The Road to Total War - Anglo-German Rivalry, 1880-1914

This thesis is an analysis of the growing Anglo-German rivalry over the years between 1880 and 1914, leading up to the First World War. It discusses several aspects of the competition, from economic and strategic, to cultural and social, to political and diplomatic. The main argument is that the peacetime antagonism between Britain and Germany was as total as the war which it helped to bring about. The rivalry was ubiquitous, being reflected in all facets of society and geopolitical relations. It was unique in its rancorous quality and omnipresence on the global stage. It evolved over the period from amity to enmity, operating in a self-reinforcing manner that drove further resentment. Unlike other Great Power competitions of the age, it linked domestic and foreign affairs, as well as European and imperial concerns. Both empires borrowed from one another, yet simultaneously viewed the other as its greatest threat; the dynamic of thesis and antithesis was constantly present. The thesis explores the relationship through a variety of frameworks, and discusses the similarities between the two powers which heightened the sense of hostility and danger. The two imperialisms are compared across a wide spectrum, touching on their motivations, methods, and ideologies. Most importantly, both Britain and Germany developed an ‘imperial synthesis’ of commerce and strategy which was foundational to their imperial ideologies. In Britain, this was seen in the liberal world system centered on London that had existed throughout the Victorian and Edwardian eras. In Germany, this was the Weltpolitik of Kaiser Wilhelm II, Bernhard von Bülow, and Alfred von Tirpitz. The similarities of these imperial approaches caused strife between the powers and led to the total rivalry which presaged total war. Exacerbating factors which reinforced the antagonism are discussed as well. Politicians in both countries used the imperial rivalry as fodder for domestic political campaigns, heightening and cementing the hostility in the public mind. That popular opinion would also be stoked by jingoistic press campaigns and political pressure groups which sought world hegemony and ever-increasing imperial strength. Imperial anxieties within each population contributed to the ramping up of the feeling of threat emanating from the rival power. The thesis explores these anxieties as seen through the lens of historical comparisons, paranoia about weakness, and popular culture, notably the poetry of Rudyard Kipling and the genre of fiction known as ‘invasion literature’. The thesis gives many concrete examples of the operation of the Anglo-German rivalry in practice, centering on the realm of infrastructure. It delves into the details of maritime infrastructure (canals and ports), railways, and the nascent field of telecommunications (both wired and wireless). These projects spanned from Latin America and Africa to the Ottoman Empire, China, and the South Pacific. The pervasive and intense competition between Britain and Germany is clearly exhibited through the prism of dual-use commercial-strategic infrastructure projects. This infrastructure serves as a microcosm of the overall relationship, and weaves into many of the pre-war crises which brought the total peacetime rivalry into a total war

Cut-sets and Cut-vertices in the Zero-Divisor Graph of ∏Zni

We examine minimal sets of vertices which, when removed from a zero-divisor graph, separate the graph into disconnected subgraphs. We classify these sets for all direct products of Γ ∏Zn

One transition, many transitions? A corpus-based study of societal sustainability transition discourses in four civil society’s proposals

When the civil society makes ‘transition’ its label, it cannot be assumed that different civil society actors share compatible varieties of localist or radical transformationists discourses. This study has comparatively analyzed the discourses in four civil society sustainability transition proposals using a corpus-based methodology. We found that the proposals are similar as they identify the economy as an object and an entry point for transition, frame the economy as embedded in the socio–ecological system, ascribe agency to grassroots movements for transitions from the bottom–up. We also found crucial differences among the discourses regarding the role of the State, the degree of reform or radical innovation, the degree of imaginative character of the sustainability vision, the degree of opposition to capitalism. We suggest that insights on how the civil society employs notions of transition with respect to the themes of politics, emotions and place can help advance theorizations and practices of societal sustainability transitions led by the civil society

Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring

Photoplethysmography (PPG) is a low-cost, noninvasive optical technique that uses change in light transmission with changes in blood volume within tissue to provide information for cardiovascular health and fitness. As remote health and wearable medical devices become more prevalent, PPG devices are being developed as part of wearable systems to monitor parameters such as heart rate (HR) that do not require complex analysis of the PPG waveform. However, complex analyses of the PPG waveform yield valuable clinical information, such as: blood pressure, respiratory information, sympathetic nervous system activity, and heart rate variability. Systems aiming to derive such complex parameters do not always account for realistic sources of noise, as testing is performed within controlled parameter spaces. A wearable monitoring tool to be used beyond fitness and heart rate must account for noise sources originating from individual patient variations (e.g., skin tone, obesity, age, and gender), physiology (e.g., respiration, venous pulsation, body site of measurement, and body temperature), and external perturbations of the device itself (e.g., motion artifact, ambient light, and applied pressure to the skin). Here, we present a comprehensive review of the literature that aims to summarize these noise sources for future PPG device development for use in health monitoring

Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice.

BACKGROUND & AIMS: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence. METHODS: We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs. RESULTS: By the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate). CONCLUSIONS: In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416

Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice.

BACKGROUND & AIMS: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence. METHODS: We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs. RESULTS: By the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate). CONCLUSIONS: In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416

Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass

Background and Aims The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases yet standard ERCP is not possible due to surgically altered gastroduodenal anatomy. Laparoscopic-ERCP (LA-ERCP) has been proposed as an option but supporting data are derived from single center small case-series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. Methods This is retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all of the following were achieved: reaching the papilla, cannulating the desired duct and providing endoscopic therapy as clinically indicated. Results A total of 579 patients (median age 51, 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (IQR 109-210) with median ERCP time 40 minutes (IQR 28-56). Median hospital stay was 2 days (IQR 1-3). Adverse events were 18% (laparoscopy-related 10%, ERCP-related 7%, both 1%) with the clear majority (92%) classified as mild/moderate whereas 8% were severe and 1 death occurred. Conclusion Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher due to the added laparoscopy-related events