bluuebunny/crossref_metadata_2025 huggingface dataset:
Simultaneous CardioFlow Optimization to facilitate hemodynamic recovery after rapid ventricular pacing during transcatheter aortic valve implantation – a Case Report
Authors: Jubeh Rami , Asher Elad , Dvir Danny , Glikson Michael , Bruoha Sharon
Published: February 2025

Background

“simultaneous CardioFlow optimization” represents an innovative technique that effectively enhances post pacing hemodynamic recovery during transcatheter aortic valve replacement (TAVR). This technique was applied in two high-risk patients presenting with severe left main trunk stenosis with concomitant severe aortic stenosis and left ventricular dysfunction.

Case summary

an 86-year-old and a 96-year-old patient were admitted with myocardial infarction. Angiography revealed severe left main trunk stenosis, while echocardiography demonstrated significant left ventricular dysfunction and severe aortic stenosis. Both cases were evaluated by the institutional multidisciplinary heart team. Considering the high surgical risk, a percutaneous management strategy was contemplated.

Discussion

We postulated that performing left main truck balloon angioplasty during rapid ventricular pacing would be better tolerated, compared to conventional balloon angioplasty, given the low coronary perfusion pressure at this stage. Additionally, coronary balloon angioplasty is expected to enhance coronary flow in the immediate post-pacing period, thus facilitating hemodynamic recovery. Both patients exhibited prompt improvement in hemodynamics following rapid ventricular pacing and had uncomplicated hospital stays. In patients with significant left main trunk stenosis accompanied by severe aortic stenosis and concomitant left ventricular dysfunction, “simultaneous CardioFlow optimisation” facilitates post pacing hemodynamic recovery.
Visit-to-visit Lipid Variability, Coronary Artery Calcification, Inflammation, and Mortality in the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Chan Jeffrey Shi Kai , Satti Danish Iltaf , Chan Raymond Ngai Chiu , Chevli Parag , Mehta Adhya , Martin Seth S , Sharma Garima , Tse Gary , Virani Salim S , Shapiro Michael D
Published: February 2025

Aims

This study aimed to explore relationships between visit-to-visit lipid variability, coronary artery calcification (CAC), inflammation, and long-term mortality, which may be prognostically relevant.

Methods

This prospective cohort study included participants from the Multi-Ethnic Study of Atherosclerosis with available plasma low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides from all three initial exams who underwent computed tomography CAC quantification at the third (index) exam. Visit-to-visit variability (coefficient of variation) was calculated from all three initial exams. Outcomes included the index Agatston score, cardiovascular mortality, all-cause mortality, and high-sensitivity C-reactive protein (hsCRP).

Results

Altogether, 1515 participants were analysed. Higher HDL-C variability was associated with higher index Agatston score (quartile 4 [Q4; vs Q1] adjusted marginal effects 0.25 [0.02-0.48]), but not LDL-C, TC, and triglycerides variability. Over a 15.1-year median follow-up, higher HDL-C (Q4 vs Q1: adjusted sub-hazard ratio 2.68 [1.61-4.48]) and TC (Q4 vs Q1: adjusted sub-hazard ratio 2.13 [1.17-3.89]) variability, but not LDL-C and triglycerides variability, were associated with higher risk of cardiovascular mortality, which remained significant after adjusting for the index Agatston score. Additionally, higher HDL-C variability was associated with higher risk of all-cause mortality (Q4 vs Q1: adjusted hazard ratio 1.46 [1.00-2.11]), but LDL-C, TC, and triglycerides variability were not. HDL-C (Q4 vs Q1: adjusted β: 0.132 [0.034-0.230]) and TC (Q4 vs Q1: adjusted β: 0.210 [0.064-0.357]) variability, but not LDL-C and triglycerides variability, may be correlated with hsCRP.

Conclusions

Elevated HDL-C variability was associated with greater CAC burden and long-term risks of cardiovascular and all-cause mortality. These mortality-related associations were probably not completely explainable by atherosclerosis.
Regional networks in revolt: opposition to the Valois in Gascony at the end of the Hundred Years’ War, c.1452–1453
Authors: Green Andrew D M
Published: February 2025

This article offers a reassessment of late medieval resistance to the Valois monarchy, through examining south-western France in the mid-fifteenth century as a case study. Whereas modern scholarship has often foregrounded Valois success and treated Gascony as sliding inexorably into the maw of the French state, it is shown here that a deep-rooted revolt against King Charles VII occurred in the south-west in 1452–53, in conjunction with Gascon exiles and the English. Influential and durable networks under the leadership of regional nobles were fundamental throughout the movement, and these entities remained a potent force even after it was defeated. Overall, this is indicative of how backing for, and cooperation with, the English in France around the end of the Hundred Years’ War has traditionally been underestimated, and of how noble-led networks retained the ability to underpin and inspire resistance to the French monarchy.
Risk-stratified hepatocellular carcinoma surveillance in non-cirrhotic patients with MASLD
Authors: Mi Ke , Ye Tingdan , Zhu Lin , Pan Calvin Q
Published: February 2025

Metabolic dysfunction-associated steatotic liver disease (MASLD) is rapidly emerging as the leading global liver disorder and is poised to become the primary cause of hepatocellular carcinoma (HCC). Research indicates that nearly 50% of HCC cases in MASLD patients occur without cirrhosis, often presenting with more advanced and larger tumors. Despite this, current guidelines primarily focus on HCC screening in cirrhotic patients, with limited guidance for non-cirrhotic MASLD individuals. This narrative review seeks to identify key risk factors for HCC development, consolidate available screening methods, and propose a practical, risk-stratified algorithm for HCC surveillance in non-cirrhotic MASLD patients. We conducted a comprehensive review of studies published between 2017 and 2023 using PubMed, Embase, and CNKI, focusing on HCC risk factors and emerging screening strategies for non-cirrhotic MASLD cohorts. Key risk factors for HCC development in these patients include male sex, age over 65, hypertension, diabetes, mild alcohol consumption, smoking, dyslipidemia, elevated alanine aminotransferase levels, and a platelet count ≤ 150 × 109/L. Among the screening methods evaluated, circulating free DNA, alpha-fetoprotein (AFP) combined with protein induced by vitamin K absence or antagonist-II (PIVKA-II), and the GALAD score (incorporating Glypican-3, AFP, alpha-1-Antitrypsin, and des-gamma-carboxy prothrombin) demonstrated the highest performance. Based on these findings, we proposed a risk-stratified HCC surveillance algorithm that integrates GALAD and PIVKA-II into the existing sonography and AFP screening protocols. This review aims to provide clinicians with actionable recommendations for HCC screening in non-cirrhotic MASLD patients.
Intergenerational Coresidence with Children and Grandchildren and Maternal Sleep Duration at Mid-life
Authors: Cao Rui , Reczek Rin , Thomeer Mieke Beth
Published: February 2025

Objectives

Mothers with young children tend to have shorter sleep durations than childfree women, but previous research has not considered heterogeneity in sleep duration among mid-life mothers who have varying coresidential patterns with their adult, minor, and grandchildren. We examine distribution of sleep duration across mothers’ different intergenerational coresidential contexts (living without any children, living with any minor children, living with only adult children, and living with any grandchildren) and test how these patterns differ across racial/ethnic groups.

Methods

Regression analyses estimate sleep duration among a sample of mid-life mothers with minor and adult children and grandchildren from the National Longitudinal Survey of Youth 1979 (NLSY79) data (N=3,300). Moderation analyses consider differences across racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic).

Results

Relative to the mothers with no coresiding children or grandchildren, mothers with coresiding minor or adult children reported less sleep. However, this gap varies across racial/ethnic groups; specifically, the lower sleep duration for mothers with coresidential children is only significant for White and Black mothers, not Hispanic mothers.

Discussion

Sleep is a critical health indicator across the life course and a contributor to other health outcomes later in life. Thus, it is important to identify whose sleep is most vulnerable—especially in mid-life when sleep trajectories are the groundwork for later-life well-being. We demonstrate the importance of coresidential status with adult and minor children and grandchildren on the sleep of mothers in mid-life, drawing specific attention to the differences across racial/ethnic groups.
The sustainability of hospital accreditation models: A cross-sectional study
Authors: Hussein Mohammed
Published: February 2025

Background

Despite the importance of hospital accreditation, its sustainability is jeopardised. This is due to the disparity between the rapid changes in the health sector and the accreditation standards that remain unchanged. This study aims to examine what improvements are important in enhancing the sustainability of the hospital accreditation model in Saudi Arabia.

Methods

All quality managers in accredited Saudi Arabian hospitals were invited to participate in a cross-sectional questionnaire-based study in July-August 2022. A structured questionnaire was developed, tested, piloted, and factorially validated using exploratory factor analysis. On a 5-point Likert scale, respondents were asked to rate the importance of recommended changes that are proposed to enhance the sustainability of accreditation policies, standards development, evaluation methods, and the evaluation team. The importance of the recommendations, according to the respondents, was described using the relative importance index, while multivariate linear regression was used to analyse the association with independent variables.

Results

A total of 158 valid questionnaires (64% response rate) were included in the analysis. On average, participants had 6.9 (SD 2.1) years of experience in quality management. The overall mean importance attached to improving standards development, accreditation policies, evaluation team, and evaluation methods were 3.55, 3.43, 3.41, and 3.21, on a 5-point scale, respectively. Shifting the focus of accreditation standards from structure and compliance to outcomes and improvement (mean importance=4.47), updating standards periodically to reflect current best practices and research (mean importance=4.41), and integrating consumer perspectives in all aspects of accreditation (mean importance=4.37) were the most important perceived recommendations. Multivariate regression analysis yielded that managers with more years of experience had significantly higher mean scores on the importance of improving accreditation policies (β=0.120, P =0.037), standards development (β=0.246, P <0.001), evaluation methods (β=0.268, P <0.001), and the evaluation team (β=0.369, P <0.001).

Conclusions

Improving accreditation policies, standards development, evaluation methods, and the evaluation team are important in enhancing the sustainability of hospital accreditation programmes. This study offers insights to assist policymakers and other stakeholders in redesigning traditional accreditation models to make them more sustainable and that can supplement other performance improvement tools in improving the quality of healthcare services.
An empirical study of using radiology reports and images to improve intensive care unit mortality prediction
Authors: Lin Mingquan , Wang Song , Ding Ying , Zhao Lihui , Wang Fei , Peng Yifan
Published: February 2025

Objectives

The predictive intensive care unit (ICU) scoring system is crucial for predicting patient outcomes, particularly mortality. Traditional scoring systems rely mainly on structured clinical data from electronic health records, which can overlook important clinical information in narratives and images.

Materials and Methods

In this work, we build a deep learning-based survival prediction model that utilizes multimodality data for ICU mortality prediction. Four sets of features are investigated: (1) physiological measurements of Simplified Acute Physiology Score (SAPS) II, (2) common thorax diseases predefined by radiologists, (3) bidirectional encoder representations from transformers-based text representations, and (4) chest X-ray image features. The model was evaluated using the Medical Information Mart for Intensive Care IV dataset.

Results

Our model achieves an average C-index of 0.7829 (95% CI, 0.7620-0.8038), surpassing the baseline using only SAPS-II features, which had a C-index of 0.7470 (95% CI: 0.7263-0.7676). Ablation studies further demonstrate the contributions of incorporating predefined labels (2.00% improvement), text features (2.44% improvement), and image features (2.82% improvement).

Discussion and Conclusion

The deep learning model demonstrated superior performance to traditional machine learning methods under the same feature fusion setting for ICU mortality prediction. This study highlights the potential of integrating multimodal data into deep learning models to enhance the accuracy of ICU mortality prediction.
Lost Japan: Focusing on the Problems of Globalism and Nationalism in Moral Education
Authors: Sakuma Hiroyuki
Published: February 2025

This paper analyses, both historically and systematically, the underlying causes of specific characteristics of globalism and nationalism in Japan focusing on an ideological moral education that lies at the heart of the problems of Japanese education. The analysis highlights two issues. (1) There is no real globalism in modern Japan. Certainly, the globalization of industry, government, and academia is now loudly proclaimed in Japan. However, in the name of globalization, English education is overemphasized. (2) There is no real nationalism in modern Japan. Japan once had a nationalism centred on the emperor system from the Meiji era. However, after World War II, the emperor system in Japan was dismantled and a democratic Japanese Constitution was enacted under the influence of the Allied Powers. Furthermore, in the Basic Act on Education, the theory of ‘the perfection of personality’ based on Kant’s philosophy was transplanted. Education in post-war Japan developed based on a democratic constitution and the Basic Act on Education, which states that the purpose of education is ‘the perfection of personality’. This means that education has a strong moral flavour. Particularly at the stage of compulsory education in Japan, which is the foundation of national education, moral education is addressed through all educational activities at school. Therefore, the issues of globalism and nationalism in moral education, which this article deals with, belong directly to core problems of Japanese education.
Jack of all trades: Crosstalk between FERONIA signaling and hormone pathways
Authors: Tang Jie , Guo Hongqing
Published: February 2025

The receptor kinase FERONIA (FER) is a multifaceted regulator of plant growth, development, reproduction and stress responses. FER is functionally connected to many plant hormones in diverse biological processes. This review summarizes the current understanding of the interplay between FER and phytohormones, with a focus on abscisic acid, ethylene, jasmonic acid, auxin and brassinosteroid. The mutual regulation between FER and plant hormones happens at multiple levels including ligands, receptors and downstream signaling components. Plant hormones can regulate the expression of genes encoding FER and its ligands RAPID ALKALINIZATION FACTORs (RALFs) as well as the abundance and kinase activity of FER proteins. On the other hand, FER can regulate hormone biosynthesis, transport, hormone perception and downstream signaling components such as transcription factors. Evidence of the crosstalk between FER and phytohormones are also emerging in crop species. Despite the rapid progress made in this field, more mechanistic studies are still needed to gain a comprehensive understanding of the FER-phytohormone crosstalk. Future research prospects and potential approaches are also discussed in this review.
The Rise and Fall of Hardbass Flash Mobs in the European Far Right
Authors: Teitelbaum Benjamin R.
Published: February 2025

This chapter explores the rise of a musical flash mob genre among European radical nationalists called “hardbass.” Though regional varieties proliferate, hardbass belongs to a broader campaign among white nationalist groups globally to rebrand their cause through expressive culture as one of antiestablishment protest. Based on reviews of online social media, personal interviews, and other ethnographic data conducted among activists in Scandinavia, this chapter shows how nationalists use hardbass and its seizure of physical and sonic space to frame themselves as dissidents operating in defiance of an oppressive mainstream. Contextualizing this practice alongside contemporaneous reforms to white nationalist music making—the introduction of rap and reggae in particular—the chapter argues that the far right’s musical imagination of itself as victimized is poised to transform yet again as populist nationalist movements gain influence throughout the West.
Who Can Stop the Drums? Fiestas as Sites of Popular Organization in Venezuela
Authors: Fernandes Sujatha
Published: February 2025

Popular fiestas in Latin American cities have been important vehicles in contemporary imaginings of urban space and cultural identity, particularly given new geographies of racial inequality and exclusion. This chapter explores the popular fiestas celebrated in barrios in Caracas, Venezuela, as new sites for popular organizing. Following decades of social dislocation, growing crime, and the militarization of the shantytowns, residents used cultural forms as a means of taking back public spaces from the private sector and the police. After the election of leftist and mixed-race president Hugo Chávez in 1998, the barrio residents who supported him were vilified by the opposition and the media. In the religious celebrations of Cruz de Mayo and San Juan, fiesta organizers created alternative repertoires of representation, positioning themselves against middle-class civil society. This chapter examines the shifting meanings of the fiestas in a Chávez era as a form of social protest.
Iron Smithing among the Lohars of Central Peninsular India: An Ethnoarchaeological Perspective
Authors: Roy Oishi
Published: February 2025

This chapter deals with the indigenous iron smiths (Lohar) residing in the region of Vidarbha, Maharashtra. The methodology adopted for this study is an ethnographic survey wherein questions revolving around working methods, beliefs, customs, and rituals have been probed. This ethnoarchaeological exercise helps us to draw probable analogies for the ancient iron smithing techniques prevalent during the Early Iron Age and practiced by the Early Iron Age Megalithic community residing in the region of Vidarbha, Maharashtra. The chapter details how iron smiths in this community produce tools such as the adze, the ax, and the nail parer. It also describes the iron smithing workshop and forging techniques adopted by the present day Lohar community. We do find artefactual evidence from archaeological context pointing towards iron smelting and iron smithery activity; however, we find difficulties in interpreting these finds. The chapter gives us an insight to the importance of ethnographic and experimental studies in interpreting the archaeological finds and postulate probable technological know-how and the cognition abilities of the Early Iron Age community.
Psycholinguistic Studies in Dravidian Languages
Authors: Narasimhan Bhuvana , Kurian Matthew Annu
Published: February 2025

The field of psycholinguistics aims to discover the psychological mechanisms that enable people to acquire, comprehend, and produce any human language. Speakers of different languages face different acquisition and processing challenges because languages can vary considerably in their vocabulary, meanings, sound and grammatical structures, and patterns of language use. Therefore, psycholinguistic theory must be founded on empirical research investigating typologically and genetically diverse languages. The chapter provides a survey of language acquisition and processing research conducted in Dravidian languages with the aim of highlighting the range of research that has been conducted in these languages and indicating possible lines of future inquiry.
Havana’s Living Dead
Authors: Hester Jennessa
Published: February 2025

Alejandro Brugués’s Juan of the Dead (2011) is often considered the origin point of Cuban horror film. This chapter challenges this myth, arguing instead that while horror movies existed in Cuba before the 2000s, they were omitted from the generic canon by white imperializing forces. This process, termed curatorial colonization, resulted in the erasure of Afro-Cuban subjection as constitutive of actual terror, rendering invisible a Black horror tradition within the nation. Through a re-curation of one such colonized film, Tomás Gutiérrez Alea’s The Last Supper (1976), this chapter details how the horror genre and its fans have unassumingly swept away narratives of Black marginalization and terror. To re-curate Cuban cinema so that it includes Black terror is to proclaim to the world that it is not just those fictional zombies that matter, but also the corpses of atrocity and enslavement.
“Time … Never Stops”
Authors: Burton Rachal , Cooper Ayanni C. H.
Published: February 2025

When the trailer for Jordan Peele’s Us (2019) was released in late 2018, viewers were struck by its inclusion of the creepy remix of hip-hop classic “I Got 5 On It” (1995). The trailer demonstrates the power of music—especially African diasporic music—in building suspense in Black horror media. Lovecraft Country (2020) similarly deploys elements of the Black diasporic soundscape to chilling and powerful effect. Part of what makes the show incredibly special is how the creative team disrupts narrative temporalities by relishing in both seamless and jagged “sonic anachronisms.” Using the show’s soundtrack Lovecraft Country acoustically integrates different time periods in Black history and mixes genres, blending minstrel songs from the late 1840s and current hip-hop music, along with speeches and spoken-word performances. These key samples occur alongside images of “pop-locking pickaninnies,” Chicago in the summertime, and racially segregated Midwestern towns. In this way, Lovecraft Country unites sound and horror to highlight the pervasiveness of anti-Blackness globally.
(Re)Summoning Candyman for a “Post-Racial” Era
Authors: Craig Byron B , Rahko Stephen E.
Published: February 2025

Since its release in 1992, the Candyman franchise has polarized scholars and critics. Many have persuasively argued that Bernard Rose’s original film celebrates white womanhood while advancing racist tropes and narratives of abject Black masculinity and miscegenation. In contrast, others have defended the film, arguing that Candyman is a complex figure. This chapter responds to scholarly commentary about the Candyman horror franchise by focusing on Nia DaCosta and Jordan Peele’s 2021 adaptation, which is set in present-day Chicago. Drawing on horror scholarship that traces the relationship between the genre’s rhetorical conventions and cultural trauma, theorists of Afro-pessimism, and postmodern theories of adaptation, this chapter is an original Afro-pessimistic interpretation of Candyman. We understand DaCosta and Peele’s adaptation as a response to current post-racial ideologies that allegorically critiques the legacy of slavery and race trauma. DaCosta and Peele advance an “allegorical adaptation” of Candyman that can be read as Afro-pessimistic.
The Allegory of the Tickle Monster
Authors: Adams Tessa
Published: February 2025

In 2016, Black British director Remi Weekes made the short horror film Tickle Monster, in which aspiring Grime rap artist Elliot discovers that his girlfriend’s room is haunted by the tickle monster. While only four minutes and fifteen seconds long, Tickle Monster offers a strong critique of race and is a companion to Weekes’s more well-known film His House (2020). Taxonomies of race are presented through the lens of critical race theory. This theory has roots in U.S. critical legal studies and is relatively new to U.K. discourses. This chapter argues that both are responses to oppression, microaggressions, and post-racialism. Further, this chapter argues that Monster and House are responses to how Blackness has been historically constructed and erased from the United Kingdom’s culture. These films are reminders to audiences that while racism may not always present itself as overt, it is a constant that is covert and overt in its attacks. This chapter argues that Weekes’s films encourage audiences to “stay woke.”
Zombie Roar
Authors: Shank Dominique
Published: February 2025

Zombies are a staple of contemporary horror and have been remarkably adaptable mass-cultural monsters. For well over a century, they have metaphorized any number of societal anxieties. However, as historian Amy Wilentz reminds us, the zombie originated in “old African religious beliefs and the pain of slavery.” Those transatlantic roots are on bruising display in Mati Diop’s Atlantique (2019) and Bertrand Bonello’s Zombi Child (2019). This chapter explores how Atlantique and Child resist deployments of sensational horror film conventions. Both films attempt to recast the zombie as an interlocutor that can communicate the grievances of the dead to the living. In this way, the zombies are beings possessed by a race, class, and gender consciousness with subversive anticolonial potential. Perhaps most tellingly, both films cast the zombie as brutally ordinary. These zombies are doubly horrifying, because they resemble the millions of workers whose labor capitalists exploit.
Historical Legends of the Buddha in the Region of Bongabhumi
Authors: Chowdhury Sanjoy Barua
Published: February 2025

In the region of Bongabhumi, Buddhism has an extensive tradition of elegance, history, and heritage from over 2,600 years ago. This chapter centers on the Buddha’s footprint in the soil of ancient Bongabhumi, revealing a connection between the Buddha and the people of ancient Bengal from its inception. Additionally, it focuses on two historical Buddhist pilgrimage sites: Chakrashala Phratara Cetiya and Ramu Rangkut Banasram Bouddho Bihar of Bangladesh. To clarify the historical legend of Buddhism in the region of Bongabhumi, this chapter also discusses Buddhist transmissions in the Bengal Delta up to the modern period, as well as illustrates how Buddhist communities and their contemporary practices express lived Buddhism in Bongabhumi.
Mary Magdalene in Africa
Authors: Okure Teresa
Published: February 2025

Mary Magdalene is a little-known figure among contemporary African Christians, aside from their encounter with her story in the gospels. As a result, there are few scholarly works on the ways in which African scholars interpret her role in Christian theology. The available works largely reject the negative depictions of Mary Magdalene as a prostitute, instead focusing on her as a faithful disciple of Jesus and the designated bearer of his resurrection message. They use her as a model and inspiration for women in the modern African contexts. In many ways, their interpretation rejects the overall neocolonial conception of Africa and African Christianity. This review of Mary Magdalene in Africa also calls for just actions to be taken with respect to both Mary Magdalene and Africa.
Understanding NATO
Authors: Sperling James , Webber Mark
Published: February 2025

NATO has shaped the governance of transatlantic security since 1949. Since the 1990s, NATO has helped redefine the meaning of liberal interventionism, orchestrated the longest-running counterterrorism and counter-insurgency operation in modern times, and has resurrected territorial defence in Europe. NATO has also been implicated in watershed moments of recent global history—from the end of the Cold War through to 9/11 (when the Alliance’s mutual defence clause was first invoked), and the Russia–Ukraine war. NATO is assessed along four dimensions: its uniqueness as a military alliance; its enduring character and ability to adapt to a changing security environment; its determining role in the national security calculations of the allies; and its ability to withstand controversies both among the allies themselves and with those states who sit outside NATO’s membership.
Gender
Authors: Wright Katharine A. M.
Published: February 2025

The Women, Peace, and Security (WPS) agenda has been formally integrated into NATO’s mission. The 2022 Strategic Concept describes WPS as informing all of the Alliance’s core tasks. What can a gender perspective add to our understanding of the Alliance? In this light, this chapter’s first step is to address the question ‘where are the women at NATO?’ so as to expose the gender politics and hierarchies that underpin NATO as an institution. Its second step is to trace the origins of NATO’s engagement with the WPS agenda. A concern with the status of women in national armed forces dates back to the Alliance’s origins. The chapter then interrogates why feminist theorizing of NATO has remained in its infancy before looking at more recent feminist conceptualizations of the Alliance. The conclusion argues that gender and feminist approaches provide an important contribution to understanding the Alliance and its place in global power structures.
Strategy
Authors: Freedman Lawrence , Michaels Jeffrey H.
Published: February 2025

The evolution of NATO’s formal strategies, embodied principally in successive Strategic Concepts, is a window on NATO’s role in transatlantic security. This chapter covers the internal debates about the direction of the Alliance and the difficulties of achieving consensus on NATO strategy. It also highlights the different functions that Alliance strategy documents serve. The chapter examines NATO during the Cold War, and specifically how Alliance strategy accommodated nuclear and conventional forces to deter attack. It then moves to the post-Cold War period and examines the Alliance’s transformation from a collective defensive posture to one geared toward out-of-area operations in the Balkans, Afghanistan, and Libya. The chapter then addresses NATO’s post-2014 efforts to balance its out-of-area commitments with the task of reassuring the allies on the eastern flank—both within the context of deterring a resurgent Russia and tackling the challenge of a rising China.
Doctrine
Authors: Deni John R.
Published: February 2025

Why does NATO doctrine appear as a lagging indicator of the changing character of conflict? During the Cold War, the post-Cold War period, and the period after Russia’s 2014 invasion of Ukraine, the Alliance has routinely promulgated doctrine well after it has begun conducting operations that would have fallen under the retrospective doctrine’s guidance. For instance, allied doctrine on peace support operations was first released in 2001, several years after NATO had begun its peace support and stabilization mission in Bosnia. This chapter unpacks the reasons why allied doctrine seems so often behind the curve. In doing so, it examines the evolution of NATO doctrine over the last several decades, from the early Cold War years through to the present day. It first identifies how NATO defines doctrine, who develops it, and how that doctrine is developed. A brief concluding section looks at the challenges of building a collective military doctrine in an alliance of equally sovereign members (something which has only become more difficult as NATO membership has expanded).
Nuclear Deterrence
Authors: Yost David S.
Published: February 2025

This chapter considers the history of NATO nuclear deterrence and related issues of decision-making, arms control, and risk- and responsibility-sharing. The chapter takes note of the origins of US nuclear commitments to NATO Europe, nuclear-sharing arrangements, the development of British and French nuclear forces, and the role of American strategic nuclear forces. The complex challenges of addressing deterrence as well as arms control objectives are illustrated by the efforts of the allies since the late 1970s to grapple with what became known as long-range theatre nuclear forces (LRTNF) and intermediate-range nuclear forces (INF). More recent strategic challenges are evident in how NATO has adapted its deterrence posture to account for the adversarial relationship with Russia. Politically, the allies have had to grapple with issues raised by the Treaty on the Prohibition of Nuclear Weapons.
Covid-19, Crisis Management, and Civil Emergency Response
Authors: Baciu Cornelia
Published: February 2025

The connection between health and security has attracted considerable scholarly attention in recent years. The health–security nexus raises a two-part question: do health-related matters pose threats to security and, if so, what is the role of security and defence organizations in countering them? Its response to COVID-19 is an example of the Alliance’s crisis management approach. NATO has performed both crisis and civil response functions since the 1950s. This chapter first examines the link between crisis management and national security. It then considers the NATO legal framework and crisis management infrastructure. Third, it unpacks historical examples of NATO civil emergency response, before moving to a case study of NATO’s response to the COVID-19 pandemic. It concludes with a critical reflection on NATO’s role during pandemics and on its wider commitment to emergency response.
Domestic Politics
Authors: Hofmann Stephanie C. , Williams Michael John
Published: February 2025

Domestic politics matters in foreign, security, and defence policies, and helps explain national orientations towards NATO. This chapter looks first at domestic actors and processes. Actors and processes are usually studied separately under the rubric of ‘organizational’ and ‘party politics’ approaches. These two approaches can be applied to both big and small allies in order to understand their preferences and behaviour within NATO. The chapter then turns to the different institutional constraints that can moderate both bureaucratic and party actors’ preferences at different times during the multilateral policy-making process. This demonstrates how organizational and party politics approaches can be fruitfully combined. We then show how NATO affects the politics of its members. Through the lens of domestic politics, we can highlight whether and how NATO has become more politicized domestically. Debates over populism and democracy illustrate the relationship between NATO and its members’ domestic politics. The chapter concludes with a discussion of new avenues for research.
Italy
Authors: Ratti Luca
Published: February 2025

For over seventy years, Italy has been one of NATO’s staunchest allies, actively contributing to allied policy and operations within and outside of Europe. Initially seen as a liability, Italy slowly turned into an indispensable asset on the Alliance’s southern flank. Italy’s support of NATO reflects first and foremost the strong bilateral bond with the United States. Persisting economic and social difficulties, the fear of being marginalized by France and Germany (particularly after the United Kingdom’s withdrawal from the European Union), the growing assertiveness of other regional and global powers in areas geographically and historically close to Italy, as well as the impact of Russia’s invasion of Ukraine on European and Mediterranean security have kept the Alliance at the centre of Italian national security policy.
Australia
Authors: Schreer Ben
Published: February 2025

Australia has long been a key Asia-Pacific partner for NATO in a relationship supported by a congruence of values and overlapping interests. Australia played a significant role in NATO’s mission in Afghanistan and has stood alongside the NATO allies in supporting Ukraine’s resistance to Russian occupation. A shared concern with China provides a long-term impetus to NATO–Australia ties. Against this background, this chapter develops a conceptual lens with which to assess NATO–Australia relations. It then traces the historical evolution of the relationship since the Cold War and concludes that despite shared values and interests obstacles remain to realizing the relationship’s full potential. Much will depend on NATO’s willingness to assume a security role in the Asia–Pacific.
The Mesolithic
Authors: Warren Graeme
Published: February 2025

This chapter asks two simple questions: what the Mesolithic is and why it matters. Answering the first question requires a review of the history of the definition of the Mesolithic including an emphasis on alternative ways of approaching the periodization of human activity. The second question asks what value knowledge about the Mesolithic brings and what might be distinctive about the period. Beyond increasing our understanding of particular regional sequences, is there something that the study of the Mesolithic might contribute to broader understandings of human variation? Both questions require reflection on the ever-expanding academic industry that is the Mesolithic. The chapter concludes by affirming the potential for a reflexive, creative Mesolithic archaeology that can celebrate different forms of human life.
Continental European Plain
Authors: Grużdź Witold , Groß Daniel , Pyżewicz Katarzyna , Vashanau Aliaksandr
Published: February 2025

This chapter focuses on presenting changes in the material culture from the ninth–fourth millennia bc, in the Northern and Eastern European Plains territory. Most of the data is based on literature and our own analyses carried out on selected C14 dated sites. We focus on the diversity in the lithic materials and the technology of blade production. The tool typology and lithic technology are characterized within the archaeological cultures Komornica, Butovo/Kunda, Kudlaevka, Chojnice-Pieńki, and Janisławice. This nomenclature is still used in the literature, but the perception of the cultures has shifted from perceiving them as societies to treating them as basic terminology to describe the most common groups of Mesolithic materials.
Sea
Authors: Bjerck Hein B.
Published: February 2025

This chapter gives a regional and temporal overview of the Mesolithic archaeological record, and demonstrates a wide range of styles of marine foraging and seafaring along the European shores. Marine resources are varied and stable, encompass wide-ranging nutritional values and raw materials, and were beyond depletion by the Mesolithic pre-industrial means of harvesting. Also, seafaring increased mobility range, reach, and speed, and also the capacity to carry people, equipment, and produce far and wide by a variety of vessels. The Mesolithic seas were as affluent as they were risky to exploit. Humans at sea are always ‘cyborgs’—depending on material devices that now are integrated in the Mesolithic archaeological record, and may be analysed by the discipline’s scientific methods. This leaves us with an optimistic starting point for addressing ‘Sea’ in Mesolithic Europe. However, a very large part of the Mesolithic coastal areas was flooded by the 130 m postglacial sea-level rise, and hence little explored.
Mountains and High Altitudes
Authors: Visentin Davide
Published: February 2025

Mountains and highland territories represented a significant ecological resource for the last European hunter-gatherers. This chapter discusses the current definition of a mountain and how this seasonal resource was exploited by Mesolithic groups. It makes particular reference to the rich evidence coming from the Alps, the main European mountain ridge. Nonetheless, the variability connected to the exploitation of the principal European mountain sectors is taken into account as much as possible. The main topics addressed are: (a) the role of mountain regions within the general settlement systems of the Mesolithic groups; (b) the possible reasons that led to the intense occupation of the uplands and in general of the ecotone zones found in mountain areas; (c) the local mobility within mountainous landscapes; and (d) the toolkits/materials that were brought along while settling these territories.
Time Matters
Authors: Schulting Rick J. , Meiklejohn Christopher
Published: February 2025

A robust chronology is essential for providing a framework within which various technological and social aspects of Mesolithic societies can be investigated. It is also crucial in the search for potential consequences of environmental change on human societies over the millennia that constitute the European Mesolithic. This chapter reviews developments in radiocarbon dating and their impact on our ability to construct increasingly high-resolution chronologies. Some challenges are also highlighted, most notably the imprecision created by marine and freshwater reservoir effects. A series of kernel density estimation (KDE) plots on dated human remains from various western European countries are presented and discussed. While the search for finer-scale chronologies is important, it is argued that this needs to be complemented by a consideration of long-term processes acting well beyond the range of individual human lifetimes. Time operates on different scales that are relevant for different kinds of questions.
Demography, Life Histories, and Population Dynamics
Authors: Stutz Aaron Jonas
Published: February 2025

Palaeodemography is the study of past population systems and population dynamics. This topic is central for understanding Mesolithic hunter-gatherer-fishers at multiple scales, from lived experience to long-term change in coupled human–environment systems. Multiple methods are increasingly used to study the palaeodemography of Mesolithic hunter-gatherer-fisher populations in Europe. Analysis of large calibrated-radiocarbon-date datasets is now often combined with palaeogenomic analyses of DNA-fragments recovered from Mesolithic human remains. These data complement model-driven bioarchaeological analyses of life history patterns in skeletal samples of Mesolithic people interred in cemeteries and other mortuary features. Recent research reveals that migration and admixture between Mesolithic forager- and Neolithic farming communities were geographically variable but tended to be asymmetric, favouring net forager geneflow into farming groups. Mesolithic populations constituted resilient cultural and demographic systems that persisted over thousands of years. Yet, Neolithic farming populations—exhibiting evidence for higher fertility, higher mortality, and higher residential population densities—were part of biocultural systems that were often dependent on more ecologically disruptive, intense levels of energy and resource extraction.
Coexistence with Neolithic Neighbours
Authors: Diniz Mariana
Published: February 2025

Mesolithic–Neolithic transition is one of the most debated topics in Prehistoric archaeology. This cultural turnover represents a major and irreversible shift in the human trajectory. In Europe, this transition from the hunter-gatherer to the agro-pastoral way of life is rooted in Near Eastern domesticated plants and animals. Wheat, barley, cattle, sheep/goat, pig, pottery, polished stone tools technologies, along with new ontologies over humans, societies, and landscapes, will appear during the Middle Holocene, in different European areas and in an eastern/western and southern/northern chronological gradient. After the seventh millennium bc in the Aegean, and the fourth millennium bc in southern Scandinavia and the British Islands, a Neolithic Europe arose. Previously, Mesolithic hunter-gatherers occupied this vast landscape marked by a strong geological, environmental, and cultural diversity where Atlantic coastal areas, but also some large riverbanks, were selected as privileged settlement areas. Scattered in small groups across vast territories, Mesolithic hunter-gatherers will, at some point, face expansionist—from a geographic and demographic perspective—Neolithic agro-pastoral groups. The social processes underlying those encounters encompass migration, resistance, and acculturation, creating a complex scenario where regional tendencies can be found along with specific cultural choices. Physical violence is absent, or extremely rare. And although subtle, the Mesolithic legacy can be found in Neolithic Europe in the form of lithic technologies, artefacts typologies, and human genes.
The Plant Food Diet of Mesolithic Northwestern Europe
Authors: Kubiak-Martens Lucy
Published: February 2025

In this chapter, we contribute to the discussion about importance of plant gathering in Mesolithic Europe by presenting archaeobotanical evidence recovered in the last few decades from archaeological sites in northwestern Europe. The recovery and identification of plant food remains from early archaeological sites can be challenging. However, novel archaeobotanical techniques and the increasing interest of archaeologists to include archaeobotany within their research strategies have considerable implications for how we view the plant component in the diet of Mesolithic hunter-gatherers. The study presented in this chapter shows the diversity of plant species and plant parts used and the environments that were explored by the Mesolithic groups in their search for food plants. This, we hope, will create a more balanced view of the complex relationship between animal and plant food components in the European Mesolithic diet.
Lithic Technology
Authors: Sørensen Mikkel
Published: February 2025

This chapter concerns lithic technology during the Mesolithic with a focus on northern Europe. Methodological aspects on how to study lithic technology are addressed, with emphasis on the chaîne opératoire, and the lithic craft tradition of the Mesolithic is addressed in light of social theory. An analysis of the two main lithic productions of the Mesolithic, the adze/axe production and the blade production, concerning their methods of production and conduction techniques, is carried out in a diachronous perspective. It is concluded that several leaps in lithic technology are seen across Europe during the eighth–seventh millennia bc, particularly concerning the introduction of the pressure and indirect knapping technique, and concerning the conical core blade concept and the handle core blade concept. These leaps are argued to be best understood as results of changes in social transmission from vertical to horizontal transmission related to cultural influences from eastern Europe to western Europe.
Quarrying and Lithic Procurement
Authors: Nyland Astrid J.
Published: February 2025

In Mesolithic Europe, lithic raw material procurement was a fundamental task, but also a multi-dimensional and heterogeneous phenomenon. Because of Europe’s varied geology and topography, procurement of specific rock types is regionally distinct. However, procurement practices also vary because practices are historically situated, specked with choices, and thus socially infused. In this chapter, although also described, lithic procurement is considered as constituted by more than the methods of quarrying, detaching, and collecting rock for tool production. Investigations of the character of procurement, the scale and intensity of exploitation, as well as distribution, can give insight into ascribed values of rock and place, mobility, settlement systems, social organization, and relations. Lithic procurement practices, the way people procured, utilized, and distributed specific rock types, is also argued as a source of knowledge for how people expressed their place in the world, their belonging or perceived ancestry, and even cosmology.