bluuebunny/crossref_metadata_2025 huggingface dataset:
Identity and Diversity on the International Bench
Authors: Baetens Freya
Published: January 2021

This chapter explores the implications of adjudicators’ identity and diversity for the normative and sociological legitimacy of international courts and tribunals. It considers a range of elements that constitute a person’s identity, including gender, national origin, legal culture, religion, and ethnicity. In doing so, the chapter provides an overview of the volume’s contribution to the existing literature on matters of identity and diversity, focusing among other on appointment processes, judicial decision-making and adjudicators’ legacies. The chapter outlines the various justifications used to advocate greater diversity, highlights the relevance of institutional frameworks, and engages with the question whether the pursuit of diversity risks affecting quality. It analyses existing and emerging regulation as well as practices relating to diversity, in search of the reasons for its lack on international benches. Finally, it outlines the tripartite structure underlying the volume (the importance of an adjudicator’s identity before, during, and after their time on the bench), explains how the individual chapters fit into this framework and sets out how future scholarship may build on the present research findings.
The Smurfette Principle
Authors: Lijnzaad Liesbeth
Published: January 2021

This chapter discusses international judges’ paths towards the bench, arguing that more attention should be paid to the nomination process, rather than focusing only on elections. It dwells on the so-called Smurfette principle, an image borrowed from the contemporary analysis of popular visual culture about the role of ‘the one woman’ singled out in a group of men—and what this means for women on the bench. In looking at how to increase the number of women on the bench, the chapter reflects on who selects candidates and how, and what institutional mechanisms exist, or could be established, to improve the gender balance. This entails an analysis of the importance of domestic selection mechanisms, including the role of the national group of the Permanent Court of Arbitration as a forum for the selection of candidates. The central idea is that a gender balance cannot be fully achieved through elections so it needs to be pursued in the preparatory stage. Finally, the chapter addresses questions about potential improvements of selection processes as the possibilities of the current system may at times be under-explored.
Judges Ad Hoc at the International Court of Justice
Authors: Palchetti Paolo
Published: January 2021

This chapter analyses whether the presence of judges ad hoc can enhance the representativeness of the International Court of Justice, and so add to the Court’s overall legitimacy. It argues that, at least in principle, the appointment of judges ad hoc may also serve the purpose of increasing regional and legal systemic diversity on the bench of the Court. The question is whether in practice States have given importance to this aspect in selecting judges ad hoc. An examination of recent practice shows that a State’s choice of judge ad hoc is generally guided by their reputation before the Court and experience within the Court, rather than by elements such as nationality, geographic origin, or cultural background. While recognizing the autonomy of the parties in the selection of judges ad hoc, greater regional and legal diversity amongst judges ad hoc would likely benefit the Court by enhancing its reputation as an institution representative of the international community.
The Party-Appointment Process
Authors: Drummond Catherine
Published: January 2021

Efforts to improve the representation of women in international dispute settlement continue to face significant challenges. While there is an increasing acknowledgement that the lack of gender diversity needs to be addressed, this abstract concern has not translated into a meaningful increase in the number of women being appointed by parties to international courts and tribunals. This Chapter focuses on the processes for the selection and appointment of arbitrators and judges ad hoc on public international law courts and tribunals. It explores what those processes reveal about the different layers of prejudice that female candidates face and their combined effect in creating and sustaining barriers to equal opportunities for women. Identifying these layers of prejudice from a processual perspective can assist with formulating practical measures that could be taken by different stakeholders to address each of the specific barriers. The Chapter also highlights the special role and responsibility that counsel for appointing parties have in granting equal opportunities for women in each individual appointment process.
Legitimacy of Investor-State Arbitration
Authors: Seifi Jamal
Published: January 2021

Due to insufficient concretization of international norms, it is of vital importance to have broadly representative international courts and tribunals. Since the end of the Cold War, the most significant divisions among States are those between developing and developed countries, whose economic and other interests differ greatly. In this context, any normative or social legitimacy debate inevitably has a development focus. For example, investment arbitration awards have been found to be correlated with arbitrators’ policy preferences whereby the development bias was most prominent. Moreover, the predominantly commercial background and outlook of investment arbitrators has resulted in expansionist trends in interpreting the jurisdictional and substantive protection provisions of the Bilateral Investment Treaties (BITs), undermining the legitimacy of the investment arbitration system. The recent North American Free Trade Agreement (NAFTA) reform reinforces the old perception that the institution of investment arbitration is predominantly designed to address north-south disputes.
The Identity Conundrum
Authors: Titi Catharine
Published: January 2021

Arguably, an international judge or arbitrator’s identity can affect international judicial or arbitral decision-making. Relevant elements of identity include: nationality, ethnicity, country of legal education, public or private international law background, extent of industrialization or development of home country, and socio-economic background. This chapter aims to rationalize some elements of the identity of international adjudicators that find expression in the statutes of international courts and tribunals, and arbitration rules. Focusing on nationality, it contemplates the varying degrees to which it matters for the selection and appointment of permanent judges, arbitrators, and judges ad hoc.
Additional Opinions and Judicial Diversity at the International Court of Justice
Authors: Mistry Hemi
Published: January 2021

Additional opinions—that is, dissenting opinions, separate opinions, and declarations—are, by definition, the primary institutional mechanism through which judges can express their individual views on a particular decision, as distinct from the judgment or decision proclaimed on behalf of the institution. Therefore, within the public sphere they are the principal institutional manifestation of the individual—and thus the individuality—of the judge. Consequently, for those who seek to understand the impact of certain personal characteristics upon how a judge discharges their professional functions and, in turn, the wider institutional and systemic implications of the participation of individuals bearing those characteristics, the study of additional opinions would seem a useful analytical enterprise. Using gender diversity at the International Court of Justice as a case study, the purpose of this chapter is twofold: first, to explain the relationship between diversity and additional opinions, and second, to explore the methodological potential, and challenges, that the study of additional opinions entails.
Citing Religious Texts in Individual Opinions to Judgments of the International Court of Justice
Authors: Waseem Mubarak A
Published: January 2021

This chapter explores, through a survey of individual Separate and Dissenting Opinions, the treatment of religious texts within the International Court of Justice (ICJ) and provides an argument for their continued usage. In order to maintain its legitimacy, the ICJ is under an obligation to serve the international community and its principles, in all their variety. International law is already, at least in part, based on natural law as reflected in religious texts. The answer to the central question, whether the Court’s judges should be more willing or more hesitant to express their own identity through citing religious texts, depends on one’s view of the role of the Court. If we view the ICJ as a quasi-arbitral forum for the clinical resolution of disputes, the answer to this question is probably negative. But this chapter argues that the Court ought to be viewed as an apex forum for a truly international legal order, one that is geographically, religiously, and culturally diverse, and whose legal concepts are the result of long and storied histories, and as such, the expression of religious identity has a place in the corpus of the living law.
Adjudicating International Trade Cases in the World Trade Organization
Authors: Hughes Valerie
Published: January 2021

The presence of women on WTO panels and the Appellate Body makes a difference from the perspective of institutional legitimacy. However, given the limited experience with women adjudicators on the WTO bench and the fact that WTO dispute reports are not signed individually but by all three adjudicators, it is impossible to prove whether women have made a difference by bringing a unique perspective to WTO adjudication. Nevertheless, it is possible to suppose that they would do so for two reasons. First, WTO Members believe that the individual perspective of an adjudicator can inform her or his decision-making, at least in the case of developing country adjudicators. Second, trade policy makers have come to realize that trade policies can affect women and men differently, and hence that developing trade policies requires a gender-based analysis. With this in mind, it is suggested that there is a gender-based approach to WTO adjudication.
Judicial Legal Culture and Victim Procedural Status at the Special Tribunal for Lebanon and Extraordinary Chambers in the Courts of Cambodia
Authors: Pérez-León-Acevedo Juan-Pablo
Published: January 2021

This chapter examines the relationship between judicial legal culture and victim procedural practices at the Special Tribunal for Lebanon (STL) and the Extraordinary Chambers in the Courts of Cambodia (ECCC). Starting with judicial composition, judges are categorized by their professional and educational backgrounds and legal cultures before assuming their STL/ECCC judicial positions: whether they originate from the common law/adversarial system, the civil law/inquisitorial system, or the ‘international’ system. The chapter then investigates connections between STL/ECCC practices concerning victim procedural status and the typical features of these legal cultures. Overall, it is argued that there is a direct relationship between the legal culture of judges and their judicial practices. The chapter explains how STL and ECCC judges have adapted several civil law/inquisitorial and common law/adversarial features to make victim procedural status fit the mandate and characteristics of the STL and ECCC, namely, the presence of sui generis international features.
Diversity and Legitimacy of the World Trade Organization’s Bench
Authors: Creamer Cosette D , Godzimirska Zuzanna
Published: January 2021

This chapter sheds light on the relationship between the composition of the bench and the sociological legitimacy of the judicial branch of the World Trade Organization (WTO). Two identity characteristics are consistently part of the criticism of the WTO’s bench: the lack of female adjudicators as well as individuals with academic experience. Overall, however, the identity of the bench does not appear to matter greatly for how WTO Members evaluate its exercise of authority. We suggest that the role of the WTO’s Legal Affairs Division and the Appellate Body Secretariat in streamlining outcomes and procedures may best explain this, as it helps prevent such diversity from manifesting in dispute rulings. Alternatively, it tells us that judicial diversity matters more for the bench’s normative legitimacy—and for scholars—than it does for governments.
Keeping Gender on the Agenda for International Benches
Authors: Jarpa Dawuni J
Published: January 2021

This chapter analyses the descriptive, symbolic, and substantive representation of women judges in international courts and tribunals. The last couple of years have witnessed slow progress in the quest to achieve sex balanced or gender parity benchmarks on the benches of international courts. While some courts have made incremental progress, others are still lagging. Using the African Court on Human and Peoples’ Rights (ACtHPR) as a case study, this chapter explores the factors that have contributed to the court’s gender parity outcomes in recent years. Moving beyond discussions of why women should be appointed, the chapter advances an argument on how to achieve gender parity through the creative interplay of three factors—legal instruments, specific strategies, and vested actors. The chapter makes a contribution to the literature on gender and diversity in international courts by highlighting some best practices for achieving and sustaining gender parity on the benches of international courts.
The EU during Brexit
Authors: Fabbrini Federico
Published: January 2021

This chapter analyses the European Union during Brexit, explaining how the EU institutions and Member States reacted to the UK’s decision to leave the EU. It outlines how they went about this in the course of the withdrawal negotiations. The EU institutions and Member States managed to adopt a very united stance vis-à-vis a withdrawing state, establishing effective institutional mechanisms and succeeding in imposing their strategic preferences in the negotiations with the UK. Nevertheless, the EU was also absorbed during Brexit by internal preparations to face both the scenario of a ‘hard Brexit’—the UK leaving the EU with no deal—and of a ‘no Brexit’—with the UK subsequently delaying exit and extending its EU membership. Finally, during Brexit the EU increasingly started working as a union of 27 Member States—the EU27—which in this format opened a debate on the future of Europe and developed new policy initiatives, especially in the field of defence and military cooperation.
The EU because of Brexit
Authors: Fabbrini Federico
Published: January 2021

This chapter examines the European Union because of Brexit, focusing on a number of transitional problems that the withdrawal of the United Kingdom from the EU—and its delay owing to subsequent requests to extend EU membership for extra time—posed for the EU’s functioning and funding. In particular, it emphasizes the consequences of Brexit for the composition of the 9th European Parliament (2019–2024), and its elections in May of 2019. It explains how the participation of the UK in this democratic process had pro tempore effects on both the EP outlook and its electoral outcome. The chapter also considers the transitional institutional challenges faced because of Brexit by both the European Commission and the Council of the EU. It highlights the implications of Brexit for the EU’s multi-annual financial framework (MFF), stressing how the UK’s withdrawal created a budget gap for the EU, attributable to the way the EU is funded, and how this would create challenges in the next MFF negotiations—as indeed happened.
The EU besides Brexit
Authors: Fabbrini Federico
Published: January 2021

This chapter assesses the European Union besides Brexit, shedding light on the multiple other crises that the EU has recently faced in addition to the withdrawal of the United Kingdom. In the last decade, the EU has weathered the euro-crisis, the migration crisis, and the rule of law crisis, each of which has continued to sour throughout the Brexit negotiations. In addition to these old crises, the EU has now faced new ones—as shown by the difficulties of dealing with the issue of enlargement, the problem of climate change, and particularly the catastrophic Covid-19 pandemic. All of these crises have exposed the disunity of the EU—a counter-point to the unity that emerged in the Brexit negotiations. The chapter explains the difficulties of the EU27 in successfully tackling once and for all any of these crises, and the growing centripetal pulls at play, owing to the rise of very different visions of European integration—what can be called a ‘polity’, a ‘market’, and an ‘autocracy’ conception of the EU, which are competing with each other.
The EU after Brexit
Authors: Fabbrini Federico
Published: January 2021

This chapter focuses on the European Union after Brexit and articulates the case for constitutional reforms. Reforms are necessary to address the substantive and institutional shortcomings that patently emerged in the context of Europe’s old and new crises. Moreover, reforms will be compelled by the exigencies of the post-Covid-19 EU recovery, which pushes the EU towards new horizons in terms of fiscal federalism and democratic governance. As a result, the chapter considers both obstacles and opportunities to reform the EU and make it more effective and legitimate. On the one hand, it underlines the difficulties connected to the EU treaty amendment procedure, owing to the requirement of unanimous approval of any treaty change, and the consequential problem of the veto. On the other hand, it emphasizes the increasing practice by Member States to use intergovernmental agreements outside the EU legal order and stresses that these have set new rules on their entry into force which overcome state veto, suggesting that this is now a precedent to consider.
The EU beyond Brexit
Authors: Fabbrini Federico
Published: January 2021

This chapter looks at the future of the European Union beyond Brexit and analyses the plan, precedents, and prospects for the Conference on the Future of Europe. The establishment of the Conference on the Future of Europe is potentially an innovative model and path-breaking initiative to reform the EU and make it more effective and legitimate, along the lines of prior, out-of-the-box initiatives such as the Conference of Messina and the Convention on the Future of Europe. The Covid-19 pandemic has delayed the start of the Conference on the Future of Europe, but has also increased its urgency. Yet, the chances of success of this initiative are closely connected to the mechanics of treaty reform. As such, the chapter suggests that the Conference should consider channelling its output into a Political Compact, subject to an entry into force rule that do away with the unanimity requirement, as it has been done previously in the field of Economic and Monetary Union (EMU). Clearly, success cannot be taken for granted and there are many difficulties ahead, but the EU is facing a decisive moment.
From Close-Ups to Long Shot
Authors: Vauchez Antoine
Published: January 2021

In a context in which EU case law is increasingly politicized, this chapter questions our analytical equipment when it comes to understanding the ‘political role’ of the Court of Justice of the European Union (CJEU). Moving from close-ups to long shot views of EU case-lawyering, the chapter repositions judicial decision-making in a dense web of political, social, and professional ramifications within and outside the Court itself. By articulating micro, meso, and macro levels of analysis, it escapes ontological discussions about the political nature of the Court (‘neoliberal’, ‘federalist’, etc.) and suggests a research strategy able to empirically measure and geographically map out the Court’s embeddedness in Europe’s laws, politics, and societies.
Waiting for the Barbarians
Authors: Nicola Fernanda G.
Published: January 2021

This chapter offers some methodological insights to those who wish to embark on a study of the archival history of the European Court of Justice (ECJ). Through her voyage into this newly opened archive, the author unpacks the comparative legal history emerging from the jurisprudence of the ECJ, a supranational court embedded in different European legal traditions. The author relies on the findings of the new legal historians who have brought to the surface legal and political resistance to the constitutionalization narrative of the ECJ. She also relies on the work of sociologists who have focused on professional networks of Eurolawyers as a powerful engine for the integration and liberalization of the single market. By deploying these insights, the chapter offers a novel reading of the grands arrêts through the dossiers de procédure now open to the public in electronic format at the Historical Archives of the EU.
The Relevance of the Network Approach to European Case Law
Authors: Šadl Urška , Tarissan Fabien
Published: January 2021

The chapter argues that the network approach is a viable methodology in legal empirical research, which can be used to study the case law of the Court of Justice. To demonstrate this potential, the chapter: first, shows how to obtain detailed information about the law from the citation network; second, it illustrates how to assess the legal relevance of cases by looking at case citations; and, third, it explores how to infer the doctrinal influence of selected landmark cases. All examples adapt different citation network tools to the study of legal structures and legal discourse which can focus, frame, support, and guide doctrinal analysis.
Germination
Authors: Hotson Howard
Published: January 2021

Decades ago, Walter Ong intuited a powerful link between the advent of printing with moveable type, the subsequent spatialization of discourse most strikingly evident in Ramism, and the corpuscular, mechanistic physics of Descartes (section 3.i). More recently, Klaas van Berkel has identified the precise location of this link in Snellius’ student, Isaac Beeckman (1588–1637), who, working at the interface of artisanal knowledge and Ramist pedagogy, developed the basic principles of a physico-mathematical philosophy of nature which he passed on to Descartes in 1618–19 and to Gassendi and Mersenne a decade later (section 3.ii). Another figure of the same generation, Henricus Reneri (1593–1639), was inspired by a very similar set of interests and aspirations to become Descartes’ first devoted follower and perhaps closest friend (section 3.iii).
Dissemination
Authors: Hotson Howard
Published: January 2021

Although typically identified with English Puritanism, the nucleus of the correspondence network which Samuel Hartlib envisaged in 1634 was originally composed primarily by intellectuals displaced, as he was, from central Europe by the Thirty Years War (section 6.i). A brief survey of contacts which Hartlib, Dury, and Comenius maintained with the easternmost figures at the top of his list—Alsted and Bisterfeld in Transylvania—exemplifies the extent of his network, its tempo of communication, and some of the common interests which bound it together (section 6.ii). A more general census reveals a large number of Hartlibian correspondents educated in Herborn, Heidelberg, Bremen, Zerbst, Brieg, and Danzig. Responses to Hartlib’s circulation of Comenius’ first pansophic tract suggests the extraordinary similarity of pedagogical interests and aspirations which helped bind this far-flung network together (section 6.iii).
Divergence
Authors: Hotson Howard
Published: January 2021

Since the function and form of Comenian pansophia derived from the previous post-Ramist tradition, its sources and basic working methods naturally betrayed the same family resemblance. Far from proceeding on strictly empirical principles, Comenius adopted from Alsted the idea that pansophia must derive from the ‘three books of God’: sense, reason, and revelation (section 8.i). Like Alsted, Comenius also collected and processed this huge variety of material within a system of commonplaces; while Hartlib and Dury, for their part, proposed using Alsted’s Encyclopaedia as the structure of a collaborative information processing centre known as the Office of Address for Communications. However bookish these methods may seem, they were not as far removed from Bacon’s actual practice as is commonly supposed (section 8.ii). The fatal disjuncture underlying the universal reform programme was not between empiricism and commonplacing but between philosophical and pedagogical goals. The fundamental objective was to expound a reformed system of universal knowledge in the systematic manner in which it could be propagated universally. But the reformation of knowledge in the patient, incremental manner advocated by Bacon required resistance to premature systematization. The Baconian pansophists were therefore forced to choose between pursuing the best means of transmitting received knowledge and the best means of transforming it. Since there was no point in communicating knowledge which remained fundamentally flawed, the universal reform agenda collapsed amongst Hartlib’s successors into the more coherent and manageable task of reforming natural philosophy alone (section 8.iii).
Reconfiguration
Authors: Hotson Howard
Published: January 2021

Alsted and Bisterfeld, Hartlib and Comenius, Welsch and Leibniz all proposed to emend the Encyclopaedia of 1630, and all failed. Contemplating the failure of these attempts opens up the broadest vista attained by this study. The idea of an ‘enkyklios paideia’, a cycle or circle of instruction or education, is an ancient one which gradually took literary shape during the Middle Ages and Renaissance. Three successive generations of reform—led by Agricola, Ramus, and Keckermann—and a fourth generation of collective effort by a whole community generated the most perfect literary manifestation of this idea in Alsted’s Encyclopaedia (section 11.i). For at least two generations after its appearance in 1630, scholars across Europe acknowledged the Encyclopaedia as the leading work of its kind and sought to revise or replace it. During this lengthy period, the connotations of the term ‘encyclopaedia’ shifted from designating a ‘cycle of studies’ to a genre of books which sought to summarize the circle of learning in print (section 11.ii). But with the failure to replace Alsted’s work, the systematically organized, pedagogically orientated, Latin encyclopaedias worthy of the name exploded into innumerable discrete topics which were reorganized in alphabetical order in the various European vernaculars to create a new genre of academic reference works inappropriately labelled ‘(en)cyclopaedias’ first by Chambers in 1728 and then by D’Alembert and Diderot in 1751. The implications of this transformation for the shape of European knowledge were profound. The demise of the age-old tradition culminating in Alsted’s Encyclopaedia can therefore be regarded as a major watershed in European intellectual history created by the simultaneous political, military, confessional, and intellectual crises of the mid-seventeenth century (section 11.iii).
Summary, Conclusions, and Prospects
Authors: Hotson Howard
Published: January 2021

The first part of this conclusion (section 12.i) surveys the development of the Ramist and post-Ramist tradition in Reformed central Europe before 1630 (narrated in Commonplace Learning), the scattering of that tradition during the Thirty Years War (1618–48), and its further development in relation to figures such as Descartes, Bacon, Comenius, and Leibniz (recounted in The Reformation of Common Learning). The second part (section 12.ii) reviews the argument of this pair of studies from a thematic perspective. Ramism is approached, not as a philosophical school, but as a pedagogical tradition, the most dynamic, innovative, disruptive, and influential to arise in the Protestant world between the Renaissance and the Enlightenment. Its trajectory, in both the Holy Roman Empire and the Dutch Republic, parallels the graphs of new educational foundations and the growth of their student bodies and catchment areas. Its motive power is student demand, fuelled by the social, political, and confessional circumstances of the era and channelled most effectively through relatively modest institutions responsive to student needs. This explains why this tradition of pedagogical innovation emerged in such fragmented landscapes, why Ramist methods and institutions served as channels thorough which mercantile and artisanal impulses percolated into the academic world, and how they could generate the power to overthrow seemingly superior cultural forces, such as the prestigious humanist educational ideals of the era and entrenched confessional commitments. The book closes with the prospect of complementing traditional top-down intellectual history with a bottom-up approach which can contextualize leading works and thinkers within whole landscapes of digitally analysable data.
Liberty, Equality, and Popular Sovereignty
Authors: Schofield Malcolm
Published: January 2021

This chapter documents the role of appeals to the liberty of the people in Roman political discourse, as evidenced in the writings of Sallust and Livy as well as Cicero’s. Liberty’s relation to contested notions of equality is discussed at length, particularly as it is explored in Livy and in On the commonwealth. Finally, the chapter turns to On the commonwealth’s conception of popular sovereignty: of the res publica as the property of the people, over which it must be able to exercise rights of ownership, if political liberty is to be secured and maintained.
Cosmopolitanism, Imperialism, and the Idea of Law
Authors: Schofield Malcolm
Published: January 2021

The cosmopolitan idea that humans have wider and more universal allegiances than to their immediate communities is presented by Cicero in On the commonwealth in both Platonic and Stoic forms. In On laws the more evidently Stoic idea of law as prescriptive right reason governs his argument. The chapter explains what Cicero takes its universal prescriptive force to consist in, and the way he conceives it to be embodied in the law codes of well-regulated constitutions of particular states, whether the Roman Republic at its best or any other ‘good and stable nation’. In On the commonwealth he had argued for the thesis that such states cannot exist or conduct their affairs without justice, which in Book 3 is the focus of a full-scale debate, particularly concerned with the justice or injustice of imperialism, not least Roman imperialism.
Republican Virtues
Authors: Schofield Malcolm
Published: January 2021

Talk of the virtues, something of signal importance in the entire Western republican tradition, was seldom absent from Cicero’s lips, whether in his oratory, letters, or theoretical writings. He is forever listing virtues or concatenating virtue words. This chapter examines some of the more theoretically grounded lists that he proposes in three of his opening chapters: civic (in On the commonwealth), Roman (in Tusculan disputations), and cardinal (in On duties). His frequent pairing of constantia and gravitas is highlighted, and his treatments in On duties of justice, magnitudo animi, and verecundia are of particular interest and receive extended discussions. The chapter concludes with a portrait of Cicero’s supremely reliable and honest republican citizen as exemplar of virtue.
Republican Decision-making
Authors: Schofield Malcolm
Published: January 2021

On duties makes development of natural impulses to virtue the basis for how one ought to act. But identifying what actually is the right and honourable thing to do in the public sphere can still be problematic, even if the overriding importance of claims upon citizens of obligations to the res publica are recognized. When the res publica is in trouble, and when civilized order is either unstable or broken down completely, then it may become entirely opaque whether any action a citizen might take could properly or effectively promote the well-being of the res publica. For Cicero, citizen and statesman in turbulent and dangerous times, such issues were as much existential as theoretical, with the potential to destabilize theory too. This chapter first explores his theoretical treatment of decision-making in On duties, and then the difficulties of fitting principle to practice encountered in civil war and its aftermath.
Elucidation of the Effects of Bisphenol A and Structural Analogs on Germ and Steroidogenic Cells Using Single Cell High-Content Imaging
Authors: Rajkumar Abishankari , Luu Trang , Beal Marc A , Barton-Maclaren Tara S , Robaire Bernard , Hales Barbara F
Published: January 2021

Concerns about the potential adverse effects of bisphenol A (BPA) have led to an increase in the use of replacements, yet the toxicity data for several of these chemicals are limited. Using high-content imaging, we compared the effects of BPA, BPAF, BPF, BPS, BPM, and BPTMC in germ (C18-4 spermatogonial) and steroidogenic (MA-10 Leydig and KGN granulosa) cell lines. Effects on cell viability and phenotypic markers were analyzed to determine benchmark concentrations (BMCs) and estimate administered equivalent doses (AEDs). In all 3 cell lines, BPA was one of the least cytotoxic bisphenol compounds tested, whereas BPM and BPTMC were the most cytotoxic. Interestingly, BPF and BPS were cytotoxic only in MA-10 cells. Effects on phenotypic parameters, including mitochondria, lysosomes, lipid droplets, and oxidative stress, were both bisphenol- and cell-line specific. BPA exposure affected mitochondria (BMC: 1.2 μM; AED: 0.09 mg/kg/day) in C18-4 cells. Lysosome numbers were increased in MA-10 cells exposed to BPA or BPAF but decreased in KGN cells exposed to BPAF or BPM. Lipid droplets were decreased in C18-4 cells exposed to BPF and in MA-10 cells exposed to BPTMC but increased in BPF, BPM, and BPTMC-exposed KGN cells. BPA and BPM exposure induced oxidative stress in MA-10 and KGN cells, respectively. In summary, structurally similar bisphenols displayed clear cell-line-specific differences in BMC and AED values for effects on cell viability and phenotypic endpoints. This approach, together with additional data on human exposure, may aid in the selection and prioritization of responsible replacements for BPA.
Local Anesthesia Injection in Upper Blepharoplasty Surgery: A Side at a Time or Both Sides at Once? A Prospective Randomized Study
Authors: Ohana Oded , Ayala-Haedo Juan , Anagnostopolous Apostolos , Lee Wendy W.
Published: January 2021

BACKGROUND

Perceived pain during local anesthesia injections can be effected by the injection sequence.

OBJECTIVE

We sought to compare pain levels during local anesthesia injections during upper lid blepharoplasty (ULB) using 2 surgical sequences.

MATERIALS AND METHODS

We conducted a prospective, randomized clinical trial. Patients with ULB were randomized to either have local anesthesia injection followed by ULB in the right eyelid and then in the left (Group A) or to have local anesthesia injection to both eyelids followed by ULB on both eyelids (Group B). Pain was assessed using a visual analog scale (VAS) for pain score of 0 to 10.

RESULTS

Forty patients were included and randomized. The mean VAS score in Group A was 2.60 ± 1.84 and 3.30 ± 1.62 (right and left, respectively, p value = .035). The mean VAS score in Group B was 2.55 ± 1.63 and 2.80 ± 1.67 (right and left eyelids, respectively, p value = .258). No intergroup difference in pain was found.

CONCLUSION

Patients having sequential anesthesia during ULB perceived more pain on injection to the second eyelid, whereas patients having local anesthesia followed by ULB perceived the same amount of pain in both eyes. Pain levels in both groups were similar. Local anesthesia injections in both groups were well tolerated.
Hypopigmentation in Extramammary Paget Disease Is an Important Prognostic Factor for High Recurrence Rate and Poor Surgical Outcome
Authors: Choi Sooyie , Oh Yeongjoo , Chung Kee Yang , Oh Byung Ho , Roh Mi Ryung
Published: January 2021

BACKGROUND

Several studies have reported the presence of hypopigmentation in extramammary Paget disease (EMPD). However, an in-depth analysis regarding its clinical implication is lacking.

OBJECTIVE

To evaluate the clinical characteristics of EMPD in the Korean population and to determine the implication of hypopigmentation on clinical outcomes.

METHODS

We retrospectively reviewed 124 cases of EMPD who underwent surgical treatment from a single tertiary hospital from December 2005 to March 2019. Baseline characteristics of the patients and hypopigmentation patterns were analyzed. Moreover, the number of stages of Mohs micrographic surgery (MMS) and recurrence rate were evaluated in relation to the hypopigmentation.

RESULTS

A total of 67.7% (n = 84) of the patients showed hypopigmentation. The adjusted odds ratio for recurrence in the hypopigmented group was 5.980, which was statistically significant (95% confidence interval = 1.347–26.553, p-value = 0.019). Furthermore, the average number of MMS stages was 2.92 in the hypopigmentation group, compared with 1.82 in the nonhypopigmentation group (p-value = .0016).

CONCLUSION

Hypopigmented lesions may disguise the tumor margin, thus raising the recurrence rate after surgery and the number of stages of MMS. The hypopigmentation status must be considered when deciding the surgical margin.
Sleep Duration, Sleep Timing, and Sleep Disordered Breathing—Associations With Obesity and Gestational Diabetes in Pregnancy
Authors: FACCO FRANCESCA
Published: January 2021

Pregnant individuals may come into pregnancy with underlying sleep abnormalities but are also predisposed to developing sleep issues such as obstructive sleep apnea, due to the physiologic changes associated with the gravid state. This article will review the epidemiology of sleep duration, sleep timing, and sleep disordered breathing in pregnancy with a focus on how the prevalence of these sleep conditions relate to body mass index. In addition, it will summarize the literature suggesting a link between these sleep disturbances and an increased risk for gestational diabetes.
Epibulbar Proliferative Fasciitis, a Variant of Nodular Fasciitis: A Differential Diagnosis of Conditions With Focal or Diffuse Myxoid Stromas
Authors: Jakobiec Frederick A. , Barrantes Paula Cortes , Ma Lina , Mihm Martin
Published: January 2021

Purpose:

To describe the clinical and pathologic features of a case of epibulbar proliferative fasciitis and to compare it with other focal or diffuse myxoid lesions.

Methods:

A clinical, histopathologic, and immunohistochemical analysis was performed. The clinical history, photographic documentation, history, and referred slides were reanalyzed. Additional immunohistochemical stains were performed at our institution.

Results:

A 68-year-old woman developed over a week a brightly vascularized and focally hemorrhagic placoid lesion on the temporal side of the OS. She had had earlier augmentation breast surgery that had been mistakenly initially reported to us to be for breast carcinoma. Hematoxylin- and eosin-stained reactions revealed microscopically a spindle cell lesion with an intact nonkeratinizing epithelium and a background myxoid stroma with prominent capillaries and a light dispersion of small T-cell lymphocytes. Most striking among the spindle cells were some widely separated large atypical cells. The atypical cells were cytokeratin positive, but an expansive panel of immunohistochemical stains for breast carcinoma was negative. The lesion was diagnosed as proliferative fasciitis and has not recurred after 1-year follow up.

Conclusion:

A rapidly evolving conjunctival lesion is unlikely to be a primary or metastatic carcinoma. In the current case, the large ganglioform or rhabdomyoblast-like cells displayed diffuse cytokeratin positivity, still consistent with a mesenchymal or connective tissue cell lineage. Cytokeratin expression has been a finding previously reported in connective tissue tumors and in lymphoma cells. While the current lesion clinically resembles a conventional nodular fasciitis, the presence of the large atypical cells can lead to the misdiagnosis of a sarcoma, which typically displays a much higher Ki-67 proliferation index in comparison with nodular/proliferative fasciitis.
Purely Behavioral: A Scoping Review of Nonpharmacological Behavioral and Lifestyle Interventions to Prevent Cardiovascular Disease in Persons Living With HIV
Authors: Ramos S. Raquel , O'Hare Olivia M. , Hernandez Colon Ailene , Kaplan Jacobs Susan , Campbell Brynne , Kershaw Trace , Vorderstrasse Allison , Reynolds Harmony R.
Published: January 2021

Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for 900,000 deaths annually. People living with HIV are at a higher risk of developing CVD. We conducted a scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis. In July 2020, six databases were searched: PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, Embase, and The Cochrane Central Register of Controlled Trials, as well as reference lists of relevant studies and key journals. Our review identified 18 studies that addressed nonpharmacological behavioral interventions into the following: physical activity (n = 6), weight loss (n = 2), dietary interventions (n = 1), and multicomponent interventions (n = 9). In the past 10 years, there has been an increased emphasis on nonpharmacological behavioral approaches, including the incorporation of multicomponent interventions, to reduce cardiovascular risk in people living with HIV. The extant literature is limited by underrepresentation of geographic regions and populations that disproportionately experience CVD.
Telehealth Exercise Intervention in Older Adults With HIV: Protocol of a Multisite Randomized Trial
Authors: Oursler Krisann K. , Marconi Vincent C. , Briggs Brandon C. , Sorkin John D. , Ryan Alice S. ,   FIT VET Project Team
Published: January 2021

People with HIV (PWH) have reduced cardiorespiratory fitness, but a high intensity, easily disseminated exercise program has not yet been successfully developed in older PWH. The purpose of this article is to describe a synchronous telehealth exercise intervention in older PWH, delivered from one medical center to two other centers. Eighty older PWH (≥50 years) on antiretroviral therapy will be randomized to exercise or delayed entry control groups. Functional circuit exercise training, which does not entail stationary equipment, will be provided by real-time videoconferencing, 3 times weekly for 12 weeks, to small groups. Continuous remote telemonitoring of heart rate will ensure high exercise intensity. We hypothesize that telehealth exercise will be feasible and increase cardiorespiratory fitness and reduce sarcopenia and frailty. Findings will provide new insight to target successful aging in older PWH and can also be widely disseminated to PWH of any age or other patient populations.
It Cannot Happen, Never: A Qualitative Study Exploring Youth Views on Disclosure of HIV Diagnosis to Their Sexual Partners in Southern Malawi
Authors: Zgambo Maggie , Arabiat Diana , Ireson Deborah
Published: January 2021

With the availability of antiretroviral therapy, more children living with HIV live longer than before and grow into young adulthood. This study examined the concerns of youth about disclosure of an HIV diagnosis to their sexual partners and attempted to gain an understanding of their HIV status disclosure experiences, views, and plans. A focused ethnography was undertaken. Using semi-structured interviews, data were collected from 20 youth between the ages of 15 and 24 years who were attending an HIV clinic. The findings highlight that youth generally struggled to disclose their HIV status to their sexual partners. The most frequent reasons for concealing their HIV status was fear of relationship termination, being unmarried, and fear that their sexual partners may reveal their HIV diagnosis to the community, thereby predisposing them to stigmatization, discrimination, and prejudice. There is a need to develop and strengthen HIV disclosure support groups for youth to help them develop life skills for overcoming HIV-related stigma.
Expression of TIGAR and its correlation with clinicopathology, prognosis, and 18F-FDG PET/CT parameters in patients with resectable pancreatic ductal adenocarcinoma
Authors: Song Yang , Wang Peng-Yuan , Zheng Yang , Liu Chang , Wang Xiao-Ming
Published: January 2021

Objective

The aim of this study was to investigate the expression of TP53-inducible glycolysis and apoptosis regulator (TIGAR) and its relationship with clinical pathology and prognosis; and to analyze the correlation between TIGAR expression and 18F-labeled fluoro-2-deoxyglucose (18F-FDG) PET/computed tomography (CT) parameters in patients with pancreatic ductal adenocarcinoma (PDAC).

Methods

We retrospectively analyzed the data of 23 patients who underwent preoperative 18F-FDG PET/CT examinations and were confirmed to have PDAC by postoperative pathology. TIGAR was detected using immunohistochemistry. The relationships between TIGAR expression and clinicopathology and its value in predicting the prognosis of patients with PDAC were analyzed. The correlations between TIGAR expression and 18F-FDG PET/CT parameters [standard uptake value (SUV) max, SUVmean, SUVpeak, metabolic tumor volume (MTV), and total lesion glycolysis (TLG)] were analyzed.

Results

The expression of TIGAR was low in 34.8% of patients and high in 65.2% of patients. There was no correlation between TIGAR expression and clinicopathology. The overall survival of patients with high TIGAR expression was significantly shorter than that of patients with low TIGAR expression (11.2 vs. 35.4 months). The 18F-FDG PET/CT parameters: SUVmax, SUVmean, SUVpeak, MTV, and TLG were positively correlated with TIGAR expression, but only the MTV correlation with TIGAR expression was statistically significant.

Conclusion

TIGAR is highly expressed in PDAC. Its expression is independent of clinicopathological data and can be used as an independent prognostic factor. TIGAR expression was significantly positively correlated with the 18F-FDG PET/CT parameter MTV.
Situational Awareness in Acute Patient Deterioration
Authors: White Anne , Maguire Mary Beth R. , Brannan Jane , Brown Austin
Published: January 2021

Background and Purpose

Prelicensure nursing students lack the situational awareness to promote timely intervention with a patient in septic shock. This study evaluated a multifaceted educational project that determined the impact on nursing students' knowledge retention and time to task (TTT).

Methods

A quasi-experimental, repeated-measures design was used to evaluate students' knowledge retention and TTT. Eighty-four prelicensure nursing students participated in groups of 4 students to participate in a high-fidelity simulation.

Results

Results show knowledge retention was significant between the pretest scores and 2 repeated assessment scores. The repeated-measures analysis of variance time effect P value was .02. The overall TTT group response suggested most (64/84, 76%) students responded within 5 minutes of patient deterioration.

Conclusions

A multifaceted approach was effective to influence knowledge of septic shock over time and demonstrate students' ability to intervene with a septic shock patient in a timely manner.