bluuebunny/crossref_metadata_2025 huggingface dataset:
The Politics of Foreign Terrorist Fighters in Europe: The Deterritorialization and Reterritorialization of Citizens?
Authors: Johansson-Nogués Elisabeth , Bonsoms Aitor
Published: June 2024

In the wake of the fall of the Daesh Islamic State “Caliphate” in 2019, the international community has been faced with the fact that thousands of displaced persons are stranded in Iraqi and Syrian detention centers. This article interrogates the governmental policies of ten Western European countries toward their nationals and legal residents held in the prisons and camps. We analyze the discourse and the practices of deterritorialization and reterritorialization of the “foreign-terrorist-fighter-citizens.” We find that the Western European governments have engaged in different types of deterritorialization and reterritorialization moves which have acted to position their foreign fighter nationals and dependents at the liminars of the body politic in a way that runs the risk of perpetuating the foreign fighters’ and their dependents’ confinement in, what some practitioners have denounced as, “Europe's Guantanamo.” We also argue that the deterritorialization and reterritorialization moves reveal the emptiness of the current-day liberal state project at its core. The discourses and practices place the liberal democratic state at odds with its own declared values and with the basic human rights of the foreign-terrorist-fighter-citizen in a manner that is corrosive to other citizens and to the ideals inherent to “good life” of the political community.
Evaluating the effects of virulence genotype, swarming motility, and multi-locus sequence types of Escherichia coli on layer chicken embryos
Authors: Ovi Fozol , Zhang Li , Jia Linan , Elliott Katie , Sukumaran Anuraj Theradiyil , Cosby Douglas , Wilson Dan , Ramachandran Reshma , Evans Jeff , Poudel Ishab , Adhikari Pratima
Published: June 2024

Aims

To determine the effects of swarming motility (SM) and multi-locus sequence types (MLST) on the main effect of virulence genotype of Escherichia coli through an embryos lethality assay between the 12th and 18th days of incubation.

Methods and results

We collected 58 E. coli isolates from asymptomatic commercial hens (n = 42) and lesions of colibacillosis cases (n = 16), then classified their virulence genotype as avirulent, moderately virulent, virulent-healthy, and virulent-colibacillosis categories by the presence of five virulence-associated genes (iroN, ompT, hlyF, iutA, and iss). These isolates were further classified as non-motile, motile, or hyper-motile by SM assay. From the 58 isolates, we selected 29 for ELA and determined their MLST. Each isolate was inoculated into 15 embryonated eggs through the allantoic cavity. We found the avirulent isolates reduced the relative embryo weight compared to virulent-colibacillosis and moderately virulent isolates (37.49 vs. 41.51 and 40.34%, P = 0.03). Among the moderately virulent and virulent-colibacillosis categories, embryo lethality was lower when isolates were non-motile. Yolk retention was unaffected by virulence categories, motility, or MLST.

Conclusion

Interaction between virulence genotype and SM substantially influenced the embryo lethality assay of E. coli isolates.
Annotation-preserving machine translation of English corpora to validate Dutch clinical concept extraction tools
Authors: Seinen Tom M , Kors Jan A , van Mulligen Erik M , Rijnbeek Peter R
Published: June 2024

Objective

To explore the feasibility of validating Dutch concept extraction tools using annotated corpora translated from English, focusing on preserving annotations during translation and addressing the scarcity of non-English annotated clinical corpora.

Materials and Methods

Three annotated corpora were standardized and translated from English to Dutch using 2 machine translation services, Google Translate and OpenAI GPT-4, with annotations preserved through a proposed method of embedding annotations in the text before translation. The performance of 2 concept extraction tools, MedSpaCy and MedCAT, was assessed across the corpora in both Dutch and English.

Results

The translation process effectively generated Dutch annotated corpora and the concept extraction tools performed similarly in both English and Dutch. Although there were some differences in how annotations were preserved across translations, these did not affect extraction accuracy. Supervised MedCAT models consistently outperformed unsupervised models, whereas MedSpaCy demonstrated high recall but lower precision.

Discussion

Our validation of Dutch concept extraction tools on corpora translated from English was successful, highlighting the efficacy of our annotation preservation method and the potential for efficiently creating multilingual corpora. Further improvements and comparisons of annotation preservation techniques and strategies for corpus synthesis could lead to more efficient development of multilingual corpora and accurate non-English concept extraction tools.

Conclusion

This study has demonstrated that translated English corpora can be used to validate non-English concept extraction tools. The annotation preservation method used during translation proved effective, and future research can apply this corpus translation method to additional languages and clinical settings.
Development of glypican-3-specific chimeric antigen receptor-modified natural killer cells and optimization as a therapy for hepatocellular carcinoma
Authors: Cao Bihui , Ni Qianqian , Chen Zhuxin , Yang Shuo , Zhang Xinkui , Su Haotao , Zhang Zhenfeng , Zhao Qi , Zhu Xiaolan , Liu Manting
Published: June 2024

Hepatocellular carcinoma (HCC) is a highly malignant tumor characterized by insidious onset and rapid progression, with limited treatment choices. One treatment modality, chimeric antigen receptor (CAR)-modified natural killer (NK) cell immunotherapy, has shown promise for various cancers. However, the treatment efficacy of CAR-NK cells for HCC remain inferior. In this study, we developed two glypican-3 (GPC3)-specific CAR-NK-92 cell lines (GPC3-CAR-NK) and explored their antitumor efficacy for the treatment of HCC. Significant levels of cytokine production and in vitro cytotoxicity were produced following co-culture of GPC3+ HCC cells with the developed GPC3-CAR-NK cells. GC33-G2D-NK cells with NK cell-specific signaling domains showed better activation and killing abilities than GC33-CD28-NK cells containing T-cell-specific signaling domains. Moreover, GC33-G2D-NK cells efficiently eliminated tumors in cell-derived xenograft and patient-derived xenograft mouse models. In an abdominal metastasis model, intraperitoneally delivered GC33-G2D-NK cells showed better antitumor ability than intravenously injected cells. Finally, the combination of microwave ablation (MWA) with GC33-G2D-NK cell administration showed greater CAR-NK infiltration and tumor regression in ablated tumors than monotherapy alone. These findings indicate that administration of GPC3-CAR-NK cells may be a potential strategy for the treatment of HCC, and regional delivery or their combination with MWA may optimize their efficacy against HCC and may have translational value.
Poverty, race, ethnicity, and survival in pediatric nonmetastatic osteosarcoma: a Children’s Oncology Group report
Authors: Ilcisin Lenka , Han Ruxu , Krailo Mark , Shulman David S , Weil Brent R , Weldon Christopher B , Umaretiya Puja , Aziz-Bose Rahela , Greenzang Katie A , Gorlick Richard , Reed Damon R , Randall R Lor , Nadel Helen , Binitie Odion , Dubois Steven G , Janeway Katherine A , Bona Kira
Published: June 2024

Background

Children living in poverty and those of marginalized race or ethnicity experience inferior disease outcomes across many cancers. Whether survival disparities exist in osteosarcoma is poorly defined. We investigated the association between race, ethnicity, and proxied poverty exposures and event-free and overall survival for children with nonmetastatic osteosarcoma receiving care on a cooperative group trial.

Methods

We conducted a retrospective cohort study of US patients with nonmetastatic, osteosarcoma aged 5-21 years enrolled on the Children’s Oncology Group trial AOST0331. Race and ethnicity were categorized to reflect historically marginalized populations, as Hispanic, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White. Poverty was proxied at the household and neighborhood levels. Overall survival and event-free survival functions of time from trial enrollment were estimated using the Kaplan–Meier method. Hypotheses of associations between risks for event-free survival, death, and postrelapse death with race and ethnicity were assessed using log-rank tests.

Results

Among 758 patients, 25.6% were household-poverty and 28.5% neighborhood-poverty exposed. Of the patients, 21% of children identified as Hispanic, 15.4% non-Hispanic Black, 5.3% non-Hispanic Other, and 54.0% non-Hispanic White. Neither household or neighborhood poverty nor race and ethnicity were statistically significantly associated with risks for event-free survival or death. Postrelapse risk for death differed statistically significantly across race and ethnicity with non-Hispanic Black patients at greatest risk (4-year postrelapse survival 35.7% Hispanic vs 13.0% non-Hispanic Black vs 43.8% non-Hispanic Other vs 38.9% non-Hispanic White; P = .0046).

Conclusions

Neither proxied poverty exposures or race and ethnicity were associated with event-free survival or overall survival, suggesting equitable outcomes following frontline osteosarcoma trial-delivered therapy. Non-Hispanic Black children experienced statistically significant inferior postrelapse survival. Investigation of mechanisms underlying postrelapse disparities are paramount.
Comparing cohort and period trends of early-onset colorectal cancer: a global analysis
Authors: Chen Jianjiu , Yang Wan
Published: June 2024

Background

Incidence of early-onset colorectal cancer (CRC) has increased globally in recent decades. We examined early-onset CRC incidence trends worldwide for potential cohort effects, defined as changes associated with time of birth (eg, early-life exposure to carcinogens), and period effects, defined as changes associated with calendar periods (eg, screening programs).

Methods

We obtained long-term incidence data for early-onset CRC diagnosed in patients aged 20 to 49 years through the year 2012 for 35 countries in the Cancer Incidence in Five Continents database. We used a smoothing method to help compare cohort and period trends of early-onset CRC and used an age-period-cohort model to estimate cohort and period effects.

Results

Cohort effects had a more dominant role than period effects in the early-onset CRC incidence in Shanghai (China), the United Kingdom, Australia, New Zealand, Canada, the United States, and Osaka (Japan). The smoothed trends show the specific birth cohorts when early-onset CRC began to increase: the 1940s-1950s birth cohorts in the United States; the 1950s-1960s birth cohorts in other Western countries; the 1960s birth cohorts in Osaka; and the 1970s-1980s birth cohorts in Shanghai. Such increases occurred earlier for early-onset cancers of the rectum than of the colon. For the other countries, the results were less clear.

Conclusions

Recent birth cohorts may have been exposed to risk factors different from earlier cohorts, contributing to increased early-onset CRC incidence in several developed countries or regions in the West and Asia. Such increases began in earlier birth cohorts in Western countries than in developed regions of Asia.
Geographically driven shifts in land use influence phytoplankton community patterns in the Inner Mongolian Plateau lakes
Authors: Geng Yue , Lei Xue , Yu Ruihong , Li Xiangwei , Sun Heyang , Liu Xingyu , Li Yuan , Zhang Xiangyu , Zhang Zhuangzhuang , Xu Jifei , Lü Changwei , Wang Lixin , Wang Jianfeng
Published: June 2024

Phytoplankton play an irreplaceable role as producers in maintaining lake ecosystems. Nevertheless, scant attention has been given to investigating the dispersion of phytoplankton communities and the factors influencing them across expansive areas. In this study, we present the results of a survey on the distribution of phytoplankton community and the effects of different driving factors in 11 lakes along Inner Mongolia in July–August 2020. Non-metric multidimensional scaling analysis and variance decomposition (VPA) were used to elucidate the distribution of phytoplankton communities and the response of drivers. A total of 169 species of phytoplankton from 8 phyla were detected. Both the abundance and diversity of phytoplankton in the Inner Mongolia lakes showed a trend of high in the east and low in the west (with Daihai Lake as the boundary). The Margalef index of phytoplankton significantly negatively correlated with salinity (r = −0.707, P < 0.05) and total dissolved solids (r = −0.720, P < 0.05), and both density and biomass highly significantly positively correlated with the suspended solids, Chlorophyll a and trophic level index. The VPA explained 38.9% of the changes in the phytoplankton community with the highest rate of explanation of land use. Therefore, preventing anthropogenic impacts, as well as reducing nutrient loads, can effectively ensure the ecological diversity of lake phytoplankton in lake populations with large geographical spans and varying levels of nutrients.
The use of complex adaptive system’s emulation and principles in planning and managing a biophilic systems transition in Singapore
Authors: McGreevy Michael Patrick , Chia (Aaron) Eng Seng
Published: June 2024

Cities have been described as complex adaptive systems (CAS). A key aspect of both natural and social CAS is that they are scaler and hierarchical. The research reported in this article looked at the purposeful adoption of CAS principles within the governance structures, socioecological and sociotechnical subsystems of the city state of Singapore in order to deliver urban ecological services. The major objective of the research was to evaluate the degree to which complex adaptive systems restoration, rehabilitation, and emulation and/or principles are holistically being applied across sectors, departments, and agencies to deliver urban ecological services that reach normative goals. The research first analysed the Singapore government’s intersectoral and sectoral ‘Big P’ policy documents. It then analysed whether policies within these are subsequently being incorporated into the ‘small p’ regulatory standards and guidelines as well as projects of relevant departments. The research found the most ‘Big P’ policy documents and to a lesser extent ‘small p’ standards and projects have purposely adopted nature-based solutions in order to deliver intersectoral urban ecological services. However, adoption is often voluntary, as a result, it is largely progressing via pilot schemes and ad hoc projects in places of least resistance. As such, it is not yet being undertaken as a holistic coordinated city-wide transition.
Evaluating virulence features of Acinetobacter baumannii resistant to polymyxin B
Authors: de Souza Camila Maurmann , Silvério de Oliveira Warley , Fleitas Martínez Osmel , dos Santos Neto Nilton Araripe , Buccini Danieli Fernanda , Nieto Marín Valentina , de Faria Júnior Célio , Rocha Maximiano Mariana , Soller Ramada Marcelo Henrique , Franco Octávio Luiz
Published: June 2024

The increasing resistance to polymyxins in Acinetobacter baumannii has made it even more urgent to develop new treatments. Anti-virulence compounds have been researched as a new solution. Here, we evaluated the modification of virulence features of A. baumannii after acquiring resistance to polymyxin B. The results showed lineages attaining unstable resistance to polymyxin B, except for Ab7 (A. baumannii polymyxin B resistant lineage), which showed stable resistance without an associated fitness cost. Analysis of virulence by a murine sepsis model indicated diminished virulence in Ab7 (A. baumannii polymyxin B resistant lineage) compared with Ab0 (A. baumannii polymyxin B susceptible lineage). Similarly, downregulation of virulence genes was observed by qPCR at 1 and 3 h of growth. However, an increase in bauE, abaI, and pgAB expression was observed after 6 h of growth. Comparison analysis of Ab0, Ab7, and Pseudomonas aeruginosa suggested no biofilm formation by Ab7. In general, although a decrease in virulence was observed in Ab7 when compared with Ab0, some virulence feature that enables infection could be maintained. In light of this, virulence genes bauE, abaI, and pgAB showed a potential relevance in the maintenance of virulence in polymyxin B-resistant strains, making them promising anti-virulence targets.
Distinction between personal data and verification of quality of personal data
Authors: Tzanou Maria
Published: June 2024

This chapter discusses Article 7 of the EU Law Enforcement Directive (LED). In addition to the basic principle of data accuracy enshrined in Article 4(1)(d) LED, Article 7 LED introduces an additional requirement not found in the General Data Protection Regulation (GDPR). Member States must provide for personal data based on facts to be distinguished from personal data based on personal assessments. Moreover, all reasonable steps should be taken to ensure that personal data which are inaccurate, incomplete, or no longer up to date are not transmitted or made available. To that end, competent authorities should, as far as practicable, verify the quality of personal data before they are transmitted or made available. A clear expectation that different categories of personal data undergoing processing within the law enforcement context should be distinguished in accordance with their degree of accuracy and reliability is the rationale behind the requirements enshrined in Article 7 LED. Such distinctions and classifications have always been particularly important in the context of judicial proceedings.
Automated individual decision-making
Authors: Gottschalk Thilo
Published: June 2024

This chapter focuses on Article 11 of the EU Law Enforcement Directive (LED), which implements a prohibition of automated individual decision making (ADM) with possibilities for exemptions based on Union or Member State law. Decisions with adverse effects that are based solely on automated processing are generally prohibited under the LED. Both the General Data Protection Regulation (GDPR) and the LED generally link risks to the processing of personal data. Article 11(1) LED pursues a slightly different approach and arguably focuses on the usage of processing outcomes in the form of ‘decisions’. Article 11 LED is hence partly described to have a hybrid character situated between data protection and procedural regulations. This results in difficulties interpreting the protective scope of the norm.
Logging
Authors: Veale Michael
Published: June 2024

This chapter reviews the Law Enforcement Directive (LED), which states that logs should be used solely for the verification of the lawfulness of processing, self-monitoring, ensuring the integrity and security of the personal data, and for criminal proceedings. It considers the logging and review of logs as an important part of the computer security required by clause 4(1)(f) LED. The LED’s logging provisions in the Netherlands under Article 25 LED are used to introduce real-time systems to monitor police use of data and detect misuse. The chapter details how logging can support internal accountability. Logging may support data minimisation efforts by evidencing the frequency of use of data and informing retention periods or collection scope.
Position of the data protection officer
Authors: Svanberg Christian Wiese
Published: June 2024

This chapter emphasizes that Article 33 LED must be read jointly with Article 32 and 34 LED on the designation of the data protection officer (DPO) and the tasks of the DPO. It reviews several issues relating to the Member State implementation of Article 33 that has been identified by the European Commission (EC). Article 33(1) LED sets out an obligation for the controller to ensure the DPO is involved in all issues that relate to the protection of personal data and sets broad requirements to organisational awareness within the controller. The chapter cites Article 33(2) LED, which addresses the need to ensure that the DPO is provided with the resources necessary to carry out the tasks set out in Article 34 LED. The DPO must have access to personal data and processing operations and must maintain his or her expert knowledge.
General principles for transfers of personal data
Authors: Boehm Franziska
Published: June 2024

This chapter describes the general principles comprised in Article 35 LED for third country data transfers according to Chapter V LED. Article 35 LED lists the conditions for all international data transfers by stipulating that the national provisions need to be complied with in order to transfer data to third countries or international organisations. It implies that processors must only carry out a transfer if they are explicitly instructed to do so on behalf of controllers. The chapter reviews conditions set by Article 35 LED for onward transfers from a third country or an international organisation to another third country or to another international organisation. The setting mentioned in Article 35 LED applies to all transfer mechanism of the LED.
Transfers on the basis of an adequacy decision
Authors: Drechsler Laura
Published: June 2024

This chapter reviews the framework contained in Article 36 LED for adequacy decisions, which is one of the mechanisms provided by the Law Enforcement Directive (LED) to justify an international personal data transfer. There are three mechanisms that exist in the system established by the LED: adequacy decisions, appropriate safeguards, and derogations. It explains that adequacy decisions have to be used when they are in place and only in their absence can transfers be based first on appropriate safeguard and second, as a last resort, on derogations. The chapter describes the function of an adequacy decision under the LED, which demonstrates that a certain third country, territory, or specific sector within a third country or an international organisation ensures an adequate level of protection. An adequacy decision under the LED confirms that a third country or international organisation has a level of protection of fundamental rights and freedoms for personal data processing.
Supervisory authority
Authors: Bonnici Jeanne Pia Mifsud , Manuvie Ritumbra
Published: June 2024

This chapter discusses Article 41 LED that tasks Member States to set up one or more supervisory authorities that are responsible for monitoring the application of the Law Enforcement Directive (LED). According to Article 41 LED, Member States must collaborate with the supervisory authorities in other Member States in order to ensure a consistent application of LED provisions across the EU. Article 41(1) LED, as well as Article 51(1) GDPR, confirms the aim of a supervisory authority to monitor the application of the respective legal instrument in order to protect the fundamental rights and freedoms of natural persons. The chapter refers to the obligation for Member States in Article 41 LED to notify the European Commission (EC) of the specific national law adopting a supervisory authority. Article 41 LED provides for the setting up of an independent supervisory authority in each Member State.
Reporting of infringements
Authors: Tsolias Grigorios
Published: June 2024

This chapter explains the extent of Article 48 of the EU Law Enforcement Directive (LED). It cites that Local education agencies (LEAs) process personal data of different categories of data subjects by conducting covert investigations, video surveillance, and other special investigation techniques to fight terrorism and other forms of serious crimes. However, the covert nature of processing may result in the violation of Article 4(1) LED principles of data processing and the deprivation of the data subject's rights. Article’s 48 LED obligation of Member States to provide for competent authorities to put in place effective mechanisms to encourage confidential reporting of the LED’s infringements counterbalances the lack of transparency and strengthens compliance to its principles. The chapter also outlines the legal background and analysis of Article 48 LED.
Right to an effective judicial remedy against a supervisory authority
Authors: Kranenborg Herke
Published: June 2024

This chapter discusses the right to an effective judicial remedy against a supervisory authority as per Article 53 of the EU Law Enforcement Directive (LED). To monitor the application of the data protection rules, the supervisory authorities are generally endowed with considerable powers of intervention. Additionally, the Court of Justice of the European Union (CJEU) highlighted the importance of the independence of supervisory authorities which allows them to perform their duties free from external influence. However, the independent supervisory authorities are still subject to the rule of law. The chapter considers when and by whom Article 54 LED can be invoked and its subsequent procedural rules and territorial limitations.
Right to compensation
Authors: Vavoula Niovi
Published: June 2024

This chapter provides an overview of the rights to compensation under Article 56 of the EU Law Enforcement Directive (LED). The right to compensation under the LED derives from the widely known Latin maxim that postulates that there should be a corresponding remedy for a breach where the law has established a right. Every legal system provides for a remedial mechanism to implement rights and obligations created or recognized by that system. Overall, Article 56 LED aims to ensure that the rights under data protection law are effectively protected. The chapter discusses the legal background of Article 56 LED and the analysis of its cumulative conditions, notion of damage, jurisdiction, and compensation for damages in respective breaches.
Commission reports
Authors: Mościbroda Anna
Published: June 2024

This chapter discusses the notion of commission reports within Article 62 of the EU Law Enforcement Directive (LED). It expounds on the rationale, policy underpinnings, and legal background of Article 62 LED. Article 62 LED revolves around the review and reports regarding the evaluation and review of the LED and the European Commission's obligation to review other legal acts adopted by the Union. The wording of Article 62 LED provisions indicates that all obligations therein relate to the evaluation of the application and functioning of provisions of the LED. The chapter then details the obligations under Article 62(6) LED, which specifies that the aim is to ensure a consistent approach to the protection of personal data within the scope of the LED.
The Sources of International Trade Law
Authors: Matthew Kennedy
Published: June 2024

The multilateral rules of international trade law are administered by the WTO through a series of agreements containing both horizontally applicable rights and obligations as well as individually scheduled commitments. Although these rules are mostly set out in agreements concluded in 1994, they incorporate instruments from the prior GATT framework as well as rules developed in other international fora. They are supplemented by decisions taken after 1994, some of which are specifically provided for in the rules. The main source of clarification has been the rulings of the WTO dispute settlement system. Bilateral and regional rules have proliferated since the establishment of the WTO. They may exist within spaces created by exceptions in the multilateral rules but they are independent sources of law. Their subject matter overlaps considerably with multilateral rules. While they tend to diverge from multilateral rules in certain areas, such as market access, they do so less in other areas. Later generations of regional trade agreements often contain chapters covering topics on which there is no dedicated multilateral agreement. Preferential trade arrangements are authorized under exceptions in multilateral trade rules but they are established in the national laws of the preference-granting Members.
The Influence of International Trade Law on International Law
Authors: James Crawford , Freya Baetens
Published: June 2024

Numerous commentators have lauded international trade law, and the WTO dispute resolution mechanism in particular, as vehicles for change in international law more generally. In the sense that new rules of international trade law enhance international law, by creating new rights and obligations for the States parties to trade agreements, it is true that international trade law develops international law generally. In preparing the Articles on Responsibility of States for Internationally Wrongful Acts for example, the International Law Commission (ILC) had frequent regard to international trade law and the WTO. However, the influence of international trade law remains curtailed within the wider field of international law, outside the realm of WTO adjudication. Such influence in non-trade areas has been restricted for reasons such as its jurisdictional separateness, its limited relevance as part of the applicable law or even source of interpretation (due to the distinct or ‘sui generis’ character of trade law) and the informal hierarchy of international norms. But, there is room for non-trade-related areas of international law, and associated dispute resolution institutions, to learn from international trade law and in particular from the WTO as an institution.
Trade and Investment Liberalization
Authors: Henry Gao
Published: June 2024

The article starts by tracing China’s long and storied history with the GATT and WTO, highlighting challenges posed by China’s unique economic system and the key commitments designed to alleviate these problems. The next parts discuss China’s role in the Doha Round, as well as its efforts to build its own network of trade agreements and arrangements, including not only traditional free trade agreements, but also the Belt and Road Initiative, and free trade zones. This is followed by a comprehensive and in-depth analysis of the main issues in the current discussions on WTO reform, a process that started at the last WTO Ministerial Conference held in December 2017. In particular, the paper examines in detail the efforts by some major players to turn it into a so-called ‘China Round’, and China’s reactions. The paper concludes with a review of the failed attempt of the United States to address some of these issues through the US-China trade war and suggests that multilateral negotiation is the best way forward.
Institutions
Authors: David Unterhalter , Erika Schneidereit
Published: June 2024

This chapter discusses the dispute settlement system of the World Trade Organization (WTO), and dispute settlement under regional and bilateral trade agreements. The WTO dispute settlement system evolved from a system predicated upon consent under the GATT 1947 into a system of compulsory and contentious jurisdiction that results in the adoption of binding resolutions to the disputes of members. The distinctive institutions, principles, rules and practices that comprise this system are given treatment in this chapter. Some emphasis is given to the Appellate Body, the institution born of the Uruguay Round, that was intended to lend stability and certainty to the system. The Appellate Body has attracted praise and criticism. Its principal critic, the United States, has rendered the Appellate Body currently inoperative. The chapter considers these issues and whether the system might be reformed so as to secure its continuation. Finally, the chapter discusses the expansion of bilateral and regional trade agreements, their dispute settlement provisions, and their cohabitation with WTO dispute settlement.
Remedies and Compliance
Authors: Geraldo Vidigal
Published: June 2024

This chapter examines the remedies that prevail in international trade adjudication, often known as ‘prospective’, ‘forward-looking’ or ‘compliance-oriented’. These terms are justified by the lack of awards for reparation for injury in this field, where remedies have evolved to focus not on past injury but on re-establishing conduct that complies with substantive obligations. The primary remedy available to trade adjudicators is an impartial determination of breach, coupled with an instruction for its cessation. These primary remedies are usually accompanied by the possibility of follow-up adjudication on compliance with them, and potentially by the threat of an authorization of retaliation in case of non-cessation of the violation. The authorization to apply regulated retaliation may be considered as a remedy in its own right, available in case the primary remedies prove insufficient to induce compliance. However, authorized retaliation should not be confused with awards for damages or analysed as a functional equivalent to monetary compensation. The practice shows that complainants in trade disputes do not request adjudication seeking retaliation and seldom implement it when authorized to do so. The right to retaliate is not perceived as a benefit in itself, but as an instrument whose threat can be used to induce performance of obligations or a settlement satisfactory to the complainant.
A Critical Analysis of Prospective Randomized Controlled Trial of an Intramedullary Nail versus Dynamic Hip Screw and Plate Fixation for Intertrochanteric Fractures of the Femur
Authors: Shaunak Shalin , Sugand Kapil , Rose Barry
Published: June 2024

There has been much speculation and debate as to the gold-standard treatment for intertrochanteric neck of femur fracture configuration. Centers tend to favor one over the other. This chapter will look at the seminal paper by Adams et al. (2001) to discuss surgical options between intramedullary nailing (IMN) and dynamic hip screws (DHSs). The study observed for incidence of complications, revision surgery, and overall functional outcomes. The conclusion was that intramedullary nailing is still associated with a higher, albeit nonsignificant, risk of postoperative complications. Hence, routine use of IMN devices cannot be recommended over DHSs for intertrochanteric neck of femur fractures when both options are amenable.
Nonoperative Treatment versus Plate Fixation of Displaced Midshaft Clavicle Fractures
Authors: Davies Andrew , Reilly Peter
Published: June 2024

The Canadian Clavicle Trial compared nonoperative management to plate fixation in randomized patients with completely displaced midshaft clavicle fractures. The study included 132 adult patients with acute closed fractures. Follow-up was extended to twelve months. Shoulder function scores were superior in the operative group at all time points, and there was no difference in range of motion. The nonunion risk was greater following nonoperative management (14%) compared to fixation (3%). Metalwork irritation and prominence occurred in 18%, and 5% of patients underwent reoperation for infection. Patients with displaced midshaft clavicle fractures should be carefully counseled regarding each management option.
Alignment in Total Knee Arthroplasty
Authors: Mahapatra Piyush , Nathwani Dinesh
Published: June 2024

Computer-navigated lower limb arthroplasty is a topical issue. Computer-assisted total knee arthroplasty using a computed tomography–free navigation system leads to improved mechanical limb alignment compared to conventional techniques. Ninety-six percent of patients in the computer-assisted group had postoperative limb mechanical axis within three degrees of the neutral axis compared with 78% in the conventional group. Coronal femoral component alignment was improved in the computer-assisted group (2.1 degrees vs. 1.5 degrees, p < 0.01). Overall, the computer-assisted technique led to more accurate and more reliable limb alignment and component position compared to conventional techniques.
Graft Selection in Anterior Cruciate Ligament Reconstructions
Authors: Edwards Thomas C. , Edmund Bourke Henry
Published: June 2024

Anterior cruciate ligament reconstruction is a common operation performed throughout the world. Restoring stability to the knee joint is important not only for returning to activities of daily living and physical activity but also to prevent future risk of meniscal and chondral damage. Graft choice remains controversial, and there is a relative paucity of well-designed robust studies investigating graft selection with long-term follow-up. This chapter explores a prospective study comparing two common autograft options: patella tendon vs. hamstring tendon with a ten-year follow-up. It aims to provide evidence to help answer the question of which graft is best and how to better inform patients on the likely prognosis of their injury.
A Randomized, Controlled Trial of Total Knee Replacement
Authors: Rudran Branavan , Jones Luke D.
Published: June 2024

Total knee replacement (TKR) is a routine treatment for end-stage knee osteoarthritis (OA). No previous high-quality studies comparing operative to nonoperative management exist. In this randomized controlled trial (RCT), fifty patients with moderate to severe knee OA were randomly assigned to receiving TKR followed by twelve weeks of nonsurgical treatment, and fifty patients to twelve weeks of nonsurgical treatment. Outcomes included patient-reported outcome measures (PROMs) and clinical assessment. At one year, the operative group had greater improvement in all outcomes than the nonoperative group. TKR and nonoperative management strategies are superior to nonoperative management strategies alone for established knee OA.
Role of Surgery in Spinal Cord Compression Caused by Metastatic Cancer
Authors: Aframian Arash , Sugand Kapil , Hassany Hamid , Mobasheri Reza
Published: June 2024

The standard treatment for spinal cord compression caused by metastatic cancer at the time of publication was corticosteroids and radiotherapy. The role of surgery was not established; therefore, authors assessed the efficacy of direct decompressive surgery in a multicenter nonblinded randomized controlled trial recruiting 101 patients. They found that direct decompressive surgery alongside postoperative radiotherapy was superior to treatment with radiotherapy alone for patients with spinal cord compression caused by metastatic cancer, so much so that the trial was stopped early. Patients in the surgical treatment arm experienced superior outcomes for all primary and secondary endpoints (i.e., ability to walk, continence and functional scores, and survival) vs. patients in the group receiving steroids and radiation therapy alone. This publication has significantly impacted subsequent practice, having been cited over 1700 times in the surgical literature. Major guidelines now recommend surgical decompression for spinal cord compression due to metastatic cancer.
Pruritis
Authors: O'Duffy Rose , Presswood Maggie
Published: June 2024

This case on itch, or pruritus, addresses the multiple causes of itch, the pharmacological and non-pharmacological treatments available, and how to tailor these to treat the most likely underlying cause. It traces the neurobiology of itch, from the initial stimulus of unmyelinated C-fibres by pruritogens like histamine, transmission to the spinal cord, and interpretation by the brain. It compares the similarities between itch and pain, particularly the sensitization aspect of itch and how this contributes to hyperkinesis and allokinesis. It also discusses the differences, i.e. the impulse to scratch. Finally, it suggests options for the management of itch in specific clinical scenarios common to palliative care, including uraemic and cholestatic itch, opioid-induced itch, and itch related to malignancy.
Constipation
Authors: Bradley Anna , Boland Jason
Published: June 2024

Constipation is very common in patients receiving palliative care and is often underdiagnosed. This case covers its definition, pathogenesis, causes, diagnosis, and assessment. It reviews the management of constipation, including non-pharmacological interventions. It explores the rationale for prescribing different laxatives in palliative care, including side effects and the evidence base. Opioid-induced constipation (OIC), the commonest iatrogenic cause of constipation in patients with cancer, with widespread effects on the whole gastrointestinal tract, is reviewed. It is defined and specific management including the role of peripherally acting mu-opioid receptor antagonists (PAMORAs) is covered. This case exemplifies the important points of diagnosing and managing a patient with constipation.
Individualized End of Life Care Plans
Authors: Hicks Stephanie , Bowers Ben
Published: June 2024

‘Individualized End-of-Life Care Plans’ covers how we might diagnose dying to how we can provide personalized care in the last hours to days of life. It outlines the origins of the approach to end-of-life care in adults in the UK, which focuses on the five priorities of care for the dying person, and how these priorities might translate into clinical practice. The case discussed highlights the importance of individualizing symptom control needs, such as anticipatory management of catastrophic haemorrhage, as well as social and spiritual needs. It also discusses clinically assisted hydration (CAH) at the end of life, including its current evidence base and the need for future research into this important and emotive area.
Learning Disabilities
Authors: Richardson Jamie , Potter Valerie
Published: June 2024

People with learning disabilities (LD) often experience poorer health, face barriers to receiving effective care and have higher excess death rates as a result. While clinical care should be the same as for the rest of the population, the patient journey often deviates significantly when people with LD come into contact with health services, and this can include patients reaching the end of their life. In this case, we shall use the example of a challenging case to explore some of the barriers people with LD can face, including communication difficulties and diagnostic overshadowing, before considering approaches to improve end-of-life care which includes communication aids, reasonable adjustments, and advanced care planning.
Delivering Palliative Care to the Patient with Severe Mental Illness
Authors: Hughes Daniel , Bisset Maggie
Published: June 2024

This case describes the journey of Yusuf, a patient with an established diagnosis of paranoid schizophrenia, who collapses whilst an in-patient under section on a psychiatric ward. He is later found to have bowel cancer not suitable for active treatment. After outlining the evidence for the prevalence of palliative care diagnoses in those with a severe mental illness and the associated ‘parity of esteem’, we explore the complexities of delivering effective palliative care to someone with a psychotic illness, including the use of the Mental Health Act and the Mental Capacity Act. We also summarize the psychodynamic principles that may be at play and explore the system-wide complexities often encountered with such cases.
Seizures
Authors: Wells Geoffrey , Neerkin Jane
Published: June 2024

Seizures explores the complex management of seizure activity in the context of terminal illness. It focuses on the case of a patient with a primary brain tumour and describes the immediate and long-term management of seizures in the context of brain tumours with reference to antiepileptic drugs (AEDs) and steroids. This case describes the options for management in hospital, hospice, and community settings. The reader is guided through prescribing challenges that are faced when managing seizures in a deteriorating patient, with particular emphasis on choice of drug and available route of administration. Clinical tips highlight important pharmacological considerations around steroid use, and management of concurrent clinical symptoms such as nausea and terminal agitation. Learning points and expert commentary describe the general causes of seizures, the presenting features of seizures secondary to tumours and their anatomical location and provide prescribing guidance regarding the choice of AEDs and benzodiazepines.
Advance Care Planning
Authors: Osborne Georgina , Wee Bee
Published: June 2024

Advance care planning (ACP) offers people the opportunity to plan their future care and support while they have capacity to do so. This case history explores what ACP can encompass, its challenges and how, when done well, it is a key process for person-centred care. Advance care planning can help the person feel more confident in maintaining some control over future decisions. Those close to them can be more reassured that they are contributing to decisions that are aligned with the person’s preference. Advance statements are not legally binding but healthcare professionals should do their best to honour these in making best interests decisions on behalf of the person who lacks capacity. The legal framework for decision-making in situations where the person lacks capacity is different across countries, and for children as opposed to adults. It is imperative that healthcare professionals understand their local legal framework and take into account the cultural context and other needs of their individual patient and those important to them.
Specific Challenges: Homelessness
Authors: Mortimer Toni , Shulman Caroline
Published: June 2024

In ‘Specific Challenges: Homelessness’, a case is presented of a patient who receives terminal care in a hostel. It describes the multidisciplinary working required to make this possible and how advance care planning may need to be adapted for this population. It also shares examples of joint-working between community services and a hostel and considers the aftercare that should be undertaken. People who are homeless and living in hostels have reduced life expectancy, high rates of multiple long-term conditions, addictions, and increased frailty. Despite their high need they often have poor access to adequate health and social care, including palliative care. Hostel staff are often left to support people with extremely complex needs, including people who may be approaching end of life. However, they are usually not set up or equipped to do this.
Transition from Children’s to Adult Palliative Care
Authors: Gupta Gurpreet , Elverson Jo
Published: June 2024

Transition from Children’s to Adult Palliative Care highlights key challenges for adult clinicians supporting young people with life-limiting conditions. It explores issues relating not only to transition itself, but also around providing developmentally appropriate care in the context of palliative and end-of-life care. The case covers the role of an adolescent psychosocial assessment, evolving understanding of appropriate parental involvement, and the legal and practical aspects of communication, decision-making, and advance care planning for young adults with complex conditions. The importance of cross-specialty and interagency collaboration is emphasized. Symptom management and assessment of distress are considered in the context of providing holistic end-of-life care for young people who may have a learning disability or communication difficulty. Finally, the case considers the impact of the young person’s illness and death on their family, peers, and carers, including the healthcare professionals involved in supporting them. 145 words
Autonomy in Children
Authors: Rooney Marie Claire , Laddie Joanna
Published: June 2024

This case illustrates how autonomy in children in the context of palliative care is a complex issue, which encompasses many ethical, moral, and legal considerations. What defines ‘childhood’ is open to debate. Consideration of the child’s welfare is at the heart of treatment decisions. This should be considered in the context of the child or young person’s competence to consent (often known as Gillick competency) and the viewpoints of those with parental responsibility. Where there is a discrepancy in what constitutes the optimal welfare of the child or young person, challenges arise and can involve complex decision-making, as illustrated by this case.