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\"Neorealists argue that all states aim to acquire power and that state cooperation can therefore only be temporary, based on a common opposition to a third country. This view condemns the world to endless conflict for the indefinite future. Based upon careful attention to actual historical outcomes, this book contends that while some countries and leaders have demonstrated excessive power drives, others have essentially underplayed their power and sought less position and influence than their comparative strength might have justified. Featuring case studies from across the globe, History and Neorealism examines how states have actually acted. The authors conclude that leadership, domestic politics, and the domain (of gain or loss) in which they reside play an important role along with international factors in raising the possibility of a world in which conflict does not remain constant and, though not eliminated, can be progressively reduced\"-- Provided by publisher.

Spread through air spaces (STAS) is reportedly associated with worse prognosis in sublobar resections of lung adenocarcinoma. Recently, it was proposed that STAS detected on frozen sections can be an indication for lobectomy instead of sublobar resection. We undertook this study to evaluate the reliability of STAS assessment on frozen sections compared to permanent sections, as well as the associations among STAS, tumor grade, and recurrence-free survival (RFS) after sublobar resection. A total of 163 stage I lung adenocarcinoma resections with frozen sections were identified retrospectively. For each case, and for frozen and permanent sections separately, the presence or absence of STAS, as well as the tumor grade, were recorded. Compared to permanent sections, STAS detection on frozen sections had low sensitivity (55%), low positive predictive value (48%), and fair agreement ( K  = 0.34), whereas there was higher specificity (80%) and negative predictive value (85%). Accuracy was 74%. Tumor grade assessment on frozen sections showed higher sensitivity (77%), positive predictive value (90%), agreement ( K  = 0.72), specificity (94%), and accuracy (87%), and the same negative predictive value (85%). High-grade histology on frozen sections was associated with shorter RFS ( p  = 0.02), whereas STAS on frozen sections was not ( p  = 0.47). Our results suggest that the intraoperative detection of STAS has low sensitivity and positive predictive value. False-positive results may lead to overtreatment of patients with lung cancer. The determination of tumor grade on frozen sections offers better sensitivity and specificity, plus it is associated with RFS, whereas STAS on frozen sections is not. Further study is needed to explore the utility of assessing tumor grade on frozen sections.

\"The world is composed of molecules. Some are synthetic while many others are products of nature. Molecules That Amaze Us presents the stories behind many of the most famous and infamous molecules that make up our modern world. Examples include the molecule responsible for the spicy heat in chilies (capsaicin), the world's first synthetic painkiller (aspirin), the pigment responsible for the color of autumn leaves (carotene), the explosive in dynamite (nitroglycerine), the antimalarial drug (quinine), the drug known as \"speed\" (methamphetamine), and many others. Other molecules discussed include caffeine, adrenaline, cholesterol, cocaine, digitalis, dopamine, glucose, insulin, methane, nicotine, oxytocin, penicillin, carbon dioxide, limonene, and testosterone. In all, the book includes 67 sections, each describing a different molecule, what it does, how it is made, and why it is so interesting.Written by experts in the field, the book is accessible and easy to read. It includes amusing anecdotes, historical curiosities, and entertaining facts about each molecule, thereby balancing educational content with entertainment. The book is heavily illustrated with relevant photographs, images, and cartoons--the aim being both to educate and entertain. \"-- Provided by publisher.

Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.

Numerous professional bodies have questioned whether traditional input-based continuing professional development (CPD) schemes are effective at measuring genuine learning and improving practice performance and patient health. The most commonly used type of long-established CPD activities, such as conferences, lectures and symposia, have been found to have a limited effect on improving practitioner competence and performance, and no significant effect on patient health outcomes. Additionally, it is thought that the impact of many CPD activities is reduced when they are undertaken in isolation outside of a defined structure of directed learning. In contrast, CPD activities which are interactive, encourage reflection on practice, provide opportunities to practice skills, involve multiple exposures, help practitioners to identify between current performance and a standard to be achieved, and are focused on outcomes, are the most effective at improving practice and patient health outcomes.

\"This exhibition marks the first full museum overview of the work produced by On Kawara after 1963. It has been organized in close collaboration with the artist, who proposed most of the sections that comprise the final structure of the show...\"--Introduction, page 19.

Partition based clustering techniques are widely used in data mining and also to analyze hyperspectral images. Unsupervised clustering only depends on data, without any external knowledge. It creates a complete partition of the image with many classes. And so, sparse labeled samples may be used to label each cluster, and so simplify the supervised step. Each clustering algorithm has its own advantages, drawbacks (initialization, training complexity). We propose in this paper to use a recursive hierarchical clustering based on standard clustering strategies such as K-Means or Fuzzy-C-Means. The recursive hierarchical approach reduces the algorithm complexity, in order to process large amount of input pixels, and also to produce a clustering with a high number of clusters. Moreover, in hyperspectral images, a classical question is related to the high dimensionality and also to the distance that shall be used. Classical clustering algorithms usually use the Euclidean distance to compute distance between samples and centroids. We propose to implement the spectral angle distance instead and evaluate its performance. It better fits the pixel spectrums and is less sensitive to illumination change or spectrum variability inside a semantic class. Different scenes are processed with this method in order to demonstrate its potential.

BackgroundSLE patients present significant challenges in the management of their condition.ObjectivesThis study aims to uncover differences in physician perceptions and real-world treatment patterns and outcomes among moderate to severely active patients in the EU5 (France, Italy, Spain, Germany, and UK).Methods1,279 moderate-to-severe (M/S) adult SLE patient records were collected in collaboration with 289 EU5 rheumatologists via an online survey platform from November 2021 through January 2022.Results22% of moderate-to-severe EU5 SLE patients in the chart audit were receiving belimumab to treat their SLE. In half of those cases where patients were NOT on belimumab they were not considered good candidates for the therapy. The key reason for not initiating belimumab treatment being that patients were “well-controlled” on their current pharmacologic regimen.Closer inspection of these “well-controlled” patients (n=228) at the chart level revealed clinical aspects that highlight a potential gap in patient care:The majority of SLE patients in the “well-controlled” subset had moderately active disease, but over one-in-ten were classified with severe disease.On average, 40% of “well controlled” SLE patients had one or more flares over the past year.One-third of the “well controlled” patient subset suffers from at least one moderate-to-severe manifestation of their SLE, with musculoskeletal, dermatologic, and renal manifestations being most prevalent.29% of “well-controlled” patients have at least one moderate-to-severe symptom of their disease. These include pain/stiffness, fatigue, synovitis, malar rash, photosensitivity, edema, fever, and alopecia.Table 1.SLE Disease SeverityModerateSevere“Well-controlled” patients89%11%SLE Flares (past year)None1 flare2 flares3 flares“Well-controlled” patients60%30%8%2%Severe SLE ManifestationsHas at least one moderate-to-severe manifestation“Well-controlled” patients32%SLE ManifestationModerate-to-Severe Manifestation SeverityMusculoskeletal24%Dermatologic11%Renal6%Pulmonary5%Severe SymptomsHas at least one moderate-to-severe symptom“Well-controlled” patients29%SymptomModerate-to-Severe Symptom SeverityPain, stiffness19%Fatigue16%Synovitis7%Malar rash6%Photosensitivity6%Edema4%Further, one-third of “well controlled” SLE patients are on steroids, with 40% on a higher dose (>5mg/day) to control their disease. The mean overall dosage of the group was 9.4mg/day, a potentially harmful dosage particularly if used long term.Figure 1.ConclusionEU5 physicians’ perception of “well controlled” SLE may not align with some patients’ clinical reality. Use of belimumab or other advanced therapies [1] in these cases may lead to improved patient outcomes and less reliance on steroids, which are often associated with adverse effects, even at low doses [2].References[1]At the time of fielding, anifrolumab had not yet been approved for treatment of SLE in the EU5.[2]European Lupus Society: SLEuro Lupus White Book, 2022 (sleuro.org). “Timely administration of immunosuppressants, either biologics or non-biologics, should be performed for a better control of disease activity coupled with an early steroid sparing effect.”Acknowledgements:NIL.Disclosure of InterestsRyan Rex: None declared, Emily Hettel: None declared, Vibeke Strand Consultant of: AbbVie, Amgen, Aria, AstraZeneca, Bayer, Bioventus, Blackrock, BMS, Boehringer Ingelheim, Celltrion, Chemocentryx, Equillium, Gilead, Genentech/Roche, Glenmark, GSK, Horizon, Inmedix, Janssen, Kiniksa, Kypha, Lilly, Merck, MiMedx, Novartis, Pfizer, Priovant, Regeneron, Rheos, R-Pharma, Samsung, Sandoz, Sanofi, Scipher, Setpoint, Sorrento, Spherix, Tonix, Sawyer May: None declared.