世界経済・社会統計 = World development indicators

Metastasis, the dissemination and growth of neoplastic cells in an organ distinct from that in which they originated, is the most common cause of death in cancer patients. This is particularly true for pancreatic cancers, where most patients are diagnosed with metastatic disease and few show a sustained response to chemotherapy or radiation therapy. Whether the dismal prognosis of patients with pancreatic cancer compared to patients with other types of cancer is a result of late diagnosis or early dissemination of disease to distant organs is not known. Here we rely on data generated by sequencing the genomes of seven pancreatic cancer metastases to evaluate the clonal relationships among primary and metastatic cancers. We find that clonal populations that give rise to distant metastases are represented within the primary carcinoma, but these clones are genetically evolved from the original parental, non-metastatic clone. Thus, genetic heterogeneity of metastases reflects that within the primary carcinoma. A quantitative analysis of the timing of the genetic evolution of pancreatic cancer was performed, indicating at least a decade between the occurrence of the initiating mutation and the birth of the parental, non-metastatic founder cell. At least five more years are required for the acquisition of metastatic ability and patients die an average of two years thereafter. These data provide novel insights into the genetic features underlying pancreatic cancer progression and define a broad time window of opportunity for early detection to prevent deaths from metastatic disease.

SF-010-4 Distant metastasis occurs late during the genetic evolution of pancreatic cancer

Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice

Design Of Observational Studies

Lasting peace after civil war is difficult to establish. One promising way to ensure durable peace is by carefully designing civil war settlements. We use a single theoretical model to integrate existing work on civil war agreement design and to identify additional agreement provisions that should be particularly successful at bringing about enduring peace. We make use of the bargaining model of war which points to commitment problems as a central explanation for civil war. We argue that two types of provisions should mitigate commitment problems: fear-reducing and cost-increasing provisions. Fear-reducing provisions such as third-party guarantees and power-sharing alleviate the belligerents’ concerns about opportunism by the other side. Provisions such as the separation of forces make the resumption of hostilities undesirable by increasing the costs of further fighting. Using newly expanded data on civil war agreements between 1945 and 2005, we demonstrate that cost-increasing provisions indeed reduce the chance of civil war recurrence. We also identify political power-sharing as the most promising fear-reducing provision.

Fostering Peace After Civil War: Commitment Problems and Agreement Design

This research note develops a new explanation of postwar peace duration: periods of peace following wars last longer when the war ends in foreign-imposed regime change. This study tests this hypothesis on a new data set (an expansion of Fortna's ( 2004 ) data) of all periods of peace following interstate war cease-fires, over the period 1914–2001. It also tests for other possible factors affecting postwar peace duration, including international institutions, the revelation of information during war, third-party intervention during war, postwar changes in the balance of power, regime type, past conflict history, and others. The article finds strong support for the central hypothesis that peace lasts longer following wars that end in foreign-imposed regime change. This pacifying effect diminishes over time when a puppet is imposed, but not when a democracy is imposed. There are other results, including that the strength of a cease-fire agreement has almost no impact on peace duration.

Ensuring Peace: Foreign-Imposed Regime Change and Postwar Peace Duration, 1914–2001

Long-term survival following in-hospital cardiac arrest: A matched cohort study

Mortality risk associated with venous thromboembolism: a systematic review and Bayesian meta-analysis.

This article contributes to an understanding of why autocrats have accepted the jurisdiction of the International Criminal Court. Leveraging their ability to obstruct their own prosecution, autocrats have traded off the risk of unwanted prosecutions against the deterrent threat that prosecutions pose to political rivals and patrons of their enemies conspiring to oust them. The risk of unwanted prosecutions and the court's deterrent threat both arise because ICC prosecutions credibly communicate guilt for international crimes to capital-disbursing democracies, which may, insofar as possible, use leader-specific economic statecraft to prevent the administration of foreign states by those whom the court signals are guilty of international crimes. Analysis using fixed effects and matching shows that a greater reliance on capital publicly financed by democracies increased the probability that a state accepted the court's jurisdiction only when it was an autocracy (1998–2017). ICC jurisdiction also lengthened the tenure of autocrats and reduced the severity of civil conflict in autocracies.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/C58360BEB267B1CDEBD18ED5CF54368E/S0020818320000065a.pdf/div-class-title-autocratic-consent-to-international-law-the-case-of-the-international-criminal-court-s-jurisdiction-1998-2017-div.pdf

Autocratic Consent to International Law: the Case of the International Criminal Court’s Jurisdiction, 1998–2017

Trauma is a major cause of morbidity and mortality in the pediatric population. However, temporal variations of trauma have not been well characterized and may have implications for appropriate allocation of hospital resources. Data from patients evaluated at an ACS-verified Level I pediatric trauma center between 2011 and 2015 were retrospectively analyzed. Date and time of injury, type of injury (blunt vs penetrating), and postemergency department disposition were reviewed. To assess temporal trends, heatmaps were constructed and a mixed poisson regression model was used to assess statistical significance. Pediatric trauma from blunt and penetrating injuries occurred at significantly higher rates between the hours of 1800 and 0100, on weekends compared with weekdays, and from May to August compared with November to February. These data provide useful information for hospital resource utilization. The emergency department, operating room, and intensive care unit should be prepared for increased trauma-related volume between May and August, weekends, and evening hours by appropriately increasing staff volume and resource availability.

Barry Hashimoto

Papers

Ensuring Peace: Foreign-Imposed Regime Change and Postwar Peace Duration, 1914–2001

Long-term survival following in-hospital cardiac arrest: A matched cohort study

Mortality risk associated with venous thromboembolism: a systematic review and Bayesian meta-analysis.

Autocratic Consent to International Law: the Case of the International Criminal Court’s Jurisdiction, 1998–2017

Temporal Variations in Pediatric Trauma: Rationale for Altered Resource Utilization.