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Despite the growing interest in secondary state efforts to avoid choosing sides in great power competition, International Relations scholars have paid scant attention to the question of how great powers respond to secondary state ‘hedging’. We offer a first approximation for this important question by focusing on ‘high-value’ hedgers, i.e. secondary states whose location or capabilities afford them the potential to tip the scales in a great power war. We posit that great powers are likely to accommodate high-value hedgers and refrain from trying to manipulate their alignment choice. This is because the likelihood and costs of losing a high-value hedger are such that competing great powers would rather be safe than sorry. Concretely, we expect established and rising great powers to (re)assure high-value hedgers: the former by demonstrating their commitment to a regional balance of power, and the latter by showing they harbour no ill intent towards the hedging secondary state. To probe our argument, we examine how Great Britain and Germany responded to Dutch hedging in the early 20th century, and how the United States and China are responding to Singapore’s hedging today.
What are the legal and political criteria that distinguish between ‘correct’ and ‘unacceptable’ legal mobilisation? How does populism facilitate legal mobilisation? The questions of the workshop organizers led us back in Hungary to the democratic transition from socialism to liberal democracy in 1989, when legal mobilisation for the rule of law, democracy and human rights was led first and primarily by non-state actors (National Round Table). Participants of the democratic transition prepared the complete revision of the 1949 Constitution, which was an emblematic element in addition to the many legislative drafts of the transitory nature of the creation of the new system. In 2010, after the successful political mobilisation, the populist party coalition (lead by Viktor Orban) gained a two-thirds constitution-making majority in Parliament (in the absence of two opposition parties), and the Parliament adopted the new Fundamental Law (new constitution). This was also an emblematic element of the new legal mobilisation conducted by the two-thirds populist Government majority. This article will describe how populism – through the instrumentalisation of the law (disregarding the inherent values in/of law based on value choice) and the destruction of institutional checks and balances – facilitated new legal mobilisation. Based on this experience of the outcome of the equally strong and effective legal mobilisation in Hungary of the liberal and the illiberal (democratic and autocratic, respectively) transitions, in this article we aim to make valid theoretical propositions on how to assess ‘correct’ and ‘incorrect’ legal mobilisation and what influences the relevance of non-state actors in populism.
Folate metabolism is involved in the development and progression of various cancers. We investigated the association of single nucleotide polymorphisms (SNP) in folate-metabolising genes and their interactions with serum folate concentrations with overall survival (OS) and liver cancer-specific survival (LCSS) of newly diagnosed hepatocellular carcinoma (HCC) patients. We detected the genotypes of six SNP in three genes related to folate metabolism: methylenetetrahydrofolate reductase (MTHFR), 5-methyltetrahydrofolate-homocysteine methyltransferase reductase (MTRR) and 5-methyltetrahydrofolate-homocysteine methyltransferase (MTR). Cox proportional hazard models were used to calculate multivariable-adjusted hazard ratios (HR) and 95 % CI. This analysis included 970 HCC patients with genotypes of six SNP, and 864 of them had serum folate measurements. During a median follow-up of 722 d, 393 deaths occurred, with 360 attributed to HCC. In the fully-adjusted models, the MTRR rs1801394 polymorphism was significantly associated with OS in additive (per G allele: HR = 0·84, 95 % CI: 0·71, 0·99), co-dominant (AG v. AA: HR = 0·77; 95 % CI: 0·62, 0·96) and dominant (AG + GG v. AA: HR = 0·78; 95 % CI: 0·63, 0·96) models. Carrying increasing numbers of protective alleles was linked to better LCSS (HR10–12 v. 2–6 = 0·70; 95 % CI: 0·49, 1·00) and OS (HR10–12 v. 2–6 = 0·67; 95 % CI: 0·47, 0·95). Furthermore, we observed significant interactions on both multiplicative and additive scales between serum folate levels and MTRR rs1801394 polymorphism. Carrying the variant G allele of the MTRR rs1801394 is associated with better HCC prognosis and may enhance the favourable association between higher serum folate levels and improved survival among HCC patients.
Judges are not the first political officials that come to mind when one considers the role of social media in modern politics. Following in the wake of some prominent judicial personalities adopting Twitter, however, a growing number of state high court judges have adopted and established more public personas on the platform. Judges use Twitter in substantively different ways than traditional elected officials (Curry and Fix 2019); however, little is understood about how the use of such social media platforms affects broader judicial networks. Recognizing that judges, like typical social media users, may aspire to expand their networks to build and appeal to broader audiences, we contend that active participation in judicial Twitterverse could yield personal and professional advantages. Here, we address a currently unexplored question: To what extent have judges formed a distinctive “judicial network,” on Twitter, and what discernible patterns present in these networks? Leveraging the unique structure of social media, we collect comprehensive network data on judging using Twitter and analyze what institutional and social factors impact greater power within the judicial network. We find that early adoption, electoral concerns, and connective links between judges all impact the strength of the judicial network, highlighting the complex motivations driving judicial Twitter engagement, and the significance of network building in judges’ social media strategies and its potential impact on career advancement.
Wave-assisted propulsion (WAP) systems directly convert wave energy into thrust using elastically mounted hydrofoils. The wave conditions as well as the design of the hydrofoil drive the fluid–structure interaction of the hydrofoil and, consequently, its performance. We employ simulations using a sharp-interface immersed boundary method to examine the effect of three key parameters on the flow physics, the fluid–structure interaction as well as thrust performance of these systems – the stiffness of the torsional spring, the location of the pitch axis and the Strouhal number. We demonstrate the utility of ‘maps’ of energy exchange between the flow and the hydrofoil system, as a way to understand and predict these characteristics. The force-partitioning method (FPM) is used to decompose the pressure forces into interpretable components and to quantify the mechanisms associated with thrust generation. Based on the results from FPM, a phenomenological model for the thrust generated by the WAP foil is presented. The parameters associated with this model are estimated based on data from over 450 distinct simulations. The predictions of the model are compared with the simulations and the use of this model for guiding WAP design is discussed.
Damage initiation hotspots around features, such as bolts and ply drops, must be investigated during the preliminary design phase of large composite structures, such as composite airframes. A global-local modelling approach is commonly employed to perform this investigation, whereby a global low-fidelity model is used to drive high-fidelity local models around the features of interest. However, this methodology is slow, repetitive and expert-dependent. In this investigation, we address these issues by applying machine learning techniques to this global-local modelling framework and demonstrate the time-saving benefit when predicting damage initiation of bolted composite joints. Feature engineering of model inputs and outputs, and appropriate customisation of machine learning methods enables damage initiation prediction. Special consideration is given to the boundary conditions that must be varied to simulate the response of the bolted composite joints. Results show over three orders of magnitude time-saving benefit and satisfactory accuracy of the proposed methodology. This indicates its potential to be developed further into a rapid design and optimisation tool.
Recently, women’s presence on top boards of directors has significantly increased, challenging the long standing of male-led corporate elites. In light of the still-developing literature, this article provides a century-long examination of women’s entry into the Spanish corporate elite, offering several original contributions. In addition to its pioneering input into the country’s historiography, the work uses a holistic model to introduce a comparative European approach. Moreover, it empirically examines the significant yet previously unexplored impact of elite training institutions on the advancement of female directors as well as their arrival through a national holding company and their presence in leading publicly traded companies. Findings showed four distinct stages in their trajectory: discriminatory exclusion, during the first third of the twentieth century; exceptional inclusion, with early positions in their family-owned firms; gradual incorporation, with increased political representation and expanded academic access in the latter decades of the last century; and promotion, supported by twenty-first-century political strategies, while still revealing the handicap of women’s delayed entry into the corporate network.
Let G be a finite group and let $\chi $ be an irreducible character of G. The number $|G:\mathrm {ker}\chi |/\chi (1)$ is called the codegree of the character $\chi $. We provide several relations between the structure of G and the codegrees of the characters in a given subset of $\mathrm {Irr}(G)$, where $\mathrm {Irr}(G)$ is the set of all complex irreducible characters of G. For example, we show that if the codegrees of all strongly monolithic characters of G are odd, then G is solvable, analogous to the well-known fact that if all irreducible character degrees of a finite group are odd, then that group is solvable.
Placental vascular anastomoses are traditionally thought to exist exclusively in monochorionic pregnancies. However, they have been reported in dichorionic twin pregnancies as well. In turn, twin to twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS) have also been noted to impact some of these gestations. Through discussion of one such case at our institution along with a review of the available literature, we review the proposed pathophysiology of placental vascular anastamoses in dichorionic twin gestations, and aim to raise awareness of the possibility of associated pathologies in dichorionic gestations. This is an emerging area of literature that will require future study to guide prenatal surveillance and mitigate morbidity.
Endomyocardial biopsy remains the gold standard for cardiac cellular rejection surveillance after heart transplantation. We studied a novel non-invasive index of left ventricular relaxation to detect cardiac cellular rejection in paediatric heart transplant patients.
Methods:
This is a single-centre retrospective study of paediatric heart transplant patients who underwent endomyocardial biopsy from June 2014 to September 2021. Left ventricular relaxation index was calculated as the sum of diastolic tissue Doppler imaging velocities (E) of the left ventricular lateral, septal, and posterior walls divided by the percentage of the left ventricular posterior wall thinning by M-mode. Statistical analysis included t-tests and Mann-Whitney tests to compare means and medians between treatment and non-treatment groups. We used the cut-off with the maximum Youden index to compare the sensitivity and specificity of left ventricular relaxation index to detect rejection.
Results:
The study included 65 patients who underwent 246 cardiac catheterizations and endomyocardial biopsies. Out of 246, 192 procedures were included and 54 were excluded due to recent transplants or lack of echocardiographic data. A total of 114 demonstrated Grade 0R, 68 Grade 1R, 8 Grade 2R, and 2 Grade 3R allograft rejection. The difference in mean left ventricular relaxation index between treatment versus non-treatment groups (2R, 3R vs. 0R, 1R) was not statistically significant (p = 0.917). A left ventricular relaxation index cut-off of 0.73 had the highest Youden index with good sensitivity (100%) and poor specificity (23%) for detecting rejections with grades 2R and 3R.
Conclusion:
Left ventricular relaxation index, a novel index of left ventricular relaxation, was not a sensitive or specific predictor of cardiac cellular rejection in paediatric heart transplants.
Post-procedural antimicrobial prophylaxis is not recommended by professional guidelines but is commonly prescribed. We sought to reduce use of post-procedural antimicrobials after common endoscopic urologic procedures.
Design:
A before-after, quasi-experimental trial with a baseline (July 2020–June 2022), an implementation (July 2022), and an intervention period (August 2022–July 2023).
Setting:
Three participating medical centers.
Intervention:
We assessed the effect of a bundled intervention on excess post-procedural antimicrobial use (ie, antimicrobial use on post-procedural day 1) after three types of endoscopic urologic procedures: ureteroscopy and transurethral resection of bladder tumor or prostate. The intervention consisted of education, local champion(s), and audit-and-feedback of data on the frequency of post-procedural antimicrobial-prescribing.
Results:
1,272 procedures were performed across all 3 sites at baseline compared to 525 during the intervention period; 644 (50.6%) patients received excess post-procedural antimicrobials during the baseline period compared to 216 (41.1%) during the intervention period. There was no change in the use of post-procedural antimicrobials at sites 1 and 2 between the baseline and intervention periods. At site 3, the odds of prescribing a post-procedural antimicrobial significantly decreased during the intervention period relative to the baseline time trend (0.09; 95% CI 0.02–0.45). There was no significant increase in post-procedural unplanned visits at any of the sites.
Conclusions:
Implementation of a bundled intervention was associated with reduced post-procedural antimicrobial use at one of three sites, with no increase in complications. These findings demonstrate both the safety and challenge of guideline implementation for optimal perioperative antimicrobial prophylaxis.
This trial was registered on clinicaltrials.gov, NCT04196777.
Understanding variations in knowledge and attitudes of psychiatrists to psilocybin therapy is important for the collective discourse about the potential impact on clinical practice and public health in Ireland.
Methods:
A 28-item questionnaire was designed based on previous studies and distributed to psychiatrists in Ireland via online mailing lists and at in-person academic events.
Results:
151 psychiatrists completed the questionnaire (73.3% were under 40 years of age, 76.0% were trainees, and 49.0% were female). In the total sample, 81.5% agreed that psilocybin therapy shows promise in the treatment of psychiatric disorders and 86.8% supported funding research, 86.8% would be willing to refer a patient if it was licensed and indicated, and 78.1% would consider the treatment for themselves, if indicated. Conversely, 6.6% agreed that psilocybin therapy was unsafe even under medical supervision, and 21.9% thought it was potentially addictive. 15.9% of the total sample reported at least one concern including, lack of robust evidence, long-term effectiveness, superiority to current interventions, potential harmful effects, cost and accessibility, and impartiality. Less than half of respondents felt knowledgeable (40.0%) and 9.9% felt adequately prepared to participate in psilocybin therapy. Consultant psychiatrists trended towards less optimism for a potential role in bipolar depression and emotionally unstable personality disorder compared to trainee psychiatrists.
Conclusion:
Overall psychiatrists in Ireland held positive attitudes towards psilocybin therapy. However, there was a lack of knowledge evident. Addressing the knowledge gap and aligning with the best available evidence will be key if psychedelic therapy is to prevail in a clinical setting.
Lipids play an important role in human nutrition. Although adequate lipid consumption is necessary for an optimal functioning of the human body, overconsumption of saturated fatty acids can lead to postprandial hypertriglyceridaemia, which triggers the development of atherosclerosis. Important parameters that impact postprandial lipaemia and inflammation are related to the matrix structure and the fat-soluble micronutrient profile of ingested foods/lipids, but the specific effect of these parameters should be further studied, as most of the available studies evaluate their effect at fasting state. This review specifically explores the effects of food structure and fat-soluble micronutrients, from either micronutrient-rich foods or supplements, on postprandial hypertriglyceridaemia and inflammation. The review also highlights the potential of emerging biomarkers such as miRNAs or circulating microvesicles, as an alternative to the widely use biomarkers (e.g. low-density lipoproteins or blood concentration of pro-inflammatory cytokines), to identify inflammation associated with postprandial hypertriglyceridaemia at early stages.