bluuebunny/crossref_metadata_2025 huggingface dataset:
Connecting the DotsCase Studies
Authors: Raible Lea
Published: July 2020

This chapter illustrates the findings of this work with three case studies. It demonstrates how the understanding of extraterritoriality developed and defended here differs from and improves upon previous accounts. The chapter analyses bilateral cooperation in higher education between Ireland and Bahrain, the implications of a Special Economic Zone, run by Chinese shareholders in Nigeria, and export subsidies for sugar produced in the EU. The case studies cover a range of issues that implicate civil and political, as well as economic and social rights. In each of these case studies, I compare my account of jurisdiction as political power with previous accounts of jurisdiction and extraterritoriality in general. In detailing the disagreements, I show that the present approach is more successful than others in explaining extraterritorial human rights obligations of states. It allows us to assess very different scenarios according to the same principle: jurisdiction is required, and it is based on political power and the application of rules because this is what integrity and equality make it. The case studies show the present theory’s potential to supply plausible guidance in a principled manner, and across a very wide spectrum of cases.
Conclusion
Authors: Raible Lea
Published: July 2020

The conclusion revisits the central tenets and strands of the argument: how to understand interpretation, why jurisdiction is necessary, and how to account for it in international human rights law, how to relate it to territory, and how to apply jurisdiction as political power to a wide range of cases. It futher connects the theory of extraterritoriality developed in the previous chapters to wider considerations and takes stock of which questions have been answered and which questions remain. Finally, we consider why a narrow view of human rights might be our best option if we want to advance claims of global justice.
Introduction
Authors: Stahn Carsten
Published: July 2020

International criminal justice relies on messages, speech acts, and performatives practices, in order to convey social meaning. This introductory chapter sets this phenomenon into perspective. It argues that expression and communication are not only an inherent part of the punitive functions of international criminal justice, but represented in a whole spectrum of practices: norm expression and diffusion, institutional actions, performative aspects of criminal procedures, and repair of harm. This account provides a novel lens to explain many of the complexities, weaknesses, and hidden contradictions of international justice. It highlights at the same time risks and tensions, such as the self-referential nature of meaning production, the use of binaries or stereotypes in legal discourse, the displacement of alternative truths or frames of reference or the creation of new social hierarchies. The social responsibilities and communicative structures that come with the expressive turn need to be re-visited.
International Criminal Justice and Expressivist Theory
Authors: Stahn Carsten
Published: July 2020

The origins of expressivism lie in sociology (e.g. Emile Durkheim) and communicative theories of criminal law (e.g. Joel Feinberg, Antony Duff). These ideas have been developed in contemporary criminal law doctrine (e.g. Günther Jakobs, Andrew von Hirsch, Tatjana Hörnle, Claus Roxin), transitional justice (e.g. Mark Osiel, Pablo de Greiff), and international criminal law. The chapter develops a contemporary theory of expressivism. It argues that expressivism is rooted in a communicative cycle between norms as messages, crimes as messages, and judicial responses. This triad provides an explanation for the functioning of expressivism. It can be divided into norm expression and diverse types of agent-related expression. Their application involves different tensions: empirics versus faith, power-related critiques, instrumentalism, and mediation of messages.
Procedural Expression
Authors: Stahn Carsten
Published: July 2020

The chapter examines to what extent international criminal proceedings enable discursive justice. It draws on performative theories (e.g. Julie Stone Peters) and semiotics to show that proceedings have symbolic, narrative, didactic, and transformative functions. They involve a stage, a plot, audiences, and scripting. In legal literature, these features are often associated with negative attributes, such as ‘show trials’ in the political sense. However, performance is not necessarily something negative. As Niklas Luhmann has demonstrated, role play, that is, the exercise of certain ascribed or expected roles in proceedings, may have certain positive effects. The chapter demonstrates how different agents in the criminal process (e.g. Prosecution, witnesses, Defence, victims, judges) have used narratives to convey messages to different audiences. It argues that international criminal proceedings encompass more performative, rather than truly discursive elements, due to their adversarial structures.
Mantrāṅkam, an Ancient Integration Project?
Authors: Oberlin Heike
Published: July 2020

This article summarizes and presents the ‘golden thread’ of a full performance of Mantrāṅkam lasting 41 days in the Kūṭiyāṭṭam tradition. A day-by-day description with a thorough analysis of the structure, short samples of the text and several photos give a clear idea of the body and composition of Mantrāṅkam. Further, the article recapitulates the study of Mantrāṅkam carried out by the author in 1995-97 and her restudy in 2013-16. Finally, an appendix provides a short summary of the plot of the āntarārttham, “the hidden meaning”, according to the Kūṭiyāṭṭam-tradition. Oberlin describes Mantrāṅkam as a kind of monumental encyclopedia of Kerala culture, civilization, and language. It is the longest play in Kūṭiyāṭṭam; the texts within the texts are constantly moving and growing; it is inclusive and expansive, containing ritual as well as social parts.
What Is Mantrāṅkam?
Authors: Shulman David
Published: July 2020

This essay attempts to provide a general thematic and analytical framework that can make sense of the immense, diverse materials that have been brought together in this 41-day performance. The argument focuses on the paradoxical nature of the central clown-like figure, Vasantaka, and the peculiar truth-value that he articulates: that of a prachanna-bārhaspatyam or ‘hidden cynicism’, a pragmatic attitude based on utilitarian deception that may, however, be deceptive itself. The editor concluded by saying that a dissonant and incongruous cognitive pragmatics outlined in the chapter can function as a mechanism of wholeness, or as a powerful solvent that in itself continually forges close links and connections, is possibly the most surprising discovery one makes in the course of watching and thinking this play.
Hashim Amla
Authors: Desai Ashwin , Vahed Goolam
Published: July 2020

Apartheid policy ensured that very few resources were thrown into ‘non-white’ sport. Cricket, a popular sport among Indians, was hampered by terrible playing fields and lack of sponsorship. However as the post-apartheid period unfolded black players became more competitive, with Hashim Amla emerging as one of the most accomplished batsmen. Through the telling of his story this chapter examines issues of sport and transformation.
Political Connection, Crassness, and Capital Wars
Authors: Desai Ashwin , Vahed Goolam
Published: July 2020

The other aspect to black upliftment is Black Economic Empowerment (BEE), which aims to provide economic opportunities for black businessmen and women. This chapter shows how some Indian business people have taken advantage of political connections to accumulate vast amounts of wealth and how this has led to anti-Indian sentiment, especially the Gupta family who acquired notoriety for their relationship to the former South African president, Jacob Zuma.
Do We Exist?
Authors: Kaur Raminder
Published: July 2020

Chapter 10 concentrates on the ways the people’s movement was contained and crushed by ‘political (re)actions from above’. Subaltern communities and their allies against the Kudankulam Nuclear Power Plant were subjected to ‘death conditions’ by way of three overlapping modalities—silent and encroaching, quick and punitive, and dismissive, deflective and demonizing. Victims, suspects, and/or targets were somatically, socially, and politically created as a consequence. The modalities of death conditions demonstrate varying syncretic subjugations to do with ‘let die’ and ‘make die’ These modalities include ecological toxicity entrenched in social hierarchies that are compounded by the neglect of low caste-class casual labourers working for the nuclear industries; more punitive and direct intentions to suppress and extinguish dissent though the actions of particular agents or agencies; and more covert, demonizing and snowballing strategies to outcaste victims of political abuse as anti-national or seditious suspects so that they can become socially tabooed and targets of further intimidation.
Introduction
Authors: Irwin Terence
Published: July 2020

In the ethical debates that begin with Socrates, some questions receive different answers and new questions arise from the old. (1) Some theories of morality take the good to be prior to the right. Others argue that the right is to be defined independently of the good. (2) Some conceptions of the good are subjective, in so far as they suppose that a person’s good consists in some subjective state of the person, such as pleasure, tranquillity, or the satisfaction of one’s desires. Other conceptions are objective, since they hold that one’s subjective states do not wholly determine whether or not one is well off. (3) Some views hold that one’s own good includes or requires the good of other people. Other views maintain that the good of others does not necessarily promote one’s own good.
Epicurus
Authors: Irwin Terence
Published: July 2020

Epicurus revives and modifies the hedonism of the Cyrenaics, but against them he maintains that the ultimate end is not simply the pleasure of the moment, but maximum pleasure over one’s life as a whole. When we keep this goal in mind, we see that we maximize pleasure over our lives if we achieve tranquillity and freedom from disturbance. Enlightened hedonists therefore will not prefer a life of strong desires followed by strong feelings of pleasure that lead in turn to further strong desires that demand satisfaction, but will prefer desires that are easily satisfied. For the same reasons enlightened hedonists cultivate the recognized virtues of character; they will be temperate and just for the sake of tranquillity.
Morality and Social Human Nature
Authors: Irwin Terence
Published: July 2020

One important link that connects mediaeval and modern moral philosophy is the theory of natural law and the natural basis of moral rightness and wrongness. Suarez claims to defend a ‘middle way’ between the views of Aquinas and the voluntarists (Scotus and Ockham). Since natural law is genuine law, it depends on commands, and therefore on divine commands. But the precepts of natural law are not the principles of morality. Right and wrong are constituted by facts about human nature, and not by any commands, divine or human. Suarez therefore is to some extent a voluntarist about natural law, but a naturalist and objectivist about morality. Grotius agrees with Suarez that the moral basis of natural law consists in facts about human nature. These facts support objective moral principles that do not depend on the laws of any particular state.
Voluntarism, Naturalism, and Moral Realism
Authors: Irwin Terence
Published: July 2020

Pufendorf criticizes Hobbes from a voluntarist point of view. He argues that if there were no divine commands, Hobbes would be right to derive morality from self-interest. Divine commands introduce the element of morality that goes beyond self-interest. Suarez is wrong, therefore, to believe in objective morality without divine commands. Shaftesbury attacks both egoists and voluntarists as ‘nominal moralists’ who overlook the objective reality of moral rightness and wrongness. Cudworth defends this position, arguing that any attempt to derive genuine morality from commands leads to a vicious regress. Clarke argues, from a position similar to Cudworth’s, that Hobbes cannot consistently maintain his view that nothing is morally right or wrong without enforcement by an organized state.
Sentimentalism: A Non-Rational Ground for Morality
Authors: Irwin Terence
Published: July 2020

Sentimentalists (including Hutcheson and Hume) take morality to rest on emotions and sentiments, not on practical reason. They argue that reason cannot be the primary guide of action, because it can only find means to ends that appeal to our emotions. Since moral judgments guide our actions, they must depend on emotions and cannot be rational judgments about objective facts. Right and wrong are partly constituted by our emotions of approval and disapproval. Our moral emotions approve of benevolence, and therefore our moral outlook is utilitarian. Even the sentiments that belong to the apparently non-utilitarian rules of justice can be explained by reference to a utilitarian outlook.
Rationalism: A Rational Ground for Morality
Authors: Irwin Terence
Published: July 2020

Rationalists (including Butler, Price, and Reid) defend an alternative to the sentimentalist position, in three main areas: (1) Against the view that practical reason is subordinate to non-rational desire, they argue that some of our actions result from desires that are responsive to reason, so that we are guided by the apparent merits of different course of action, not just by our non-rational preferences. (2) Against the view that moral judgments depend on our emotions, and moral facts are partly constituted by our emotional reactions, they argue that moral judgments cannot be understood unless we recognize that they are rational judgments about objective facts. (3) Against the view that our moral outlook is utilitarian, they argue that utility is only one relevant moral consideration, and that we have good reason to attend to justice, generosity, and other aspects of morality that are not subordinate to utility.
Schopenhauer
Authors: Irwin Terence
Published: July 2020

According to Schopenhauer, Kant is right on two points: (1) Morality is to be separated from self-interest. (2) The categorical imperative states a universal law for all rational agents. But Kant is wrong to believe that his second point supports the first. The only purely rational aspect of morality is a demand for consistency that is compatible with any content whatever. We understand morality only when we see that it rests on compassion for others, which moves us to care about the welfare and suffering of others for their own sake. The right moral outlook requires us to overcome two errors about the reality of other people: (1) Egoism rests on failure to recognize that other people are just as real as I am. (2) Compassion requires us to see that there is no real distinction between myself and other people.
Utilitarianism
Authors: Irwin Terence
Published: July 2020

While Hutcheson and Hume present a utilitarian outlook, Mill and Sidgwick offer a systematic defence of it. They argue: (1) Utilitarianism makes sense of ordinary moral beliefs, so that anyone who takes these beliefs seriously has good reason to be a utilitarian. The utilitarian principle is the primary principle that explains the approximate truth of the secondary principles—ordinary moral rules. Apparent exceptions to utilitarianism—e.g., principles about justice and rights—can be reconciled with it. The hedonist theory of value—suitably interpreted—can explain the widespread view that pleasure is not the only good. (2) Utilitarianism follows from basic principles of practical reason, so that anyone who questions ordinary moral beliefs still has good reason to be a utilitarian. Once we understand that rational concern for our own interest requires us to aim at our own greatest good, without caring more or less about different times, we see that rational concern for everyone’s interest requires us to maximize the total good, without caring about whether this or that person gets more of it.
Beyond Kantian and Utilitarian Morality: An Idealist Alternative
Authors: Irwin Terence
Published: July 2020

Green and Bradley believe that a Hegelian conception of self-realization allows us to recognize what is true and false in utilitarian and Kantian views, and to see the connexion between these modern views and Aristotelian eudaemonism. A free and rational will aims at self-realization, the fulfilment of one’s capacities as a rational agent. This is different from, and more plausible, than, the utilitarian conception of one’s good as maximum pleasure. Moreover, attention to self-realization helps to explain why we should not recognize any basic conflict—either for utilitarian or for Kantian reasons—between the requirements of self-realization and the demands of morality. Since the realization of one’s own capacities includes the realization of those that essentially involve relations to other people, it requires us to belong to a social and moral system in which we occupy roles that achieve one’s good as a member of a well-ordered society.
Computational aspects of polymorphism
Authors: Bernstein Joel
Published: July 2020

The application of computational techniques to polymorphic systems is reviewed. Topics covered include the energetics of molecular geometric features (bond lengths, bond angles, torsion angles) and the energetics of intermolecular interactions of various types. Methods and techniques for the presentation of polymorphic structures are described, followed by some historically important early examples of conformational polymorphism. The latter subject is treated in light of recent developments, including some exemplary studies of conformational polymorphism and the prototypical example of “ROY” is discussed in detail. The computational prediction and comparison of polymorphs is discussed in the framework of the computational prediction of crystal structures. Methods discussed on polymorphs include the comparison based on geometric criteria, comparison based on Hirshfeld surfaces, a comparison based on energetic environment, comparison of X-ray diffraction patterns, and the use of partitioned lattice energy to investigate the details of similarities and differences in polymorphic structures.
Polymorphism of high energy materials
Authors: Bernstein Joel
Published: July 2020

The intimate connection between structure and properties is particularly acute in establishing the effectiveness and safety of high energy materials based on molecular compounds: chemical and physical stability, shelf-life, sensitivity to shock, pressure, and temperature. Compared to other classes of compounds treated in the book for which the polymorphs with less suitable properties are not chosen for use, and thus relegated to lower importance, for high energy materials the risks and dangers of lack of familiarity and control of the polymorphic system can entail considerable long-term risks. The chapter is divided into two major sections distinguishing between aliphatic materials and the aromatic materials, commonly known by their alphabetic moniker. Throughout the chapter the history of the development of many of these materials is provided, including some rather obscure references culled from formerly classified government research reports. A detailed discussion of the classic enigmatic polymorphism of trinitrotoluene (TNT) is presented.
Is There an Ethical Upper Limit on Risks to Study Participants?
Authors: Eyal Nir
Published: July 2020

Are some risks to study participants too much, no matter how valuable the study is for society? This article answers in the negative.
Benefits of Adding Gluteal Dry Needling to a Four-Week Physical Exercise Program in a Chronic Low Back Pain Population. A Randomized Clinical Trial
Authors: Martín-Corrales Cristina , Bautista Irene Victoria , Méndez-Mera José Enrique , Fernández-Matías Rubén , Achalandabaso-Ochoa Alexander , Gallego-Izquierdo Tomás , Nuñez-Nagy Susana , Pecos-Martín Daniel
Published: July 2020

Objective

To determine if adding dry needling to a four-week exercise program has an additional benefit compared with adding sham dry needling to the same exercise program in subjects with chronic low back pain.

Design

Randomized clinical trial.

Setting

Physiotherapy and Pain Clinic of Alcala University.

Subjects

Forty-six patients with chronic low back pain.

Methods

Subjects were randomized to two groups: the dry needling group (N = 23) or sham dry needling group (N = 23). Both groups received a four-week exercise program and before the exercise started a session of dry needling or sham dry needling. Pain (visual analog scale), disability (Roland-Morris Questionnaire), and fear avoidance beliefs (Fear Avoidance Beliefs Questionnaire) were assessed at baseline, after treatment, and at three-month follow-up. Pressure pain thresholds (algometer) were measured at baseline, after the dry needling or the sham dry needling, and after treatment.

Results

Both groups showed significant improvements for all variables. In the between-group comparison, the dry needling group improved significantly in pain at three-month follow-up and pressure pain thresholds at the end of treatment for all measures, and at three-month follow-up there was no improvement in gluteus medium.

Conclusions

In chronic low back patients, adding dry needling to a four-week exercise program has an additional benefit in pain and sensitivity compared with adding sham dry needling to the same exercise program.
Burden of illness among subgroups of patients with primary Sjögren’s syndrome and systemic involvement
Authors: Gairy Kerry , Knight Claudia , Anthony Papa , Hoskin Ben
Published: July 2020

Objectives

To describe how patients with primary SS (pSS) and systemic organ involvement are classified and clustered in routine practice.

Methods

This multinational, cross-sectional survey of real-world quantitative data was conducted across Europe and the US. Rheumatologists who treated seven or more adult patients per month with pSS and current/past systemic manifestations undertook a survey before completing a patient record form capturing demographic, clinical and treatment information for their next six eligible patients. Patients with a completed patient record form were invited to complete a patient self-completion questionnaire capturing insights into their disease and treatment. Subgroups were defined by physicians’ assessment of disease severity; clusters were derived based on key clinical characteristics using latent class analysis.

Results

Rheumatologists completed 316 physician surveys and 1879 patient record forms; 888 patients completed the patient self-completion questionnaire. pSS severity reflected organ involvement and symptomatology. Latent class analysis produced five clusters distinguished by the organ systems involved and the presence of pain and fatigue symptoms at the time of the survey. A minority of patients [n = 67 (4%)] were categorized with multiple organ involvement and the highest frequency of pain and fatigue. A total of 324 patients (17%) were categorized as ‘low burden’. The remaining three clusters exhibited high frequencies of articular involvement but were distinguished by the extent of other organ system involvement.

Conclusion

Cluster analysis using a real-world cohort of patients with pSS and systemic organ involvement highlights the heterogeneous presentation of patients with pSS and confirms the importance of pain and fatigue as well as organ involvement when determining disease burden.
The dysregulation of monocyte subpopulations in individuals at risk of developing rheumatoid arthritis
Authors: Prajzlerová Klára , Kryštůfková Olga , Komarc Martin , Mann Heřman , Hulejová Hana , Petrovská Nora , Gregová Monika , Hánová Petra , Pavelka Karel , Vencovský Jiří , Šenolt Ladislav , Filková Mária
Published: July 2020

Objectives

Individuals carrying antibodies against citrullinated proteins (ACPA) are at high risk of developing RA. EULAR provided a clinical definition of individuals with arthralgia suspicious for progression to RA (clinically suspect arthralgia, CSA). The alteration of monocyte subpopulations in patients with established RA has been previously described. We analysed peripheral blood monocyte subpopulations in individuals with arthralgia at risk of RA.

Methods

We included 70 at-risk individuals, defined as having arthralgia without arthritis and being either ACPA+ or meeting the clinical CSA definition, 23 patients with early RA (ERA) and 19 healthy controls (HCs). Monocytes classified as classical (CD14++CD16−), intermediate (CD14++CD16+/++) and nonclassical (CD14−/+CD16++) were analysed by flow cytometry.

Results

Of the 70 at-risk individuals, 46 were ACPA+ and 45 met the CSA definition. The at-risk individuals and, especially, ERA patients had a lower percentage of classical monocytes and a higher percentage of nonclassical monocytes than the HCs. ACPA positivity had no effect on the difference in the distribution of the monocyte subsets between at-risk individuals and ERA patients, but a difference was determined in those reaching the ERA phase. However, when compared with HCs, the shift of monocyte subsets was more significant in ACPA+ than in ACPA− individuals with arthralgia. This trend was observed in individuals who did not meet the CSA definition. This finding was, however, determined by a selection bias, as these individuals were solely ACPA+.

Conclusion

The shift from classical to nonclassical monocyte subpopulations was observed already in individuals at risk of developing RA.
Association between meniscal volume and development of knee osteoarthritis
Authors: Xu Dawei , van der Voet Jan , Hansson Nils M , Klein Stefan , Oei Edwin H G , Wagner Femke , Bierma-Zeinstra Sebastia M A , Runhaar Jos
Published: July 2020

Objective

To assess the association between meniscal volume, its change over time and the development of knee OA after 30 months in overweight/obese women.

Methods

Data from the PRevention of knee Osteoarthritis in Overweight Females study were used. This cohort included 407 women with a BMI ≥ 27 kg/m2, free of OA-related symptoms. The primary outcome measure was incident OA after 30 months, defined by one out of the following criteria: medial or lateral joint space narrowing (JSN)  ≥ 1.0 mm, incident radiographic OA [Kellgren and Lawrence (K&L)  ≥ 2], or incident clinical OA. The secondary outcomes were either of these items separately. Menisci at both baseline and follow-up were automatically segmented to obtain meniscal volume and delta-volumes. Generalized estimating equations were used to evaluate associations between the volume measures and the outcomes.

Results

Medial and lateral baseline and delta-volumes were not significantly associated to the primary outcome. Lateral meniscal baseline volume was significantly associated to lateral JSN [odds ratio (OR) = 0.87; 95% CI: 0.75, 0.99], while other measures were not. Medial and lateral baseline volume were positively associated to K&L incidence (OR = 1.32 and 1.22; 95% CI: 1.15, 1.50 and 1.03, 1.45, respectively), while medial and lateral delta-volume were negatively associated to K&L incidence (OR = 0.998 and 0.997; 95% CI: 0.997, 1.000 and 0.996, 0.999, respectively). None of the meniscal measures were significantly associated to incident clinical OA.

Conclusion

Larger baseline meniscal volume and the decrease of meniscal volume over time were associated to the development of structural OA after 30 months in overweight and obese women.
Theta Phase Synchrony Is Sensitive to Corollary Discharge Abnormalities in Early Illness Schizophrenia but Not in the Psychosis Risk Syndrome
Authors: Roach Brian J , Ford Judith M , Loewy Rachel L , Stuart Barbara K , Mathalon Daniel H
Published: July 2020

Background

Prior studies have shown that the auditory N1 event-related potential component elicited by self-generated vocalizations is reduced relative to played back vocalizations, putatively reflecting a corollary discharge mechanism. Schizophrenia patients and psychosis risk syndrome (PRS) youth show deficient N1 suppression during vocalization, consistent with corollary discharge dysfunction. Because N1 is an admixture of theta (4–7 Hz) power and phase synchrony, we examined their contributions to N1 suppression during vocalization, as well as their sensitivity, relative to N1, to corollary discharge dysfunction in schizophrenia and PRS individuals.

Methods

Theta phase and power values were extracted from electroencephalography data acquired from PRS youth (n = 71), early illness schizophrenia patients (ESZ; n = 84), and healthy controls (HCs; n = 103) as they said “ah” (Talk) and then listened to the playback of their vocalizations (Listen). A principal component analysis extracted theta intertrial coherence (ITC; phase consistency) and event-related spectral power, peaking in the N1 latency range. Talk–Listen suppression scores were analyzed.

Results

Talk–Listen suppression was greater for theta ITC (Cohen’s d = 1.46) than for N1 in HC (d = 0.63). Both were deficient in ESZ, but only N1 suppression was deficient in PRS. When deprived of variance shared with theta ITC suppression, N1 suppression no longer differentiated ESZ and PRS individuals from HC. Deficits in theta ITC suppression were correlated with delusions (P = .007) in ESZ. Theta power suppression did not differentiate groups.

Conclusions

Theta ITC-suppression during vocalization is a more sensitive index of corollary discharge-mediated auditory cortical suppression than N1 suppression and is more sensitive to corollary discharge dysfunction in ESZ than in PRS individuals.
A Rehabilitation of the Institutional Approach to Japanese Economic History: Introduction to the Special Issue
Authors: CATO Susumu , NAKABAYASHI Masaki
Published: July 2020

The following is a short introduction to this special issue, which builds on and significantly extends and updates the research published recently in the Iwanami Series on Japanese economic history. First, we offer a modern interpretation of four institutional elements that are particularly important for understanding the growth path of the Japanese economy. These are (a) ownership; (b) regulation of factor markets; (c) labor mobility and (d) the judiciary. These four elements properly clarify the incentive structure behind economic institutions. We then briefly explain how the four articles in this special issue—two at the macro level providing updated estimates of long-run rates of growth in gross domestic product (GDP) and total factor productivity (TFP), and two at the micro level examining institutional changes in specific markets—build on this unified framework, and deepen our understanding of Japanese economic history.
New Drugs for Breast Cancer
Authors: Aschenbrenner Diane S.
Published: July 2020

The kinase inhibitor tucatinib (Tukysa) has been approved to treat advanced unresectable or metastatic HER2-positive breast cancer. The drug is given orally in combination with trastuzumab (Herceptin) and capecitabine (Xeloda). It is not first-line therapy.

Sacituzumab govitecan-hziy (Trodelvy) has been approved to treat triple-negative breast cancer that has metastasized. It is a targeted therapy monoclonal antibody given by IV infusion. The drug carries a boxed warning for risk of severe neutropenia and severe diarrhea.
Aspirin Lowers Risk of Colorectal, Other Digestive Tract Cancers
Authors: Rosenberg Karen
Published: July 2020

According to this study:

Aspirin use is inversely related to the risk of colorectal and other digestive tract cancers.

This favorable effect tends to increase with longer use, and, for colorectal cancer, increasing dose.
Is Video Game Addiction Real?
Authors: Rosenberg Karen
Published: July 2020

According to this study:

Most adolescents have relatively few pathological video game symptoms.

For some, pathological gaming can result in sustained negative behavioral and mental health outcomes.
Care Bundle Doesn't Improve Sepsis Outcomes
Authors: Rosenberg Karen
Published: July 2020

According to this study:

Care adherent to the Early Management Bundle for Severe Sepsis/Septic Shock wasn't associated with better outcomes in patients with hospital- or community-onset sepsis.

Individual components of the care bundle were associated with improved outcomes in patients with community-onset sepsis.
An Evidence-Based Approach to Increasing Nurses' Publication Rates
Authors: Fischer-Cartlidge Erica
Published: July 2020

Background:

Writing for publication in peer-reviewed journals is one of the most important types of writing that nurses engage in. It is essential for advancing the nursing profession, health care organizations, and individual nurses. Despite its importance, however, the rate of publication remains very low among nurses. At one large academic medical center, a baseline assessment of dissemination practices found a low publication rate. To address this, an evidence-based writing-for-publication program was designed to support professional dissemination of scholarly work.

Methods:

A 12-week workshop was designed and writers were matched with a mentor. The workshop started with a four-hour kickoff session on the process of getting published, including choosing a journal, querying an editor, drafting a manuscript, and working with coauthors. Participants also began developing an outline for their manuscript. Drafts were due to the mentor every four weeks for editing and feedback. At the end of the 12 weeks a wrap-up session was held for participants to read each other's manuscripts and give peer feedback.

Outcomes:

As of this writing, five cohorts have completed the program, and 89 nurses participated. Twenty-nine manuscripts were completed and submitted to peer-reviewed journals; of these, 22 (76%) were accepted, four (14%) are still under review, and three (10%) were recommended for submission to a different journal. Among the 89 nurse participants, 84% reported being likely or very likely to write for publication again, and 96% reported improvement in their writing skills.

Conclusions:

Without more nurses acquiring the skills to engage in writing for publication, the body of advancing knowledge that drives clinical decision-making may wane as aging, experienced nurse authors leave the profession. To protect the future of nursing, a continuous commitment to developing nurse authors across all generations is necessary. Nursing leaders and health care organizations must commit to ensuring novice nurse authors are provided with the resources to engage in disseminating knowledge.
The Present Concern
Authors: Frush Benjamin
Published: July 2020

A physician explores why it's harder to simply be with patients than to try to fix them.
Cultivating Empathy Through Virtual Reality: Advancing Conversations About Racism, Inequity, and Climate in Medicine
Authors: Roswell Robert O. , Cogburn Courtney D. , Tocco Jack , Martinez Johanna , Bangeranye Catherine , Bailenson Jeremy N. , Wright Michael , Mieres Jennifer H. , Smith Lawrence
Published: July 2020

Problem

Racism and bias are fundamental causes of health inequities, and they negatively affect the climate of academic medical institutions across the United States.

Approach

In 2019, the Zucker School of Medicine and Northwell Health piloted a virtual reality (VR) racism experience as a component of professional development for medical school and health system leaders, faculty, and staff. Participants experienced a 60-minute, interactive, large-group session on microaggressions and, as individuals, a 20-minute VR module. These were followed by group reflection and debriefing. The sessions, developed in collaboration with a VR academic team, represented a response to institutional climate assessment surveys, which indicated the need for expanded professional training on cross-cultural communication and enhancing inclusion.

Outcomes

In October 2019, 112 faculty and staff participated in the workshop. On a postworkshop survey, completed by 76 participants (67.9%), most respondents (90.8%) reported feeling engaged in the VR experience. Additionally, the majority agreed that VR was an effective tool for enhancing empathy (94.7%), that the session enhanced their own empathy for racial minorities (85.5%), and that their approach to communication would change (67.1%). In open-ended responses, participants frequently conveyed enthusiasm, powerful emotional and physiologic responses, and enhanced empathy. They also suggested more time for follow-up discussions.

Next Steps

Next steps include assessing the scalability of the VR module; determining effective complementary engagements; and measuring the module’s longitudinal effects on racial empathy, discrimination, and institutional climate. As VR becomes more common in medical education, developing VR modules to address other forms of discrimination (e.g., sexism, homophobia) could also benefit the institutional climates of medical schools and health systems as academic medicine continues to build toward health equity.
Baseline Characteristics of a Dyadic Cohort of Mothers With Chronic Pain and Their Children
Authors: Wilson Anna C. , Stone Amanda L. , Poppert Cordts Katrina M. , Holley Amy L. , Mackey Sean , Darnall Beth D. , Palermo Tonya M.
Published: July 2020

Objectives:

A growing body of research has demonstrated a robust link between parental chronic pain and child pain and psychological function. Although the association between parent and child pain is strong, there are limited data to understand environmental and behavioral processes that account for the association and how this develops over time. This longitudinal cohort study was designed to understand the potential mechanisms that confer risk or resilience for chronic pain among child offspring of mothers with chronic pain.

Methods:

The current paper presents baseline data on the cohort to describe the pain and psychosocial characteristics of mothers with chronic pain and their 8- to 12-year-old children. A total of 400 mothers with chronic pain and their children were enrolled into the longitudinal study and completed measures of pain, physical, and psychosocial functioning.

Results:

Mothers reported a range of pain and pain-related disability and were grouped into 4 pain grades (PGs) representing different pain and disability levels. Mothers in these groups differed on rates of widespread pain and opioid use. Maternal PGs also differed by physical function, fatigue, sleep disturbance, and psychological function. Most children in this sample reported pain and psychosocial symptoms in the nonclinical range, and child variables did not differ by maternal PG. Maternal disability and function were concurrently associated with child psychosocial function.

Discussion:

While maternal PGs map broadly onto several dimensions of maternal functioning, they were not significantly related to child pain or function. Results may help identify potential protective factors in the intergenerational transmission of risk for chronic pain.
Pain Catastrophizing, Self-reported Disability, and Temporal Summation of Pain Predict Self-reported Pain in Low Back Pain Patients 12 Weeks After General Practitioner Consultation
Authors: Petersen Kristian K. , Jensen Martin B. , Graven-Nielsen Thomas , Hauerslev Lissa V. , Arendt-Nielsen Lars , Rathleff Michael S.
Published: July 2020

Objectives:

Patients with low back pain (LBP) often demonstrate pain sensitization, high degree of pain catastrophizing, and psychological distress. This study investigated whether pain sensitization mechanisms, the Pain Catastrophizing Scale (PCS), and Start Back Screening Tool were associated with pain in recurrent LBP patients 12 weeks after consulting their general practitioner (GP).

Materials and Methods:

In 45 LBP patients, pressure pain thresholds, temporal summation of pain (TSP), conditioned pain modulation (CPM), the Roland Morris Disability Questionnaire (RMDQ), and the PCS were assessed before consultation. Patients were classified into low to medium or high risk of poor prognosis on the basis of the Start Back Screening Tool. Worst pain within the last 24 hours was assessed on a visual analogue scale (VAS) at inclusion and 12 weeks after GP consultation.

Results:

VAS scores were reduced after 12 weeks in the low-to-medium (N=30, P<0.05), but not the high-risk group (N=15, P=0.40). RMDQ was reduced after 12 weeks (P<0.001), but with no difference between the groups. PCS was reduced in the low-to-medium and the high-risk group (P<0.05). TSP was significantly higher at follow-up in the high-risk group compared with the low-to-medium-risk group (P<0.05). A linear regression model explained 54.9% of the variance in VAS scores at follow-up utilizing baseline assessments of TSP, RMDQ, and PCS.

Discussion:

This study indicate that patients with LBP and high self-reported disability, high pain catastrophizing, and facilitated TSP assessed when consulting the GP might predictive poor pain progression 12 weeks after the consultation.
Prevalence of Complete Airway Closure According to Body Mass Index in Acute Respiratory Distress Syndrome
Authors: Coudroy Rémi , Vimpere Damien , Aissaoui Nadia , Younan Romy , Bailleul Clotilde , Couteau-Chardon Amélie , Lancelot Aymeric , Guerot Emmanuel , Chen Lu , Brochard Laurent , Diehl Jean-Luc
Published: July 2020

Background

Complete airway closure during expiration may underestimate alveolar pressure. It has been reported in cases of acute respiratory distress syndrome (ARDS), as well as in morbidly obese patients with healthy lungs. The authors hypothesized that complete airway closure was highly prevalent in obese ARDS and influenced the calculation of respiratory mechanics.

Methods

In a post hoc pooled analysis of two cohorts, ARDS patients were classified according to body mass index (BMI) terciles. Low-flow inflation pressure–volume curve and partitioned respiratory mechanics using esophageal manometry were recorded. The authors’ primary aim was to compare the prevalence of complete airway closure according to BMI terciles. Secondary aims were to compare (1) respiratory system mechanics considering or not considering complete airway closure in their calculation, and (2) and partitioned respiratory mechanics according to BMI.

Results

Among the 51 patients analyzed, BMI was less than 30 kg/m2 in 18, from 30 to less than 40 in 16, and greater than or equal to 40 in 17. Prevalence of complete airway closure was 41% overall (95% CI, 28 to 55; 21 of 51 patients), and was lower in the lowest (22% [3 to 41]; 4 of 18 patients) than in the highest BMI tercile (65% [42 to 87]; 11 of 17 patients). Driving pressure and elastances of the respiratory system and of the lung were higher when complete airway closure was not taken into account in their calculation. End-expiratory esophageal pressure (ρ = 0.69 [95% CI, 0.48 to 0.82]; P < 0.001), but not chest wall elastance, was associated with BMI, whereas elastance of the lung was negatively correlated with BMI (ρ = −0.27 [95% CI, −0.56 to −0.10]; P = 0.014).

Conclusions

Prevalence of complete airway closure was high in ARDS and should be taken into account when calculating respiratory mechanics, especially in the most morbidly obese patients.

Editor’s Perspective

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What This Article Tells Us That Is New
Tau Contributes to Sevoflurane-induced Neurocognitive Impairment in Neonatal Mice
Authors: Yu Yang , Yang Yongyan , Tan Hong , Boukhali Myriam , Khatri Ashok , Yu Yonghao , Hua Fuzhou , Liu Ling , Li Mengzhu , Yang Guang , Dong Yuanlin , Zhang Yiying , Haas Wilhelm , Xie Zhongcong
Published: July 2020

Background

Sevoflurane anesthesia induces Tau phosphorylation and cognitive impairment in neonatal but not in adult mice. This study tested the hypothesis that differences in brain Tau amounts and in the activity of mitochondria–adenosine triphosphate (ATP)–Nuak1–Tau cascade between the neonatal and adult mice contribute to the age-dependent effects of sevoflurane on cognitive function.

Methods

6- and 60-day-old mice of both sexes received anesthesia with 3% sevoflurane for 2 h daily for 3 days. Biochemical methods were used to measure amounts of Tau, phosphorylated Tau, Nuak1, ATP concentrations, and mitochondrial metabolism in the cerebral cortex and hippocampus. The Morris water maze test was used to evaluate cognitive function in the neonatal and adult mice.

Results

Under baseline conditions and compared with 60-day-old mice, 6-day-old mice had higher amounts of Tau (2.6 ± 0.4 [arbitrary units, mean ± SD] vs. 1.3 ± 0.2; P < 0.001), Tau oligomer (0.3 ± 0.1 vs. 0.1 ± 0.1; P = 0.008), and Nuak1 (0.9 ± 0.3 vs. 0.3 ± 0.1; P = 0.025) but lesser amounts of ATP (0.8 ± 0.1 vs. 1.5 ± 0.1; P < 0.001) and mitochondrial metabolism (74.8 ± 14.1 [pmol/min] vs. 169.6 ± 15.3; P < 0.001) in the cerebral cortex. Compared with baseline conditions, sevoflurane anesthesia induced Tau phosphorylation at its serine 202/threonine 205 residues (1.1 ± 0.4 vs. 0.2 ± 0.1; P < 0.001) in the 6-day-old mice but not in the 60-day-old mice (0.05 ± 0.04 vs. 0.03 ± 0.01; P = 0.186). The sevoflurane-induced Tau phosphorylation and cognitive impairment in the neonatal mice were both attenuated by the inhibition of Nuak1 and the treatment of vitamin K2.

Conclusions

Higher brain Tau concentrations and lower brain mitochondrial metabolism in neonatal compared with adult mice contribute to developmental stage–dependent cognitive dysfunction after sevoflurane anesthesia.

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Mixed-method analysis of barriers to surgical care in Uganda
Authors: Incorvia Joseph J. , Du Robin , Tafreshi Ali R. , Vissoci Joao R.N. , Fuller Anthony T. , Rice Henry E. , Kebba Naomi , Doshi Pratik , Galukande Moses , Haglund Michael M.
Published: July 2020

Introduction:

Barriers to surgical care in low- and middle-income countries have roots in theoretical frameworks, but are often left undefined and understudied. On the basis of the Access Evaluation Framework and Healthcare Barrier Model, this study implemented 2 consumer decision tools and a qualitative interview to elucidate significant barriers to seeking surgical care in Uganda.

Methods:

Participants were recruited from a convenience sample within the surgical wards of 1 national referral hospital and 1 regional referral hospital in Uganda. Individuals selected for the study answered a brief questionnaire and a ranking and rating exercise followed by an in-depth, semi-structured interview. The questionnaire evaluated demographic, economic, transportation, and care-seeking characteristics, while the ranking and rating exercises assessed potential barriers to surgical care. Descriptive statistics were used to assess characteristics of the sample. Ranking and rating medians were compared between the 2 exercises for each barrier.

Results:

Among the 214 participants, cost of surgery, distance to hospital, and transportation to hospital were identified as the most significant barriers to care. Language barrier, no control over decision making, and no caretaker available at the hospital were identified as the least significant barriers to care. Mulago National Referral Hospital had significantly greater costs and transportation times, indicating larger scale barriers to care than Jinja Regional Referral Hospital, even though top barriers were similar.

Conclusions:

Cost was the most significant barrier to surgical care among care-seekers in Uganda. Transportation to the hospital and distance from the hospital remain large barriers that need to be considered as well. These complementary analysis tools provide evidence that future policies and research need to consider mitigating cost, distance, and transportation issues for patients that need a surgical intervention. Next steps in determining more granular level differences between barriers will improve understanding on how best to address these issues.