The West against the rest? Democracy versus autocracy promotion in Venezuela

Venezuela provides a strong test case for the weakening of democracy and the strengthening of autocracy promotion. External actors are a key part of the domestic political game: the European Union and the United States (EUUS) promote ‘democracy by coercion’ and recognised Juan Guaidó as president, whereas China, Cuba and Russia (CCR) bolster the regime of Nicolás Maduro. A comparative foreign policy analysis argues that, firstly, EUUS sanctions have resulted in strengthening CCR's autocratic leverage and linkage; and secondly, the division ‘between the West and the Rest’ has posed an additional obstacle for a transition to democracy and national reconstructio

Stabilization of global temperature at 1.5°C and 2.0°C: implications for coastal areas

The effectiveness of stringent climate stabilization scenarios for coastal areas in terms of reduction of impacts/adaptation needs and wider policy implications has received little attention. Here we use the Warming Acidification and Sea Level Projector Earth systems model to calculate large ensembles of global sea-level rise (SLR) and ocean pH projections to 2300 for 1.5°C and 2.0°C stabilization scenarios, and a reference unmitigated RCP8.5 scenario. The potential consequences of these projections are then considered for global coastal flooding, small islands, deltas, coastal cities and coastal ecology. Under both stabilization scenarios, global mean ocean pH (and temperature) stabilize within a century. This implies significant ecosystem impacts are avoided, but detailed quantification is lacking, reflecting scientific uncertainty. By contrast, SLR is only slowed and continues to 2300 (and beyond). Hence, while coastal impacts due to SLR are reduced significantly by climate stabilization, especially after 2100, potential impacts continue to grow for centuries. SLR in 2300 under both stabilization scenarios exceeds unmitigated SLR in 2100. Therefore, adaptation remains essential in densely populated and economically important coastal areas under climate stabilization. Given the multiple adaptation steps that this will require, an adaptation pathways approach has merits for coastal areas. This article is part of the theme issue ‘The Paris Agreement: understanding the physical and social challenges for a warming world of 1.5°C above pre-industrial levels’

Comparative Coastal Risk Index (CCRI): A multidisciplinary risk index for Latin America and the Caribbean

As the world's population grows to a projected 11.2 billion by 2100, the number of people living in low-lying areas exposed to coastal hazards is projected to increase. Critical infrastructure and valuable assets continue to be placed in vulnerable areas, and in recent years, millions of people have been displaced by natural hazards. Impacts from coastal hazards depend on the number of people, value of assets, and presence of critical resources in harm's way. Risks related to natural hazards are determined by a complex interaction between physical hazards, the vulnerability of a society or social-ecological system and its exposure to such hazards. Moreover, these risks are amplified by challenging socioeconomic dynamics, including poorly planned urban development, income inequality, and poverty. This study employs a combination of machine learning clustering techniques (Self Organizing Maps and K-Means) and a spatial index, to assess coastal risks in Latin America and the Caribbean (LAC) on a comparative scale. The proposed method meets multiple objectives, including the identification of hotspots and key drivers of coastal risk, and the ability to process large-volume multidimensional and multivariate datasets, effectively reducing sixteen variables related to coastal hazards, geographic exposure, and socioeconomic vulnerability, into a single index. Our results demonstrate that in LAC, more than 500,000 people live in areas where coastal hazards, exposure (of people, assets and ecosystems) and poverty converge, creating the ideal conditions for a perfect storm. Hotspot locations of coastal risk, identified by the proposed Comparative Coastal Risk Index (CCRI), contain more than 300,00 people and include: El Oro, Ecuador; Sinaloa, Mexico; Usulutan, El Salvador; and Chiapas, Mexico. Our results provide important insights into potential adaptation alternatives that could reduce the impacts of future hazards. Effective adaptation options must not only focus on developing coastal defenses, but also on improving practices and policies related to urban development, agricultural land use, and conservation, as well as ameliorating socioeconomic conditions

Domestic elites and external actors in post-conflict democratisation: mapping interactions and their impact

Following the end of the Cold War, post-conflict democratisation has rarely occurred without a significant international involvement. This contribution argues that an explanation of the outcomes of post-conflict democratisation requires more than an examination of external actors, their mission mandates or their capabilities and deficiencies. In addition, there is a need to study domestic elites, their preferences and motivations, as well as their perceptions of and their reactions to external interference. Moreover, the patterns of external–internal interactions may explain the trajectory of state-building and democracy promotion efforts. These issues deserve more attention from both scholars and practitioners in the fields of peace- and state-building, democracy promotion, regime transition and elite research. Analyses of external actors and domestic elites in post-conflict democratisation should therefore address three principal issues: (1) the identification of relevant domestic elites in externally induced or monitored state-building and democratisation processes, (2) the dynamics of external–domestic interactions and (3) the impact of these interactions on the outcomes of post-conflict democratisation

Popliteal pseudoaneurysm after FOLFOX chemotherapy for metastatic colorectal cancer

INTRODUCTION: Popliteal artery aneurysms are a rare occurrence in the general population. We present the case of a male who developed a popliteal artery pseudoaneurysm following chemotherapy for metastatic colorectal cancer. CASE PRESENTATION: A 49-year old male presented with a popliteal artery pseudoaneurysm after completing four two-weekly cycles of FOLFOX chemotherapy. There was no history of infection, knee trauma, inflammatory diseases, or any family history of cardiovascular disease or aneurysms. Examination revealed a tender pulsatile mass in the right popliteal fossa with calf oedema. Computed tomography angiography demonstrated a right popliteal pseudoaneurysm, that was treated with endovascular stent grafting. DISCUSSION: Anecdotal evidence suggests a link between chemotherapy and the rapid development of abdominal aortic aneurysms exists. Aneurysms have been reported following cisplatin and 5-fluorouracil treatment and trans-arterial administration of irinotecan, a key component of chemotherapy. Chemotherapeutic agents have also been shown to compromise the integrity of the vascular wall through apoptosis of endothelial and smooth muscle cells. In our case, the pseudoaneurysm developed acutely after treatment with FOLFOX, therefore a mechanistic association is plausible. CONCLUSION: Differentiating aneurysms as false (pseudo) or true is important to help determine the underlying aetiology. Common causes of pseudoaneurysms include arterial blunt or penetrating trauma. True aneurysms commonly develop from inflammatory atherosclerosis, however mycotic infection, inflammatory arteritis, and entrapment syndrome should be excluded. There may be some evidence to suggest a genetic predisposition to popliteal artery aneurysms. Anecdotal evidence suggests a weak association between chemotherapy and aneurysm progression, warranting further investigation into a causative link

Gesundheitsriskantes Verhalten von Jugendlichen: Tabak- und Alkoholkonsum. In (Hrsg.). (456-457).

Kolip P, Bucksch J. Gesundheitsriskantes Verhalten von Jugendlichen: Tabak- und Alkoholkonsum. In (Hrsg.). (456-457). In: Hoffmann GF, SJ, ZF, Lentze MJ, Spanger J, Zepp F, eds. Pädiatrie. Grundlagen und Praxis. 4.th ed. Berlin: Springer; 2014: 456-457

Case report: Iatrogenic brachial artery dissection with complete anterograde occlusion during elective arterial line placement

INTRODUCTION: Brachial arterial catheters provide a more accurate reflection of central aortic arterial pressure compared to their radial counterparts. Although brachial arterial line complications are uncommon, we report a case of a rare iatrogenic brachial artery dissection with complete anterograde occlusion from elective arterial line placement. PRESENTATION OF CASE: A 41-year-old female presented for a right upper and middle lobe resection of a large neuroendocrine lung cancer. A brachial arterial line was inserted for continuous blood pressure monitoring using clinical landmarks. Six hours postoperatively the left hand was noted to be pale, cool and pulseless with complete paraesthesia. Thrombus was initially suspected on computed tomography angiography. Upon return to theatre, extensive dissection of the posterior brachial arterial wall was identified. CONCLUSION: We review our diagnostic pathway and treatment of this rare complication. Recommendations to minimise the risks of complications from brachial arterial line insertion are also overviewed. We recommend the routine utilization of ultrasound-guided technique and regular post-insertion neurovascular monitoring for the prevention and early recognition of complications from brachial artery catheter insertion