Fraught with friction:Inclusive development for informal workers in urban Ghana

Informal workers are a heterogeneous group distinguished by diverse activities and interests, but they have in common that they operate largely outside state regulations. In this article, we analyse the ways in which informal workers in Ghana are organising (themselves) in response to proposed relocations of their workspace. Borrowing from Tsing, we distinguish three layers of friction that can lead to (structural) change, collective action, and an increase in informal workers' political leverage. Our two case studies in Accra and Kumasi show how striving for inclusive development is a process shaped by diverse agendas and potentially conflicting interests. These relational and political aspects are crucial for understanding the frictions involved, as well as how these may lead to change. Where the tendency is to gloss over these frictions, we argue that they need to be the starting point for effective policies and initiatives for inclusive development

Histologic Heterogeneity of Extirpated Renal Cell Carcinoma Specimens: Implications for Renal Mass Biopsy

Pathologic characteristics of extirpated renal cell carcinoma (RCC) specimens <7 cm were reviewed to get better information on technical nuances of renal mass biopsy (RMB). Specimens were stratified according to tumor stage, nuclear grade, size, histology, presence of lymphovascular invasion (LVI), necrosis, and sarcomatoid features. When considering pT1 (0–7 cm) tumors, pT1b (4–7 cm) RCC masses were more likely to have necrosis (43% vs 16%, P < 0.001), LVI (6% vs 2%, P = 0.024), high-grade nuclear elements (29% vs 17%, P < 0.001), and sarcomatoid features (2% vs 0%, P = 0.006) compared with pT1a (0–4 cm) tumors. Additionally, pT3a tumors were more highly associated with necrosis (P = 0.005), LVI, sarcomatoid features, and high-grade disease (P for all < 0.001) when compared to pT1 masses. For masses ≤ 4 cm, pT3a cancers were more likely to demonstrate necrosis (38% vs 16%, P < 0.001), LVI (22% vs 2%, P < 0.001), high-grade nuclear elements (45% vs 17%, P < 0.001), and sarcomatoid features (12% vs 0%, P < 0.001) compared to pT1a tumors. Similarly, for masses 4–7 cm, pathologic T3a tumors were significantly more likely to have sarcomatoid features (12% vs 2%, P = 0.006) and LVI (22% vs 6%, P = 0.003) compared to pT1b tumors. In summary, pT3a tumors and those RCC masses >4 cm exhibit considerable histologic heterogeneity and may harbor elements that are not easily appreciated with limited renal sampling. Therefore, if RMB is considered for renal masses greater than 4 cm or those that abut sinus fat, a multi-quadrant biopsy approach is necessary to ensure adequate sampling and characterization of the mass

The magical realism of body counts: How media credulity and flawed statistics sustain a controversial policy

The drone war in Pakistan poses humanitarian, legal, ethical and political challenges. The tactic is controversial and has been condemned by the United Nations’ special rapporteur on extrajudicial killings. Yet, polls have shown high support for the tactic in the United States (and to a lesser degree in the United Kingdom). Much of this has to do with the media reporting on the war, which consistently underestimates its human toll. Dubious statistics have sustained the image of a surgical war with little collateral damage. But as this article shows, there are reasons to doubt these numbers. The article argues that two interrelated factors have contributed to a flawed accounting of the war’s human toll: (1) rituals of objectivity that privilege ‘official sources’ and (2) fetishizing of statistics as hard facts without regard for the underlying data. The coverage has also been distorted by news values that downplay or ignore deaths in distant places unless they cross an inordinately high threshold

Deciding on appropriate use of force: human-machine interaction in weapons systems and emerging norms

This article considers the role of norms in the debate on autonomous weapons systems (AWS). It argues that the academic and political discussion is largely dominated by considerations of how AWS relate to norms institutionalised in international law. While this debate on AWS has produced insights on legal and ethical norms and sounded options of a possible regulation or ban, it neglects to investigate how complex human-machine interactions in weapons systems can set standards of appropriate use of force, which are politically-normatively relevant but take place outside of formal, deliberative law-setting. While such procedural norms are already emerging in the practice of contemporary warfare, the increasing technological complexity of AI-driven weapons will add to their political-normative relevance. I argue that public deliberation about and political oversight and accountability of the use of force is at risk of being consumed and normalised by functional procedures and perceptions. This can have a profound impact on future of remote-warfare and security policy

Endothelial Membrane Remodeling Is Obligate for Anti-Angiogenic Radiosensitization during Tumor Radiosurgery

While there is significant interest in combining anti-angiogenesis therapy with conventional anti-cancer treatment, clinical trials have as of yet yielded limited therapeutic gain, mainly because mechanisms of anti-angiogenic therapy remain to a large extent unknown. Currently, anti-angiogenic tumor therapy is conceptualized to either "normalize" dysfunctional tumor vasculature, or to prevent recruitment of circulating endothelial precursors into the tumor. An alternative biology, restricted to delivery of anti-angiogenics immediately prior to single dose radiotherapy (radiosurgery), is provided in the present study.Genetic data indicate an acute wave of ceramide-mediated endothelial apoptosis, initiated by acid sphingomyelinase (ASMase), regulates tumor stem cell response to single dose radiotherapy, obligatory for tumor cure. Here we show VEGF prevented radiation-induced ASMase activation in cultured endothelium, occurring within minutes after radiation exposure, consequently repressing apoptosis, an event reversible with exogenous C(16)-ceramide. Anti-VEGFR2 acts conversely, enhancing ceramide generation and apoptosis. In vivo, MCA/129 fibrosarcoma tumors were implanted in asmase(+/+) mice or asmase(-/-) littermates and irradiated in the presence or absence of anti-VEGFR2 DC101 or anti-VEGF G6-31 antibodies. These anti-angiogenic agents, only if delivered immediately prior to single dose radiotherapy, de-repressed radiation-induced ASMase activation, synergistically increasing the endothelial apoptotic component of tumor response and tumor cure. Anti-angiogenic radiosensitization was abrogated in tumors implanted in asmase(-/-) mice that provide apoptosis-resistant vasculature, or in wild-type littermates pre-treated with anti-ceramide antibody, indicating that ceramide is necessary for this effect.These studies show that angiogenic factors fail to suppress apoptosis if ceramide remains elevated while anti-angiogenic therapies fail without ceramide elevation, defining a ceramide rheostat that determines outcome of single dose radiotherapy. Understanding the temporal sequencing of anti-angiogenic drugs and radiation enables optimized radiosensitization and design of innovative radiosurgery clinical trials

‘Gatekeepers’ of Islamic financial circuits: Analysing urban geographies of the global Shari’a elite

This paper analyses the importance of 'Shari'a scholars' in the Islamic Financial Services (IFS) sector, which has been a growing global practice since the 1970s. Based on Shari'a Law, IFS firms provide banking, finance and insurance respecting faith-based prohibitions on interest, speculation and risk taking. Although IFS firms operate across a variety of scales and involve a range of actors, this paper focuses on the transnational capacities of Shari'a experts employed by IFS firms. These scholars use their extensive knowledge of Shari'a Law to assess the 'Islamic' character of a firm's operations, and assist the development of Shari'a-compliant products. As they embody necessary entry-points into Islamic circuits of knowledge and authority, members of what we dub the 'global Shari'a elite' can be regarded as 'gatekeepers' of Islamic financial circuits. Drawing on a comprehensive data source we present a geographical analysis of Shari'a board membership, nationality and educational background of 253 Shari'a scholars. The results show that the global Shari'a elite connects a limited number of IFS hubs (e. g. Dubai, Kuala Lumpur, Kuwait City, Manama, and London) to knowledge and authority networks falling outside 'mainstream' business and service spheres

Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer: can oncologic outcomes be improved with multimodality therapy?

Purpose To report the outcomes of patients with pathologic T4 UTUC and investigate the potential impact of peri-operative chemotherapy combined with radical nephroureterectomy (RNU) and regional lymph node dissection (LND) on oncologic outcomes. Materials and Methods Patients with pathologic T4 UTUC were identified from the cohort of 1464 patients treated with RNU at 13 academic centers between 1987 and 2007. Oncologic outcomes were stratified according to utilization of perioperative systemic chemotherapy and regional LND as an adjunct to RNU. Results The study included 69 patients, 42 males (61%) with median age 73 (range 43-98). Median follow-up was 17 months (range: 6-88). Lymphovascular invasion was found in 47 (68%) and regional lymph node metastases were found in 31 (45%). Peri-operative chemotherapy was utilized in 29 (42%) patients. Patients treated with peri-operative chemotherapy and RNU with LND demonstrated superior oncologic outcomes compared to those not treated by chemotherapy and/or LND during RNU (3Y-DFS: 35% vs. 10%; P = 0.02 and 3Y-CSS: 28% vs. 14%; P = 0.08). In multivariate Cox regression analysis, administration of peri-operative chemotherapy and utilization of LND during RNU was associated with lower probability of recurrence (HR: 0.4, P = 0.01), and cancer specific mortality (HR: 0.5, P = 0.06). Conclusions Pathological T4 UTUC is associated with poor prognosis. Peri-operative chemotherapy combined with aggressive surgery, including lymph node dissection, may improve oncological outcomes. Our findings support the use of aggressive multimodal treatment in patients with advanced UTUC

Subcortical surface morphometry in substance dependence: An ENIGMA addiction working group study

While imaging studies have demonstrated volumetric differences in subcortical structures associated with dependence on various abused substances, findings to date have not been wholly consistent. Moreover, most studies have not compared brain morphology across those dependent on different substances of abuse to identify substance‐specific and substance‐general dependence effects. By pooling large multinational datasets from 33 imaging sites, this study examined subcortical surface morphology in 1628 nondependent controls and 2277 individuals with dependence on alcohol, nicotine, cocaine, methamphetamine, and/or cannabis. Subcortical structures were defined by FreeSurfer segmentation and converted to a mesh surface to extract two vertex‐level metrics—the radial distance (RD) of the structure surface from a medial curve and the log of the Jacobian determinant (JD)—that, respectively, describe local thickness and surface area dilation/contraction. Mega‐analyses were performed on measures of RD and JD to test for the main effect of substance dependence, controlling for age, sex, intracranial volume, and imaging site. Widespread differences between dependent users and nondependent controls were found across subcortical structures, driven primarily by users dependent on alcohol. Alcohol dependence was associated with localized lower RD and JD across most structures, with the strongest effects in the hippocampus, thalamus, putamen, and amygdala. Meanwhile, nicotine use was associated with greater RD and JD relative to nonsmokers in multiple regions, with the strongest effects in the bilateral hippocampus and right nucleus accumbens. By demonstrating subcortical morphological differences unique to alcohol and nicotine use, rather than dependence across all substances, results suggest substance‐specific relationships with subcortical brain structures