymphatic channels was successful, and LVB creation was completed in all cases. This approach makes ILR feasible when a fluorescent-capable microscope is unavailable, broadening access to more patients.
Choroidal Vascularity in Chronic Central Serous Chorioretinopathy and its association with risk single-nucleotide polymorphisms
Authors: Kaye Rebecca A. , Peto Tunde , Hogg Ruth , Griffiths Helen , Trial Group The VICI , Sivaprasad Sobha , Lotery Andrew J.
Published: December 2023

Purpose:

To analyse the choroidal parameters of patients with chronic central serous chorioretinopathy (cCSC), and the association with CSC susceptibility genes.

Methods:

The choroidal vascular index (CVI) was obtained by binarizing spectral domain optical coherence tomography (OCT) enhanced depth images of cCSC patients and healthy age-matched controls. cCSC patients were genotyped for three CSC susceptibility SNPs: rs4844392 (mir-29b-2/CD46), rs1329428 (CFH) and rs2379120 (upstream GATA5).

Results:

103 eyes with cCSC and 53 control eyes were included. There was a significant increase in the sub-foveal choroidal area in in both the affected (2.4 ± 0.6mm2) and fellow (2.2 ± 0.6mm2) eyes of patients with cCSC compared to controls (1.8 ± 0.5mm2, (p<0.0001 and p<0.0001). The CVI was reduced in cCSC patients 63.5 ± 3.1% compared to controls 65.4 ± 2.3% (p<0.001) and also in the affected compared to the fellow eyes 64.6 ± 2.9% (p<0.01). There was a significant association between CVI in the cCSC group and presence of the risk SNP rs2379120 at GATA5 (p<0.01).

Conclusion:

The relative reduction of CVI in cCSC patients may suggest a persistence of vessel hyper-permeability over dilation in chronic disease. GATA5 is associated with CVI in cCSC patients and therefore, may have a role in choroidal vascularity.
My Approach to Failed Rotator Cuff Repair
Authors: Chan Emily , Remedios Sarah , Wong Ivan
Published: December 2023

Failed rotator cuff repairs pose several challenges due to the high incidence rate, complexity, and range of symptoms. We propose an overview for assessing and treating failed rotator cuff repairs. For active young patients, attempt revision repair with patch augmentation if possible. When anatomic revision is not viable, but muscle is retained, consider partial repair with interposition bridging. Isolated, irreparable supraspinatus tears may benefit from superior capsule reconstruction. Tendon transfer is suitable for patients with significant atrophy and multiple irreparable cuff tears. Low-demand elderly patients or those with substantial glenohumeral arthritis may consider reverse total shoulder arthroplasty if conservative management fails. There are a variety of reported outcomes in the literature but long-term studies with larger cohorts are needed to improve the management of failed rotator cuff repair.
Subscapularis Tendon Tears: How Best to Approach This Issue
Authors: Magnuson Justin A. , Coulson Christian J. , Oh Luke S. , Bonner Kevin F.
Published: December 2023

Subscapularis tears, either in combination with more extensive rotator cuff pathology or in isolation, are a relatively common cause of shoulder pain and dysfunction which often requires surgical intervention. Similar to the general treatment of most rotator cuff tears, patients may respond to conservative treatment and not require surgical intervention, especially in the elderly or those with partial tears. However, many subscapularis tears require intervention to address complaints of pain, dysfunction, or both. The spectrum of subscapularis tears ranges from low-grade partial requiring simple debridement to full-thickness tears which have become retracted and irreparable necessitating complex repair. Although open repair had been performed with success, most subscapularis repairs can be accomplished with arthroscopic techniques.
Discarded livers tested by normothermic machine perfusion in the VITTAL trial: Secondary end points and 5-year outcomes
Authors: Mergental Hynek , Laing Richard W. , Kirkham Amanda J. , Clarke George , Boteon Yuri L. , Barton Darren , Neil Desley A.H. , Isaac John R. , Roberts Keith J. , Abradelo Manuel , Schlegel Andrea , Dasari Bobby V.M. , Ferguson James W. , Cilliers Hentie , Morris Chris , Friend Peter J. , Yap Christina , Afford Simon C. , Perera M. Thamara P.R. , Mirza Darius F.
Published: December 2023

Normothermic machine perfusion (NMP) enables pretransplant assessment of high-risk donor livers. The VITTAL trial demonstrated that 71% of the currently discarded organs could be transplanted with 100% 90-day patient and graft survivals. Here, we report secondary end points and 5-year outcomes of this prospective, open-label, phase 2 adaptive single-arm study. The patient and graft survivals at 60 months were 82% and 72%, respectively. Four patients lost their graft due to nonanastomotic biliary strictures, one caused by hepatic artery thrombosis in a liver donated following brain death, and 3 in elderly livers donated after circulatory death (DCD), which all clinically manifested within 6 months after transplantation. There were no late graft losses for other reasons. All the 4 patients who died during the study follow-up had functioning grafts. Nonanastomotic biliary strictures developed in donated after circulatory death livers that failed to produce bile with pH >7.65 and bicarbonate levels >25 mmol/L. Histological assessment in these livers revealed high bile duct injury scores characterized by arterial medial necrosis. The quality of life at 6 months significantly improved in all but 4 patients suffering from nonanastomotic biliary strictures. This first report of long-term outcomes of high-risk livers assessed by normothermic machine perfusion demonstrated excellent 5-year survival without adverse effects in all organs functioning beyond 1 year (ClinicalTrials.gov number NCT02740608).