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The Use of U.S. Diplomatic Foreign Policy for Conflict Resolution
No full textThis dissertation examines U.S. diplomatic intervention for the purposes of conflict resolution. When are different diplomatic foreign policy tools used effectively? Understanding the effectiveness of U.S. diplomatic foreign policy in conflict resolution requires a multi-pronged approach that takes seriously the role of individual presidents, domestic political constraints and incentives, and the unique efficacy of different types of policy tools.The dissertation uses an empirical approach, combining original observational data sources with survey results and supplementary illustrative case studies. I present the results of a survey of academic experts on the relationship between U.S. presidents and the foreign policy bureaucracy, demonstrating the variation across different administrations in the relationship and conduct of foreign affairs. I also collect and utilize an original dataset on U.S. diplomatic involvement in peace processes (U.S.D.I.P.P. data) in large-N statistical analyses of the president’s choices . A set of original survey experiments provide insight into how the public views foreign policy choices and outcomes. Finally, a set of cross-case comparisons and a case study of George Mitchell as the U.S. Special Envoy to Northern Ireland provide evidence for the efficacy of special envoys as a diplomatic tool.I find that U.S. presidents’ relationship with the foreign policy bureaucracy shape their use of diplomacy for conflict resolution, and also find evidence that the president is motivated by the ability to claim credit for successes and avoid blame for failures. Results suggest that the public does differentially assign credit and blame to the president based on context. I also demonstrate the particular mechanism by which special envoys can be an effective tool of conflict diplomacy. Overall, the dissertation provides a clear picture of the relationship between the U.S. president and executive branch and the conduct of peacemaking. U.S. diplomatic intervention for the purposes of conflict resolution is shaped by the relationship between the president and the foreign policy bureaucracy as well as the president's ability to claim personal political credit and avoid blame for policy failures. This incentive structure also maps onto the specific efficacy of diplomatic foreign policy tools, such as the use of special envoys.</p
Websites or Videos: Which Offer Better Information for Patients? A Comparative Analysis of the Quality of YouTube Videos and Websites for Cosmetic Injectables.
No full textBackgroundYouTube is used by more than 70 percent of adults and 81 percent of 15- to 25-year-olds. The information quality of videos related to the two most performed aesthetic procedures-botulinum toxin type A (Botox) and soft-tissue filler injections-has not been assessed or compared to that of websites.MethodsA YouTube search for "Botox" and "fillers" was performed in July of 2020, identifying the most popular health information videos. Quality was assessed using the validated Journal of American Medical Association, Health on the Net principles, and the DISCERN criteria in addition to a procedure-specific content score. Quality scores were compared between different groups of video contributors and against websites.ResultsA total of 720 measurements of quality were performed across 95 YouTube videos and 85 websites. The mean quality scores were as follows: Journal of the American Medical Association, 1.74/4 ± 0.718; Health on the Net, 6.66/16 ± 2.07; DISCERN, 40.0/80 ± 9.25; and content, 39.1/100 ± 11.9. Physician, nonphysician health professionals, and other (news, magazine channels, and influencers) were all of higher quality than patient-based videos (p ConclusionsImprovement is needed in the quality of YouTube videos related to aesthetic injectables. Plastic surgeons, who are the most frequent video contributors, are most qualified to provide this change. Plastic surgeons should include videos as part of their online presence, as they may help facilitate a greater viewership
Kenneth Burke’s Theory of Attention: Homo Symbolicus’ Experiential Poetics
No full textIn light of cross-disciplinary interest in rethinking the conceptions of attention and attention economy, this paper conducts an archeology of Kenneth Burke’s concepts in order to construct a theory of attention implicit in his work. First, I overview key parts of rhetorical studies highlighting calls for reexamining and developing the idea of attention. Then, I read Burke’s concepts for their implicit attentional aspects and implications. These findings are collected, listed into a glossary, and extrapolated into an account of Burkean attention, which I reframe as “symbol-formed attention” to complement and round out the reigning empirical theories of attention often borrowed from the sciences. I conclude by formalizing a rhetorical idea of attention itself: a terministic screen adaptively re-configurable to situation and strategy. This project is useful for rhetorical analyses, creative engagement with communication, and reforming attention structures via symbols
Optimal surgical care for adolescent idiopathic scoliosis: an international consensus.
No full textPurposeThe surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40° and 90° Cobb angle.MethodsFrom July 2012 to April 2013, the AOSpine Knowledge Forum Deformity performed a modified Delphi survey where current expert opinion from 48 experienced deformity surgeons, representing 29 diverse countries, was gathered. Four rounds were performed: three web-based surveys and a final face-to-face meeting. Consensus was achieved with ≥ 70% agreement. Data were analyzed qualitatively and quantitatively.ResultsConsensus of what constitutes optimal care was reached on greater than 60 aspects including: preoperative radiographs; posterior as opposed to anterior (endoscopic) surgical approaches; use of intraoperative spinal cord monitoring; use of local autologous bone (not iliac crest) for grafts; use of thoracic and lumbar pedicle screws; use of titanium anchor points; implant density of ConclusionsInternational consensus was found on many aspects of what does and does not constitute optimal operative care for adolescents with AIS. In the absence of current high-level evidence, at present, these expert opinion findings will aid health care providers worldwide define appropriate care in their regions. Areas with no consensus provide excellent insight and priorities for future research
Exploring Cancer Stigma Experienced by Pediatric Cancer Patients and Their Caregivers in Mwanza, Tanzania
No full textBackground: Cancer is grossly underreported and underdiagnosed in Africa, as only an estimated 57% of childhood cancers are diagnosed and survival rates for children with cancer are very low; an estimated 20% of children survive cancer in Africa. Several factors can lead to delays in treatment and discontinuing treatment such as lack of knowledge about cancer and negative beliefs or stigma about cancer. The research objective of this paper is to explore the types of stigmas faced by pediatric cancer patients and their families to inform interventions to reduce cancer stigma and increase survival rates of pediatric cancer patients in Tanzania.Methods: The study took place at Bugando Medical Centre (BMC) in Mwanza, Tanzania. The study sample included more than 300 patients who had completed treatment for pediatric cancer at Bugando Cancer Centre. This qualitative study was conducted using structured focus group discussions (FGD) and in-depth interviews (IDI) with patients and caregivers. Data was transcribed and translated into English and NVivo12 was used for qualitative data analysis and coding through an inductive and deductive approach.
Results: The main themes of stigma found in both the FGDs and IDIs were severity of condition, avoidance, financial discrimination, beliefs about causes of cancer and stigma due to physical changes. These themes were found among all age groups and were experienced by both caregivers and patients.
Conclusions: The results and data gathered from this study illustrate that cancer stigma is still an issue faced by pediatric cancer patients and their families. It also illustrates that, although some aspects of stigma have been described and addressed in the literature through adult stigma studies, there are aspects of stigma for pediatric cancer patients specifically that should be addressed. The data gathered here can be used to develop interventions targeted towards cancer stigma for pediatric populations, to reduce cancer stigma and increase survival rates of pediatric cancer patients in Tanzania.</p
Proposal for Increasing Consistency When Incorporating Ecosystem Services into Decision Making
No full textIn October 2015, the U.S. Executive Offices of the President—the Office of Management and Budget, the Council on Environmental Quality, and the Office of Science and Technology Policy—released a memo, “Incorporating Ecosystem Services into Federal Decision Making,” that directed federal agencies to develop work plans and implementation guidance by the end of 2016. But many practical questions remain about how ecosystem services can most effectively be used in decision making. This policy brief explores how to achieve consistency in the use of ecosystem services, primarily in terms of which ecosystem services are selected for assessment and how they are quantified. An initial idea for promoting consistency might be to require all decision makers to consider a common set of ecosystem services, each with a pre-defined metric. Although this strategy might seem logical, it may not provide relevant or useful information for decision makers because even fairly constrained categories of these services—say those for maintaining air and water quality, managing water quantity, and reducing risks from fire, storms, and droughts—when further refined break up into many more services that are defined by who is affected and how they are affected. For example, a water quality management issue results in a change in water quality for downstream stakeholders—which can alter services such as municipal water supplies, irrigation, fishing, swimming, and so on. Each of these services involves different stakeholder populations or beneficiaries. Moreover, each of these services might be more or less relevant in different contexts or regions. The ecosystem services that should be considered in a particular decision depend on the ecosystem type, the attributes and qualities of that ecosystem, the ways in which surrounding human communities use or appreciate the ecosystem, vulnerabilities and characteristics of those communities, and the preferences and values of human beneficiaries in different areas and policy contexts. They also depend on the temporal and spatial scale of the project, plan, program, or policy under consideration. Consequently, achieving consistency in the selection of ecosystem services to be considered is a complex task, as is achieving consistency in quantification of those services across decision contexts
Posterior Polyethylene Tethers Reduce Occurrence of Proximal Junctional Kyphosis After Multilevel Spinal Instrumentation for Adult Spinal Deformity: A Retrospective Analysis.
No full textBackgroundProximal junctional kyphosis (PJK) is a common postoperative complication after adult spinal deformity (ASD) surgery and may manifest with neurological decline, worsening spinal deformity, and spinal instability, which warrant reoperation. Rates of PJK may be as high as 69.4% after ASD surgery.ObjectiveTo evaluate the efficacy of junctional tethers for PJK prophylaxis after multilevel instrumented surgery for ASD with minimum 2-yr follow-up.MethodsSingle-center retrospective analysis of adult patients (age ≥18 yr) who underwent ASD surgery with index operations performed between November 2010 and June 2016 and achieved minimum 2-yr follow-up. Patients with ASD were subdivided into 3 treatment cohorts based on institutional protocol: no tether (NT), polyethylene tether-only (TO), and tether with crosslink (TC). PJK was defined as a proximal junctional angle (PJA) >10° and 10° greater than the corresponding preoperative measurement. Patient demographics, operative details, standard radiographic scoliosis measurements (including PJA and assessment of PJK), and complications were analyzed.ResultsOf 184 patients, 146 (79.3%) achieved minimum 2-yr follow-up (mean = 45 mo; mean age = 67 yr; 67.8% women). PJK rates reported for the NT, TO, and TC cohorts were 60.7% (37/61), 35.7% (15/42), and 23.3% (10/43), respectively. PJK rates among TC patients were significantly lower than NT (P = .01601).ConclusionJunctional tethers with crosslink significantly reduced the incidence of PJK and revisions for PJK among ASD patients treated with long-segment posterior instrumented fusions who achieved minimum 2-yr follow-up
Design, selection, and development of cyclic peptide ligands for human erythropoietin.
No full textThis work presents the selection and characterization of erythropoietin (EPO)-binding cyclic peptide ligands. The sequences were selected by screening a focused library of cyclic depsipeptides cyclo[(Nα-Ac)Dap(A)-X1-X6-AE], whose structure and amino acid compositions were tailored to mimic the EPO receptor. The sequences identified through library screening were synthesized on chromatographic resin and characterized via binding-and-elution studies against EPO to select a pool of candidate ligands. Sequences with higher hydrophobicity consistently showed stronger binding to EPO, with the exception of FSLLSH, which was noted for its lower hydrophobicity and high EPO binding. Mutagenesis studies performed on FSLLSH with natural and non-natural amino acid substitutions led to the identification of critical EPO-binding determinants, and the discovery of new peptide ligands. In particular, histidine-scanning mutagenesis performed on three lead sequences yielded the discovery of variants whose EPO-binding is more pH-sensitive, which facilitates EPO recovery. Selected ligands were studied to correlate the elution yield to the salinity of the binding buffer and the elution pH. Elution yields were consistently higher when EPO binding was performed at low ionic strength. The crystal structures of lead cyclic peptides were docked in silico against EPO to estimate the binding affinity in solution. Isotherm adsorption studies performed on FSLLSH indicated that the cyclic version of the ligand (KD=0.46μM) has a higher affinity for EPO than its corresponding linear variant (KD=1.44μM). Collectively, these studies set the stage for use of the cyclic peptide ligands as EPO purification and detection tools
Operative Versus Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis.
No full textBackgroundThe effectiveness of operative compared with nonoperative treatment at initial presentation (no prior fusion) for adult lumbar scoliosis has not, to our knowledge, been evaluated in controlled trials. The goals of this study were to evaluate the effects of operative and nonoperative treatment and to assess the benefits of these treatments to help treating physicians determine whether patients are better managed operatively or nonoperatively.MethodsPatients with adult symptomatic lumbar scoliosis (aged 40 to 80 years, with a coronal Cobb angle measurement of ≥30° and an Oswestry Disability Index [ODI] score of ≥20 or Scoliosis Research Society [SRS]-22 score of ≤4.0) from 9 North American centers were enrolled in concurrent randomized or observational cohorts to evaluate operative versus nonoperative treatment. The primary outcomes were differences in the mean change from baseline in the SRS-22 subscore and ODI at 2-year follow-up. For the randomized cohort, the initial sample-size calculation estimated that 41 patients per group (82 total) would provide 80% power with alpha equal to 0.05, anticipating 10% loss to follow-up and 20% nonadherence in the nonoperative arm. However, an interim sample-size calculation estimated that 18 patients per group would be sufficient.ResultsSixty-three patients were enrolled in the randomized cohort: 30 in the operative group and 33 in the nonoperative group. Two hundred and twenty-three patients were enrolled in the observational cohort: 112 in the operative group and 111 in the nonoperative group. The intention-to-treat analysis of the randomized cohort found that, at 2 years of follow-up, outcomes did not differ between the groups. Nonadherence was high in the randomized cohort (64% nonoperative-to-operative crossover). In the as-treated analysis of the randomized cohort, operative treatment was associated with greater improvement at the 2-year follow-up in the SRS-22 subscore (adjusted mean difference, 0.7 [95% confidence interval (CI), 0.5 to 1.0]) and in the ODI (adjusted mean difference, -16 [95% CI, -22 to -10]) (p ConclusionsOn the basis of as-treated and MCID analyses, if a patient with adult symptomatic lumbar scoliosis is satisfied with current spine-related health, nonoperative treatment is advised, with the understanding that improvement is unlikely. If a patient is not satisfied with current spine health and expects improvement, surgery is preferred.Level of evidenceTherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence