A vast amount of clinical data are still stored in unstructured text. Automatic extraction of medical information from these data poses several challenges: high costs of clinical expertise, restricted computational resources, strict privacy regulations, and limited interpretability of model predictions. Recent domain adaptation and prompting methods using lightweight masked language models showed promising results with minimal training data and allow for application of well-established interpretability methods. We are first to present a systematic evaluation of advanced domain-adaptation and prompting methods in a lower-resource medical domain task, performing multi-class section classification on German doctor’s letters. We evaluate a variety of models, model sizes (further-pre)training and task settings, and conduct extensive class-wise evaluations supported by Shapley values to validate the quality of small-scale training data and to ensure interpretability of model predictions. We show that in few-shot learning scenarios, a lightweight, domain-adapted pretrained language model, prompted with just 20 shots per section class, outperforms a traditional classification model, by increasing accuracy from $48.6\%$ to $79.1\%$. By using Shapley values for model selection and training data optimization, we could further increase accuracy up to $84.3\%$. Our analyses reveal that pretraining of masked language models on general-language data is important to support successful domain-transfer to medical language, so that further-pretraining of general-language models on domain-specific documents can outperform models pretrained on domain-specific data only. Our evaluations show that applying prompting based on general-language pretrained masked language models combined with further-pretraining on medical-domain data achieves significant improvements in accuracy beyond traditional models with minimal training data. Further performance improvements and interpretability of results can be achieved, using interpretability methods such as Shapley values. Our findings highlight the feasibility of deploying powerful machine learning methods in clinical settings and can serve as a process-oriented guideline for lower-resource languages and domains such as clinical information extraction projects.

This article analyzes how the multidirectional movement of legal and popular printed texts, newspapers, letters, and citizens contributed to the political and legal influence of individual lawyers across the Atlantic. It is based on a case study of leading common law barrister and Whig MP Thomas Erskine (1750–1823). It examines the dissemination of Erskine's legal and political arguments, and other publications in support of freedom of the press and the constitutional importance of trial by jury in libel trials. Erskine's Country Whig politics, key role in the passage of the 1792 Libel Act, and support for American independence were admired by American lawyers, diplomats, and politicians. His disinterested public service as an advocate meant he personified the ideal of a patriot lawyer that underpinned the classical republican model of law, citizenship, and politics on both sides of the Atlantic. Erskine's powerful, often emotive forensic rhetoric was equally admired as part of a shared transatlantic legal culture, linking law, politics and literature. The speeches were reprinted and widely circulated in edited collections, texts on oratory, trial reports, newspapers, and periodicals; key arguments were also referenced in legal treatises on libel. Hence, parts of his most significant speeches in English libel trials came to be regarded as “usable” legal texts studied by students and re-cited by American defense lawyers in court.

Since US President Donald J. Trump took office in January 2017, the future of the global economy has looked distinctly uncertain. This is not because a process of clear and purposeful change can be said to be underway. Instead, it is because of a pattern of piecemeal, inconsistent and contradictory fragments of policy, both domestic and international in orientation, in the arenas of trade, taxation, business relations, finance and banking, social and welfare provision, immigration, and environmental protection, whose cumulative significance remains unclear. The modest task of this essay is therefore to sketch the contours, patterns, inconsistencies and confusions presented by the Trump administration's approach to shaping the US economy and, by extension, the global economic order, and on that basis to offer an interpretation of its emerging implications for inequality both within the United States and across the world.

This article examines the nature of the emerging regional economic regime in the Americas and argues that the dominant approach to economic governance is one defined by the assertion of U.S. power in the region and oriented toward distinctively U.S. interests and preferences. This has been clearly evident in the evolution of the Free Trade Area of the Americas but also, with the deceleration and fragmentation of that process during 2002 and 2003, in the growing prioritization of bilateralism. The leverage afforded by the bilateral negotiation of trade agreements acts to situate primary influence in shaping the rules that constitute the regional economic regime, and the primary functions associated with governing in this context, firmly within the agencies of the U.S. state. This essay therefore explores how the hegemonic power of the United States manifests itself in the substance of the hemispheric project and the shape of the economic regime associated with it.

The concept of ‘securitization’ has become particularly influential in the post-9/11 world. This paper aims to scrutinize and, ultimately, reject an emerging set of claims about political economy which draw upon this framework. The contention that US foreign economic policy is increasingly subject to a process of securitization misrepresents the substance of contemporary US foreign policy, the political environment in which it is articulated and the process by which it is made. Pursuing this argument, the paper sets out a framework within which to understand the evolution of contemporary US policy, paying attention to distinctive forms of the economic–security nexus; the form of ‘ad hoc reactivism’ that has consistently characterized US foreign economic policy; the set of commercial and wider economic goals to which policy responds; and the dynamics of competition for leadership in key regions.

Primary cerebellopontine angle (CPA) cholesteatoma grows slowly and silently in the subarachnoidal spaces. The diagnosis is often late, when the lesion has reached large dimensions. Surgical removal is the only available therapy. Fifteen consecutive cases of CPA cholesteatoma managed at a tertiary otoneurosurgical referral unit between September 1985 and April 1999 were reviewed. The study population, consisting of seven males and eight females, had a mean age of 44 years of age (range 21–69) at the time of surgery. The clinical, audiological and radiological presentations were examined. The tumours were classified according to the Moffat classification of CPA cholesteatomas. In 67 per cent of cases the presenting symptom was related to the vestibulo-cochlear nerve. The average duration of symptoms was 23 months (ranging from one month–10 years). The hearing preservation approaches were utilized the most (11 cases), while the translabyrinthine approach alone, or in association with a middle fossa craniotomy, was performed in four cases. Tumour removal was total in 12 cases and subtotal in three cases. In cases undergoing hearing preservation surgery the mean pre-operative pure tone average (PTA) for the frequencies 0.5, 1, 2, and 3 kHz was 19.3 dB HL (SD 13.84) and the mean pre-operative speech discrimination score (SDS) was 89.8 per cent (SD 5.97). In 44.4 per cent of patients the hearing was preserved and the mean post-operative PTA was 20.29 dB HL (SD 15.84). In five patients post-operative complications occurred. No peri- or post-operative death occurred in this series, one patient developed a recurrence 15 years after the initial surgery.