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The internationalists : how a radical plan to outlaw war remade the world
A bold and provocative history of how an overlooked 1928 treaty was among the most transformative events in modern history. On a hot summer afternoon in 1928, the leaders of the world assembled in Paris to outlaw war. Within the year, the treaty signed that day, known as the Peace Pact, had been ratified by nearly every state in the world. War, for the first time in history, had become illegal the world over. But the promise of that summer day was fleeting. Within a decade of the signing of the Pact, each state that had gathered in Paris to renounce war was at war. And in the century that followed, the Peace Pact was dismissed as an act of folly and an unmistakable failure. This book argues that that understanding is inaccurate, and that the Peace Pact ushered in a sustained march toward peace that lasts to this day. [This book] tells the story of the Peace Pact by placing it in the long history of international law from the seventeenth century through the present. It details the brutal world of conflict the Peace Pact helped extinguish and the subsequent era where tariffs took the place of tanks. Accessible and gripping, this book will change the way we view the history of the twentieth century--and show how we must work together to protect the global order the internationalists fought to make possible.
Book
Proximate Cause Explained
One of the oldest debates in American jurisprudence concerns the concept of \"proximate cause.\" According to so-called formalists, the legal concept of proximate cause is the same as the ordinary concept of \"cause.\" The legal question of whether a cause is proximate for the purposes of establishing tort liability, therefore, is an objective matter about the external world determinable by familiar descriptive inquiry. By contrast, legal realists think that issues of proximate causation are disguised normative questions about responsibility. As the realists William Prosser and W. Page Keeton put it, proximate cause is better called \"responsible cause.\"
Recent work in cognitive science has afforded us new insights into the way people make causal judgments that were unavailable at the time of the original debate between formalists and realists. We now have access to the results of systematic experimental studies that examine the way people ordinarily think about causation and morality. This work opens up the possibility of a very different approach to understanding the role of causation in the law—one which combines the attractive features of both formalism and realism without accepting their implausible consequences.
In addition to providing a model for interpreting the case law of proximate cause, this Article also introduces a new way of doing legal theory—a method we call \"experimental jurisprudence.\" Experimental jurisprudence is the study of jurisprudential questions using empirical methods. Jurisprudential disputes about proximate cause are especially ripe for empirical analysis because the debate revolves around whether the legal concept of proximate cause is the same as the ordinary concept of causation. Interrogating the ordinary concept of causation, therefore, should shed light on this question.
Journal Article
Neurofibromatosis Type 2 (NF2) and the Implications for Vestibular Schwannoma and Meningioma Pathogenesis
Patients diagnosed with neurofibromatosis type 2 (NF2) are extremely likely to develop meningiomas, in addition to vestibular schwannomas. Meningiomas are a common primary brain tumor; many NF2 patients suffer from multiple meningiomas. In NF2, patients have mutations in the NF2 gene, specifically with loss of function in a tumor-suppressor protein that has a number of synonymous names, including: Merlin, Neurofibromin 2, and schwannomin. Merlin is a 70 kDa protein that has 10 different isoforms. The Hippo Tumor Suppressor pathway is regulated upstream by Merlin. This pathway is critical in regulating cell proliferation and apoptosis, characteristics that are important for tumor progression. Mutations of the NF2 gene are strongly associated with NF2 diagnosis, leading to benign proliferative conditions such as vestibular schwannomas and meningiomas. Unfortunately, even though these tumors are benign, they are associated with significant morbidity and the potential for early mortality. In this review, we aim to encompass meningiomas and vestibular schwannomas as they pertain to NF2 by assessing molecular genetics, common tumor types, and tumor pathogenesis.
Journal Article
Outcasting: Enforcement in Domestic and International Law
This Artical offers a new way to understand the enforcement of domestic and international law that we call \"outcasting.\" Unlike the distinctive method that modern states use to enforce their law, outcasting is nonviolent: it does not rely on bureaucratic organizations, such as police or militia, that employ physical force to maintain order. Instead, outcasting involves denying the disobedient the benefits of social cooperation and membership. Law enforcement through outcasting in domestic law can be found throughout history — from medieval Iceland and classic canon law to modern-day public law. And it is ubiquitous in modern international law, from the World Trade Organization to the Universal Postal Union to the Montreal Protocol. Across radically different subject areas, international legal institutions use others (usually states) to enforce their rules and typically deploy outcasting rather than physical force. Seeing outcasting as a form of law enforcement not only helps us recognize that the traditional critique of international law — that it is not enforced and is therefore both ineffective and not real law — is based on a limited and inaccurate understanding of law enforcement. It also allows us to understand more fully when and how international law matters.
Journal Article
International law and its transformation through the outlawry of war
The First World War was the last great war of what we have called the ‘old world order’—the legal regime that European states adopted in the seventeenth century and spent the next three centuries imposing on the rest of the globe. This order formed the basis of what scholars call ‘classical international law’. But this body of rules differed starkly from the ones that govern today: the old world order did not just sanction war, it relied on and rewarded it. States were permitted to wage war to right any legal wrong, and the right of the victors to extract territory and treasure from the losers was legally guaranteed. That all began to change when the nations of the world decided to outlaw war in the 1928 Kellogg–Briand treaty. As a result, the rules governing international behaviour have transformed radically—indeed, they are the polar opposite of what they once were. This article describes the decision to outlaw war and the transformation it unleashed in the world order generally, and in international law specifically. We argue that a simple but perplexing fact—that modern international law prohibits states from using force to enforce international law—is key to understanding international law and state behavior in the modern era.
Journal Article
Speech, Spatial, and Qualities of Hearing Scale and Tinnitus Functional Index Improvements After Cochlear Implant Surgery for Single‐Sided Deafness
Objective Examine improvements in hearing and tinnitus‐related quality‐of‐life metrics that occur after cochlear implant surgery in patients with single‐sided deafness (SSD) and asymmetric hearing loss (AHL). Methods Adult patients undergoing cochlear implant surgery for SSD or AHL during a 2‐year period at a quaternary academic medical center completed the validated survey instruments tinnitus functional index (TFI) and Speech, Spatial, and Qualities of Hearing Scale (SSQ) before surgery, and at least 3 months after cochlear implant activation. Standardized protocols for audiometric assessment were completed pre‐ and postoperatively. Results Twenty‐four patients met inclusion criteria and had complete audiometric and survey data. Overall, composite TFI score improved significantly from a mean severity of 48.2 ± 9.2–18.6 ± 6.53; after cochlear implantation (q = 2.01, p < 0.001) and there was statistically significant improvement in all eight subdomains of the TFI after surgery. The SSQ composite scores significantly improved from a mean of 2.5 ± 0.30–5.07 ± 0.44 after CI (q = 2.01, p < 0.001). All three subdomains of the SSQ improved significantly after cochlear implantation though the magnitude of the changes were higher for Speech Hearing and Spatial Hearing compared with the Qualities of Hearing domain. Conclusions Cochlear implantation surgery in patients with SSD or AHL leads to significant overall improvements in hearing related quality of life, but particularly in the areas of speech understanding, spatial aspects of hearing, and tinnitus severity. Level of Evidence 3 Cochlear implant surgery in patients with single‐sided deafness (SSD) or asymmetrical hearing loss (AHL) leads to statistically significant overall improvements in hearing related quality of life, but particularly in the domains of speech understanding, spatial aspects of hearing, and tinnitus severity. Patients receiving cochlear implants for SSD/AHL also see improvements in the quality of hearing, but this may be less significant than in other aspects. Counseling of SSD/AHL patients regarding expected outcomes of cochlear implantation should incorporate these findings.
Journal Article
Intraoperative detection of isocitrate dehydrogenase mutations in human gliomas using a miniature mass spectrometer
Knowledge of the isocitrate dehydrogenase (IDH) mutation status of glioma patients could provide insights for decision-making during brain surgery. However, pathology is not able to provide such information intraoperatively. Here we describe the first application of a miniature mass spectrometer (MS) to the determination of IDH mutation status in gliomas intraoperatively. The instrumentation was modified to be compatible with use in the operating room. Tandem MS was performed on the oncometabolite, 2-hydroxyglutarate, and a reference metabolite, glutamate, which is not involved in the IDH mutation. Ratios of fragment ion intensities were measured to calculate an IDH mutation score, which was used to differentiate IDH mutant and wild-type tissues. The results of analyzing 25 biopsies from 13 patients indicate that reliable determination of IDH mutation status was achieved (p = 0.0001, using the Kruskal-Wallis non-parametric test). With its small footprint and low power consumption and noise level, this application of miniature mass spectrometers represents a simple and cost-effective platform for an important intraoperative measurement.
Journal Article
346 Temporary Inferior Vena Cava Filter to Prevent Pulmonary Embolism in Thrombophilic Neurosurgery Patients
Abstract
INTRODUCTION:
Patients with symptomatic thrombophilia are treated with therapeutic anticoagulation. These patients can require neurosurgery. The patient must have their anticoagulation reversed before, during, and after surgery. After surgery they must be anticoagulated again. This entails a risk of embolic and hemorrhagic complications. Eighty-seven of these patients underwent neurosurgery between 2003 and 2015. Forty-two had a retrievable inferior vena cava filter before surgery and 45 had no filter placed. We report our results on this novel approach.
METHODS:
Prospective analysis of 87 thrombophilic patients. The author had his thrombophilic patients get an inferior vena cava (IVC) filter before elective spine/cranial surgery. The filter was left in for 2 weeks after surgery and then removed and anticoagulated. Other neurosurgeons did not have a filter placed in their thrombophilic patients. These patients were normalized a few days before surgery and anticoagulated at various time points after surgery. χ2 analysis of the results was performed.
RESULTS:
In the 45 patients with no filter, there were 6 pulmonary embolisms (PEs) of which 3 (10%) died acutely. There were 4 reoperations for spinal/cranial epidural hemorrhage after resumption of anticoagulation. Of the 41 patients with temporary IVC filters placed, there were no PEs, postoperative hemorrhages, or deaths. The filter was removed 2 weeks after surgery, when the patient was ambulatory and therapeutically anticoagulated. In 10, there was clot on the filter at removal. There were no complications due to the filter. χ2 analysis documented a significant reduction in the risk of PE, mortality, and postoperative hemorrhage (P < .01).
CONCLUSION:
A temporary IVC filter in thrombophilic neurosurgery patients is safe and significantly lessens the risk of PE, mortality, and perioperative hemorrhage.
Journal Article
Neurosurgical Education in a Changing Healthcare and Regulatory Environment: A Consensus Statement from 6 Programs
Abstract
The purpose of neurosurgical education is to teach the clinical knowledge and surgical skills necessary to become a neurosurgeon. Another goal is to inculcate the principles of the scientific method. However, increasing expectations about attending involvement during surgery, duty hour requirements, and new curricular mandates have put programs under stress to ensure adequate training, in less time, in an environment of limited resident independence. More recently, the Accreditation Council for Graduate Medical Education has developed a new tracking process based on “milestones” or defined educational outcomes. At the same time, our healthcare system is undergoing a rapid socioeconomic transition in organization and payment models, which traditionally has not been a focus of formal teaching. A 2008 survey conducted by the Council of State Neurosurgical Societies found that graduating residents felt inadequately prepared in areas like contract negotiation, practice evaluation, and management.
Journal Article