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Time to reporting antimicrobial susceptibility testing (AST) results to physicians plays an essential role in antibiotic stewardship programs. Expert software has been developed for facilitating the microbiologists’ AST review process. The reliability of the VITEK®2 Advanced Expert™ software to effectively alert the microbiologist in detection of atypical and inconsistent AST results was assessed at the Labor Berlin—Charite Vivantes services. The results demonstrated a confidence rate of 99.3% in reporting fully consistent AST results to physicians.

Bisphenol A (BPA) is an endocrine-disruptive chemical derived from plastics and epoxies which have been linked to atherosclerosis and obesity. Cardiovascular disease (CVD) also disproportionately affects minority populations. Among environmental toxins, Black Americans are found to have higher BPA levels than the general population. In this study, we assessed the hypothesis that if BPA leads to higher mortality outcomes among individuals with hypertension only in Non-Hispanic Black Americans.From the 2003-2010 National Health and Nutrition Examination Survey, we analyzed data on adults (≥ 20 years), with mortality data obtained through 2015. Hypertension status was determined from medication usage information and self-report status. The causes of death for adults (N=3407) were defined using the International Classification of Disease coding (ICD-10). Urinary BPA levels were considered elevated at ≥1.97 μg/g. Complex Samples Cox Regression was used to assess if BPA levels influence the effect of hypertension on mortality and if this pattern persists across races. Out of the Non-Hispanic Black respondents, 10.5% of males died from hypertension versus 13.1% of females. During the 8.6-year follow-up, the unadjusted hazard ratio (HR) of hypertension to no hypertension for Non-Hispanic Black Adults was 3.22; 95% confidence interval [CI: 2.19-4.75]. The adjusted HR was elevated, 2.98 (CI 1.19-7.46, p = 0.02), among BPA-exposed individuals but closer to 1.0 (1.08 CI 0.45-2.59, p = 0.87) among unexposed individuals, after controlling for medical and demographic risk factors. However, among Non-Hispanic White individuals, increased BPA levels did not significantly influence mortality in those individuals with hypertension. In conclusion, there was increased mortality outcomes among BPA-exposed, Non-Hispanic Black individuals experiencing hypertension than those individuals without hypertension. Due to the chronicity of exposure among environmental hazards, social disparities are compounded over a long period of time. Environmental exposures like BPA should be monitored especially among vulnerable populations and thereby improve hypertension related health outcomes.

Time to reporting antimicrobial susceptibility testing (AST) results to physicians plays an essential role in antibiotic stewardship programs. Expert software has been developed for facilitating the microbiologists' AST review process. The reliability of the VITEK®2 Advanced Expert™ software to effectively alert the microbiologist in detection of atypical and inconsistent AST results was assessed at the Labor Berlin-Charité Vivantes services. The results demonstrated a confidence rate of 99.3% in reporting fully consistent AST results to physicians.

The study of reputation is one of the foundational topics of modern international relations. However, fundamental questions remain, including the question of to whom reputations adhere: states, leaders, or both? We offer a theory of influence‐specific reputations (ISR) that unifies competing accounts of reputation formation. We theorize that reputations will adhere more to actors who are more influential in the relevant decision‐making process. We employ two survey experiments, one abstract and one richly detailed involving a U.S.‐Iran conflict, to evaluate ISR. We find evidence of large country‐specific reputations and moderately sized leader‐specific reputations. Consistent with the theory of influence‐specific reputations, leader‐specific reputations are more important when leaders are more influential.

Japan and South Korea have been locked in a territorial dispute over the islands of Dokdo/Takeshima since the end of wwii. In this essay, we analyze the reasons why the issue has been a thorny issue for such a long time in their bilateral relationship. The calculus of domestic and international benefits and costs of the top decision makers in both countries reveal that neither party is likely to change their current position in the absence of a clear legal focal point, because both will have to come up with a substantial concession in order to achieve a peaceful resolution.

Killer cell immunoglobulin-like receptor (KIR ) genes encode for activating and inhibitory surface receptors, which are correlated with the regulation of Natural Killer (NK) cell cytotoxic activity. Reduced NK cell cytotoxic activity has been consistently reported in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) patients, and KIR haplotypes and allelic polymorphism remain to be investigated. The aim of this article was to conduct a pilot study to examine KIR genotypes, haplotypes, and allelic polymorphism in CFS/ME patients and nonfatigued controls (NFCs). Comparison of KIR and allelic polymorphism frequencies revealed no significant differences between 20 CFS/ME patients and 20 NFCs. A lower frequency of the telomeric A/B motif ( P < 0.05) was observed in CFS/ME patients compared with NFCs. This pilot study is the first to report the differences in the frequency of KIR on the telomeric A/B motif in CFS/ME patients. Further studies with a larger CFS/ME cohort are required to validate these results.

In this article, we argue that international law can help state leaders reach a settlement in territorial disputes by suggesting a focal point for negotiations. International law is more likely to serve as a focal point when the legal principles relevant to the dispute are clear and well established and when one of the states in the dispute has a stronger legal claim to disputed territory. When these two conditions are present, we expect the state with a legal advantage to push for and receive favorable terms of settlement. In our analysis of all negotiated settlements in territorial disputes from 1945 to 2000, we find strong support for the importance of international law in influencing the terms of settlements. States with a strong legal advantage are more likely to secure favorable terms, whereas states lacking a strong legal claim are more likely to receive unfavorable terms.

In this paper, we investigate how international law shapes leaders' decisions regarding the use of force in the context of territorial disputes. We argue that if the legal principles relevant to the dispute are capable of suggesting a focal point, international law will have a powerful role to play in informing leader behavior. Specifically, if a focal point exists, the state that it favors will avoid using force and prefer negotiations when considering an initial challenge to the status quo. However, we expect focal points to have the opposite effect once states are involved in a militarized dispute. Under these circumstances, the state with a legal advantage will be more likely to escalate the level of military force. Using a series of statistical tests, we find strong support for our theoretical argument.

In this article, we explain the role of international law in the resolution of territorial disputes from 1945 to 2000. In doing so, we focus on three outcomes of interest. First, when do states choose to revise the territorial status quo through negotiations instead of force? Second, when are states able to reach a final settlement? Third, when do states prefer a process of legal dispute resolution (i.e., adjudication or arbitration) to bilateral negotiations? To answer these questions, we argue that when the legal principles relevant to the dispute are unambiguous and clearly favor one side, a law-based focal point will emerge. This focal point, in turn, facilitates the settlement process by helping leaders overcome distribution problems, a central obstacle in reaching a final agreement. We find strong and consistent empirical support for our hypotheses regarding international law and peaceful dispute resolution. I s a legal advantage an important source of bargaining leverage for state leaders as they negotiate over security issues in international disputes? Does international law provide the foundation for the peaceful settlement of security-related disputes? In a system defined by anarchy, there are reasons to question whether international law can play a central role in the orderly and peaceful resolution of disputes when security issues are at stake for leaders. Indeed, many would argue that the shadow of military power is an ever-present influence over such bargaining processes and that international law is, therefore, not a viable substitute for military strength and credible threats of force to secure the peace. As a result, although law may have an important role to play in governing international economic relations (e.g., Goldstein, Rivers, and Tomz 2007; Simmons and Hopkins 2005; von Stein 2005; Zangl 2008), where the parties will often have strong incentives to coordinate their behavior, the role of law in settling disagreements over security-related issues is a far more contentious question among scholars and policy makers. In such situations, leaders will often have divergent preferences over how the issue should be resolved, making the identification of a mutually acceptable solution difficult. The security aspect of the dispute compounds this problem because leaders will be reluctant to sign any agreement that they believe might decrease

In this article, we seek to advance the theoretic and empirical literature on the diversionary use of force. We argue that state leaders are more likely to engage in diversionary foreign policy behavior when opposition groups from within the winning coalition press for policy changes, but the government rejects those policy demands. Only when domestic unrest threatens a loss of political support from groups that are politically important to the leadership do we expect leaders to try and rally their support through heightened international conflict. We test this argument in an analysis of Japanese foreign policy behavior from 1890 to 1941 regarding (i) the initiation of military threats, (ii) concessions in negotiations, and (iii) the escalation of military confrontations. Drawing upon new data sets collected on Japanese domestic politics and foreign relations, we find strong support for our argument in a series of statistical tests.

In this paper, we argue that the greater accountability of democratic leaders to their citizens creates powerful pressures on leaders to reduce the human costs of war. In an analysis of a new dataset of fatalities in interstate wars (1900 to 2005) we find that highly democratic states suffer significantly fewer military and civilian fatalities. We argue that democracies limit their war losses primarily by adopting four specific foreign and military policies. First, democracies generate higher military capabilities than nondemocracies in times of war. Second, democracies are more likely to augment their national capabilities by joining more powerful coalitions of states during war. Third, democracies are more likely than other states to utilize battlefield military strategies that minimize their fatalities. Finally, democracies are more likely to fight wars on battlefields that are not contiguous to their home territories, thereby shielding their civilian populations from the fighting.

Territorial disputes are a common source of armed conflict and war, yet, during the twentieth century, governments have resolved dozens of territorial disputes through recourse to international arbitration or adjudication. In this research we consider why governments agree to international legal dispute settlement as a means of resolving territorial disputes. We put forward and test three explanations for the decision to pursue legal dispute settlement: a realist explanation, a domestic “political cover” explanation, and a legal “focal point” explanation. Results obtained from a series of generalized estimating equation (GEE) models reveal considerable support for arguments which highlight the domestic political cover function of international arbitration and adjudication.

We develop and test a general argument about the conditions under which state leaders are most likely to choose legal dispute resolution over bilateral negotiations as a means to settle international disputes. Our central claim is that leaders who anticipate significant domestic audience costs for the making of voluntary, negotiated concessions are likely to seek the “political cover” of an international legal ruling. In such cases, it will be easier for leaders to justify the making of concessions if they are mandated as part of a ruling by an international court or arbitration body. We test a series of domestic-level hypotheses using a dataset comprised of nearly 1,500 rounds of talks concerning disputed territorial claims. Our multivariate analyses indicate that state leaders opt for legal dispute resolution when they are highly accountable to domestic political opposition, as well as when the dispute is highly salient to domestic audiences.

The arrangement and composition of flowpath types within a given network are thought to govern its functioning. This concept assumes that different flowpath types are functionally distinct. We investigated this assumption in a fluvial ecosystem by comparing the riparian zone, parafluvial zone (in-channel gravel bars), and surface stream. We hypothesized that differences in advection, uptake, and sorption would render material cycles more (a) open and (b) mutable in the surface stream, whereas the converse would occur in the riparian zone, and an intermediate state would be seen in the intervening parafluvial zone. To test our first hypothesis, we predicted that spatial heterogeneity in solute concentrations would be least in the surface stream, greater in the parafluvial zone, and greatest in the riparian zone. Using a null model, we ascertained that this pattern was shown by all solute species we examined (nitrate, ammonium, total dissolved inorganic nitrogen [DIN], dissolved organic N, total dissolved N, soluble reactive phosphorus, dissolved organic carbon, and chloride). To test our second hypothesis, we predicted that temporal change in spatial heterogeneity would be greatest in the surface stream, less in the parafluvial zone, and least in the riparian zone. Nitrate, DIN, and chloride showed this pattern. In particular, surface stream inorganic N was less spatially variable following months of high rainfall. According to an extant hypothesis, these results suggest that inorganic N processing may be a stable function in this ecosystem. Other solute species did not support our second prediction, perhaps because their retention and release dynamics are influenced principally by geochemistry. Generally, our findings indicate that a geomorphic template can generate spatial patterns in ecosystem function, warranting an expansion of the spiraling framework to a variety of flowpath types.

Do the international laws of war effectively protect civilian populations from deliberate attack? In a statistical analysis of all interstate wars from 1900 to 2003 the authors find no evidence that signatories of The Hague or Geneva Conventions intentionally kill fewer civilians during war than do nonsignatories. This result holds for democratic signatories and for wars in which both sides are parties to the treaty. Nor do they find evidence that a state's regime type or the existence of ethnic or religious differences between combatants explains the variation in civilian targeting. They find strong support, however, for their theoretical framework, which suggests that combatants seek to kill enemy civilians when they believe that doing so will coerce their adversaries into early surrender or undermine their adversaries' war-related domestic production. The authors find that states fighting wars of attrition or counterinsurgency, states fighting for expansive war aims, and states fighting wars of long duration kill significantly more civilians than states in other kinds of wars.

Civilian suffering from civil war extends well beyond the period of active warfare. We examine longer-term effects in a cross-national analysis of World Health Organization data on death and disability broken down by age, gender, and type of disease or condition. We find substantial long-term effects, even after controlling for several other factors. We estimate that the additional burden of death and disability incurred in 1999 alone, from the indirect and lingering effects of civil wars in the years 1991-1997, was nearly double the number incurred directly and immediately from all wars in 1999. This impact works its way through specific diseases and conditions, and disproportionately affects women and children.

The health of humanity varies enormously: by genetic endowment, environmental conditions, and access to health care; by age, gender, income level, and country.1 Some people live long healthy lives in peace and affluence; many others’ lives are briefer and burdened by major disabilities from disease or injury, and often the characterization “nasty, brutish, and short” is all too apt. Our central claim in this chapter is that politics plays an important role in influencing public health conditions, but unfortunately political scientists and other scholars have only conducted limited systematic research on the topic.2 As a result, the existing literature on the comparative cross-national analysis of the determinants of public health performance is largely based on the work of economists and public health experts in which political processes and conditions are understudied.3 We believe that political scientists can contribute substantially to a better understanding of why public health conditions vary in systematic ways across countries.

A political accountability model is developed to explain how the accountability of incumbent democratic leaders to domestic political opposition influences the diplomatic and military policies of governments. The model is situated within the democratic peace literature and compared with existing theoretical work. Empirically, the hypotheses are tested on a new data set of 348 territorial disputes for the period from 1919 to 1995. Each dispute is divided into three separate stages so that hypotheses about the initiation and outcome of both negotiations and military confrontations, and opposing patterns of war and dispute settlement, can be tested. Results provide strong support for a number of hypotheses concerning the importance of electoral cycles and the strength of opposition parties in explaining patterns of both conflictual and cooperative behavior by democratic states.

We argue that the prevailing dyad-year research design employed in quantitative tests of the theoretical literature on the democratic peace suffers from several limitations. We propose an alternative research design that focuses on three different stages or "games" that typically emerge in the evolution of international disputes over time. In this type of research design the units of observation are the policy choices of "challenger" and "target" states in each of these three games. We argue that this alternative research design has several advantages, such as requiring researchers to test a more complete and extensive set of hypotheses as well as helping them to address statistical issues related to strategic behavior and selection effects.

▪ Abstract The utility of military threats as a means to deter international crises and war has been a central topic of international relations research. Rational choice models have provided the foundation for theorizing about the conditions under which conventional deterrence is likely to succeed or fail. Rational deterrence theorists have focused on four sets of variables: the balance of military forces, costly signaling and bargaining behavior, reputations, and interests at stake. Over the past two decades, scholars have tested propositions from rational deterrence theory utilizing both statistical and comparative case study methods. Although the empirical results from these tests have supported a number of hypotheses derived from the theoretical literature, they have also challenged some theoretical arguments and have sparked vigorous debates about both theory and research designs for conducting empirical research.

The author tests a set of hypotheses about the conditions under which major powers intervene with military support for states that are threatened in a crisis. The hypotheses are derived from a general theoretical approach that integrates a realist framework with recent works that focus on the domestic political determinants of foreign policy. Seven of the eight hypotheses tested are supported by the results of logit analysis on major power interventions in 272 international crises from 1918 to 1988. The broad theoretical implication is that scholars drawing on realist approaches to studying international politics should think rigorously about the role of domestic politics in foreign policy decisions.

A number of chemicals released into the environment have the potential to interfere with physiological and developmental processes by disrupting endocrine pathways. Among the best known of these endocrine disruptors are compounds that mimic the action of the steroid hormone 17β-estradiol. These xenobiotic estrogens are believed to pose health risks to both humans and wildlife. Our laboratories are designing in vivo bioassays for xenobiotic estrogens based on induction of the egg-yolk precursor protein vitellogenin. Vitellogenin is normally produced by the liver of adult female nonmammalian vertebrates under estrogen stimulation. In immature or male animals, which have low levels of endogenous estrogens, vitellogenin can serve as a reliable biomarker for exposure to xenobiotic estrogens. Our model system used the African clawed frog, Xenopus laevis, an ideal species for laboratory screening of endocrine disruptors. Xenopus laevis vitellogenin was purified by diethylaminoethyl (DEAE) chromatography and used to generate polyclonal antibodies in rabbits. The resulting antiserum was used to develop an enzyme-linked immunosorbent assay (ELISA) for measurement of serum vitellogenin. Frogs were exposed to compounds by immersion in order to mimic environmental exposure to aquatic contaminants. Initially, frogs were immersed in the potent estrogenic agent diethyl-stilbestrol (DES) at a concentration of 1 ppm for 11 d to test the efficacy of the immersion protocol. Diethylstilbestrol exposed animals showed substantial induction of serum vitellogenin, indicating that the frogs are capable of responding to estrogenic agents present in their aquatic environment. Vitellogenin induction was then investigated for chlordane, dieldrin, endosulfan, and toxaphene, compounds that have been shown through in vitro assays to be weakly estrogenic when administered individually but more strongly estrogenic in combination. Adult male frogs were immersed in water containing the compounds (1 ppm, 11 d), both singly and in paired combinations. Endosulfan proved toxic at this concentration. Toxaphene- and dieldrin-treated frogs showed significant levels of vitellogenin induction, while chlordane-treated animals did not differ from controls. There was no evidence of a synergistic response between any of the combinations. This research demonstrates the utility of vitellogenin as a biomarker for exposure to estrogenic agents. The assays developed could be used to screen chemicals for estrogenic properties, to test waters for the presence of estrogenic agents, or to assess wildlife exposure to environmental estrogens.

(1997). Reputations and deterrence: A theoretical and empirical assessment. Security Studies: Vol. 7, No. 1, pp. 72-99.

Justifications for war often invoke reputational or social aspirations: the need to protect national honor, status, reputation for resolve, credibility, and respect. Studies of these motives struggle with a variety of challenges: their primary empirical manifestation consists of beliefs, agents have incentives to misrepresent these beliefs, their logic is context specific, and they meld intrinsic and instrumental motives. To help overcome these challenges, this review offers a general conceptual framework that integrates their strategic, cultural, and psychological logics. We summarize important findings and open questions, including (a) whether leaders care about their reputations and status, (b) how to address the tension between instrumental and intrinsic motives, (c) how observers draw inferences, (d) to whom and across what contextual breadth these inferences apply, and (e) how these relate to domestic audience costs. Many important, tractable questions remain for future studies to answer.

The literature on the democratic peace has emerged from two empirical claims: (1) Democracies are unlikely to conflict with one another, and (2) democracies are as prone to conflict with nondemocracies as nondemocracies are with one another. Together these assertions imply that the democratic peace is a dyadic phenomenon. There is strong support for the first observation, but much recent scholarship contravenes the second. This paper assesses whether the democratic peace is a purely dyadic, a monadic, or perhaps a mixed dyadic and monadic effect. Our analysis offers two important advances. First, our model directly compares the dyadic and monadic explanations by using the state as the unit of analysis rather than the potentially problematic dyad. Second, our model controls for an important but overlooked confounding variable: satisfaction with the status quo. Our results indicate that the initiation of violence within crises is predominantly a dyadic phenomenon, but we also find evidence suggesting a strong monadic effect regarding the emergence of crises.

In this paper a set of hypotheses about the conditions under which territorial disputes evolve into enduring rivalries are tested against a dataset of 129 territorial disputes in the international system from 1950-1990. During this period only 36 territorial disputes developed into enduring rivalries. The central theoretical question I address is what conditions cause foreign policy leaders to adopt non-violent and more flexible diplomatic policies over disputed territory and, conversely, when will leaders pursue territorial claims in a more aggressive and confrontational manner? To answer this question I utilize a modified realist approach which posits that foreign policy choices are shaped by the domestic political goal of state leaders to retain their position of political power. From this theoretical approach a series of hypotheses focusing on the issues at stake in control of disputed territory, the domestic political context, and the international political-military environment of challenger states are formulated. Empirical results, based on statistical tests, are then presented and provide considerable evidence of the interplay of domestic and international level variables in the decisions of state leaders whether to pursue territorial goals by means of diplomatic and military pressure over an extended period of time.