The Normative Agency of Regional Organizations and Non‐governmental Organizations in International Peace Mediation

This article analyzes the increasingly prominent role of regional organizations (ROs) and non‐governmental organizations (NGOs) in promoting norms in mediation processes. In particular, we seek to understand the processes by which RO and NGO mediators promote the inclusivity norm to negotiating parties and the outcomes that result. We employ the concepts of local agency and social practices in examining the normative agency of ROs and NGOs in promoting and redefining the inclusivity norm. Through illustrative case studies of peace processes in South Sudan and Myanmar, we argue that ROs’ and NGOs’ mediation practices reflect their claims to alternative resources of power, such as long‐standing expertise and insider status in the context, and build congruence with strong local norms. We provide nuanced theoretical insights on RO and NGO mediators’ claims to agency and provide empirical illustrations on how these claims contribute to constitutive changes to norms

Political Transitions and Macro-level Foundations of Political Stability

Why do some political transitions end peacefully while others give rise to instability and conflict? Starting from the\u2018Third Wave\u2019of democratization in the Seventies, an optimist outlook has traditionally accompanied the demise of authoritarian regimes, and the idea of\u2018exporting democracy\u2019possibly represents the peak of such position. Yet, conflicts that ensued the end of the Communist bloc, failed transitions in Sub-Saharan Africa, and post-regime change in Afghanistan and Iraq in the new century, showed that authoritarian regimes\u2019crises can lead to further instability. Through a newly-compiled database of political transitions and crises embracing the period 1975\u20132009, this contribution shows the relative impact of domestic social, economic and political factors, as well the role of international action. The piece also contributes to the analysis of\u2018stability\u2019through a macro, large-N perspective, fostering dialogue between qualitative and quantitative research agendas on the topic

Autonomic dysreflexia caused by cervical stenosis

IntroductionAutonomic dysreflexia (AD) is a well-known sequela of high spinal cord injuries (SCI). The characteristic episodic presentation is one of increased sympathetic tone: diaphoresis, hypertension, tachycardia, or reflex bradycardia. The episodes are triggered by visceral sensations and can last days to weeks.Case presentationThis report presents the case of a 73-year-old male with cervical stenosis, with a longstanding history of "hot flashes" accompanied by dizziness, flushing and diaphoresis, and palpitations. The patient was evaluated extensively by cardiology, endocrinology, and neurology with no treatable pathology determined aside from the patient's cervical stenosis. The patient was diagnosed with autonomic dysreflexia caused by cervical spinal stenosis and underwent anterior cervical decompression and fusion (ACDF) at the stenotic C5-C6 level. He found near complete resolution of his autonomic symptoms.DiscussionWe hypothesize that the cervical compression caused a disruption in the regulatory control of the sympathetic preganglionic neurons resulting in the autonomic symptoms. Although numerous studies exist of patients with a traumatic onset of AD, to the best of our knowledge, this is the first case report in the literature of autonomic symptoms that stemmed from cervical stenosis. The purpose of this case report is to alert clinicians to a potential association between AD and spinal stenosis, which may exist outside the realm of SCI

Trends in mechanical thrombectomy and decompressive hemicraniectomy for stroke: A multicenter study

Acute ischemic stroke has increasingly become a procedural disease following the demonstrated benefit of mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) on clinical outcomes and tissue salvage in randomized trials. Given these data and anecdotal experience of decreased numbers of decompressive hemicraniectomies (DHCs) performed for malignant cerebral edema, we sought to correlate the numbers of strokes, thrombectomies, and DHCs performed over the timeline of the 2013 failed thrombolysis/thrombectomy trials, to the 2015 modern randomized MT trials, to post-DAWN and DEFUSE 3. This is a multicenter retrospective compilation of patients who presented with ELVO in 11 US high-volume comprehensive stroke centers. Rates of tissue plasminogen activator (tPA), thrombectomy, and DHC were determined by current procedural terminology code, and specificity to acute ischemic stroke confirmed by each institution. Endpoints included the incidence of stroke, thrombectomy, and DHC and rates of change over time. Between 2013 and 2018, there were 55,247 stroke admissions across 11 participating centers. Of these, 6145 received tPA, 4122 underwent thrombectomy, and 662 patients underwent hemicraniectomy. The trajectories of procedure rates over time were modeled and there was a significant change in MT rate (  = 0.002) without a concomitant change in the total number of stroke admissions, tPA administration rate, or rate of DHC. This real-world study confirms an increase in thrombectomy performed for ELVO while demonstrating stable rates of stroke admission, tPA administration and DHC. Unlike prior studies, increasing thrombectomy rates were not associated with decreased utilization of hemicraniectomy