American Experts Research Articles

Latin American consensus on the treatment of melasma.

Melasma is a chronic, relapsing hyperpigmentation disorder that primarily affects photoexposed areas, occurring most frequently in adult women with darker skin phototypes. The primary factors contributing to its development include sun exposure, sex hormones (e.g., pregnancy), and genetic predisposition. Melasma is highly prevalent in Latin America, where many countries lie in intertropical zones and exhibit significant ethnic diversity because of centuries of intermixing among Native Americans, Europeans, and Sub-Saharan Africans. Nine Latin American experts formulated a DELPHI-based consensus to develop a valuable approach for treating melasma in this diverse population. After establishing an accurate diagnosis, assessing the impact on quality of life, and determining disease severity, the consensus recommends mitigating known triggers and promoting rigorous photoprotection. Active therapy should be tailored based on individual characteristics (e.g., pregnancy status, previous treatments, skin sensitivity). Treatment options include topical depigmenting agents, systemic therapies, and procedural interventions such as laser therapy, microneedling, and chemical peels. Periodic reassessment of the treatment is essential, with strategies adjusted if targeted outcomes are not achieved. Once clinical remission is attained, patients should continue using topical depigmenting agents and maintain strict photoprotection measures to prevent recurrence.

‘For the Farmers of the Country’: Indian Agricultural Universities at the Cusp of Nation-Building Plans and the Cold War, 1947–67

Agricultural universities are integral to the history of modern India. The aspiration of the Indian state to be economically and socially modern is coincident with the origin of agricultural universities. This paper explores the making of agricultural universities from the Radhakrishnan Committee to the New Agricultural Strategy and shows their connections to the political and economic needs of the nation. Also, the Cold War imperatives encouraged American involvement in India’s agricultural reforms. However, this paper argues that neither the Indian state nor the American experts determined the evolution of these institutes as per their developmental goals. Geopolitical events, like the Partition, the Union-state relationship and the history of marginalisation of agricultural scientists combined and produced varying dynamics. It is within these historical contexts that the paper has analysed the growth trajectory of agricultural institutions, with particular reference to the Punjab Agricultural University—the pivot of the agricultural modernisation programme.

Evaluation of Long-term Antithrombotic Management for Atrial Fibrillation Patients with a History of Coronary Stent Implantation

Purpose: American expert consensus publications recommend discontinuation of antiplatelet agents 6 to 12 months after Percutaneous Coronary Intervention (PCI) in patients with Atrial Fibrillation (AF) who require chronic anticoagulation, and use of oral anticoagulant monotherapy thereafter. This study aimed to assess real-world long-term antithrombotic therapy management practices and factors associated with the continuation of antiplatelet agents past 12 months post-PCI in patients with AF requiring chronic anticoagulation. Methods: Patients with AF and a history of PCI greater than 12 months before their most recent encounter with physicians at an outpatient electrophysiology clinic were identified by chart review. Patient demographics, clinical characteristics, and current antithrombotic regimen were collected from encounters that occurred between July 2019 and June 2022. The independent predictive factors associated with the continuation of antiplatelet agents were identified using univariate and regression analyses. Results: Out of 66 patients, 67% continued antiplatelet therapy for greater than 12 months post-PCI. Patients on antiplatelets were significantly less likely to have bare metal stents (p = 0.006), be greater than five years post-PCI (p = 0.002), and have a HASBLED score of two or less (p = 0.028) when compared to patients on oral anticoagulant monotherapy. Bare metal stent history (p = 0.045) and HASBLED score of two or less (p = 0.016) were also significant in regression analysis. Conclusion: This study found that most patients with AF and a history of PCI continued antiplatelet therapy longer than 12 months post-PCI, often despite the high bleeding risk.

One becomes three: An integrative morphological and molecular analysis of the windowpane oyster Placuna (Bivalvia: Pectinida) reveals new species.

For decades, many marine animals have been considered to exhibit cosmopolitan or transoceanic distribution. This situation is prevalent in Asia, where many species were collected and named by American or European experts in the 1700s to early 1900s. Using the windowpane oysters Placuna-a small genus of bivalves with five recognized species-we show that careful analysis is required to reassess the validity of these species. Currently, only two species of Placuna (P. placenta and P. ephippium) widely reported in the Indo-Pacific region have been recorded from Chinese coastal waters. Here, we described two new species of Placuna from China. Placuna vitream sp. nov. can be distinguished from P. placenta by its larger ridge angle. Phylogenetic analysis using five gene fragments fully supported that P. vitream sp. nov. is a sister to the specimen from Singapore identified as P. placenta and more distant from other Placuna species with available molecular data. Besides, based on subfossil shells, we describe Placuna aestuaria sp. nov. that differs from its congeneric species by its broad hinge, medium ridge angle, and nearly straight ridges. Finally, we suggest a combination of hinge structure and ridge angle that can be used for identifying Placuna species and preparing a key to this genus. Our findings of two new species expand the diversity of Placuna and prompt reassessment of the many presumably widely distributed marine species in Asia.

North American Expert Consensus on the Post-procedural Care of Patients After Per-oral Endoscopic Myotomy Using a Delphi Process

There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process. A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management. A total of 34 experts participated in the 2 rounds of the Delphi process, with quantitative and qualitative data analyzed for each round to achieve consensus. A total of 23 statements achieved a high degree of consensus. Overall, the expert panel agreed on the following: (1) same-day discharge after POEM can be considered in select patients; (2) a single dose of prophylactic antibiotics may be as effective as a short course; (3) a modified diet can be advanced as tolerated; and (4) all patients should be followed in clinic and undergo objective testing for surveillance and management of reflux. Consensus could not be achieved on the indication of post-POEM esophagram to evaluate for leak. The results of this Delphi process established expert agreement on several important issues and provides practical guidance on key aspects in the care of patients following POEM.

NATO enlargement to the East and the war in Ukraine from the American perspective

The aim of the article is to analyze the legitimacy of justifying the outbreak of war in Ukraine by expanding NATO to the East after the Cold War. The study was conducted from the American perspective. The main research problem is the question of whether, from the point of view of American scholars and experts, post-Cold War NATO expansion to the East was a strategic mistake and was responsible for the current war in Ukraine. There is no consensus among them whether NATO enlargement after the Cold War was an error and led to Russian aggression in Ukraine. Most of them, however, dispute such a statement, rejecting Moscow’s accusations that the United States and the West are accountable for the current situation in Ukraine.

Type 2 diabetes in latin America: recommendations on the flash glucose monitoring system

ObjectiveTo establish recommendations through the consensus of a Latin American experts panel on the use of the flash glucose monitoring system (fCGM) in people living with type 2 diabetes mellitus (T2DM) regarding the benefits and challenges of using the fCGM.MethodsAn executive committee of experts was created, comprised by a panel of fifteen physicians, including endocrinologists and internal medicine physicians, with expertise in management of adult patients with T2DM. The experts were from various countries: Colombia, Chile, Peru, Mexico, Argentina, and Brazil. The modified Delphi method was used, considering a consensus level of at least 80% of the participants. A seventeen-item instrument was developed to establish recommendations on the use of fCGM in patients with T2DM in Latin American.ResultsThe number of glucose scans recommended per day with the fCGM for patients managed with oral antidiabetic drugs or basal insulin was a median of 6 scans per day, and for those managed with multiple insulin doses, a median of 10 scans per day was recommended. Additionally, a holistic and individualized management approach was recommended, taking into account new treatment directions and identifying patients who would benefit from the use of the fCGM.ConclusionContinuous use of the fCGM is recommended for people living with T2DM, regardless of their type of treatment. These metrics must be evaluated individually for each patient profile.

Development of Institutional Arbitration in Spain

INTRODUCTION. The development of the statuto­ry regulation of institutional arbitration in Spain has been briefly outlined at the present study. The legal status of arbitral institution, the legal nature of its rights, obligations and liabilities have been examined. The role of arbitral institutions at the current arbitra­tion situation in Spain has been briefly outlined.MATERIALS AND METHODS. The study has been based upon Spanish legislation, key judicial acts and works of Spanish and Latin American experts in the field. General scientific methods of knowledge – analy­sis, synthesis, induction and deduction – have been applied during the study. Special legal methods – for­mal-legal, technical-legal, the method of legal analogy, as well as the comparative legal method – have been also applied.RESEARCH RESULTS. The study demonstrates three factors which obstacle a full-scale development of institutional arbitration in Spain. The first factor is that the commercial arbitration itself has been a new phenomenon and it has been still unknown to the most of the Spanish population except a rather narrow community of professionals. As a consequence, the most of Spanish business community members put their best faith upon the judicial way of disputes reso­lution. As another consequence, confidentiality of pro­ceedings and absence of appellation remedy have been treated rather as weaknesses than advantages of arbi­tration. The second factor is that there has been a deep-rooted point of view across Spanish business and lawyers communities that an arbitrator is rather legal representative of the party he has been appointed by. Which provokes reasonable doubts regarding inde­pendence and impartiality not only of an arbitrator, but an arbitral institution as well. The both factors outcome a low number of arbitrations in Spain and activate the third one. The third factor is a rather low level of competence of arbitrators and arbitral institu­tions staff due to the lack of practice. The study dem­onstrates significant efforts of the leading Spanish ar­bitral institutions in order to eliminate the factors.DISCUSSION AND CONCLUSIONS. The devel­opment of the statutory regulation of institutional ar­bitration in Spain has been briefly outlined. The legal status of arbitral institution, the legal nature of its rights, obligations and liabilities have been examined. The role of arbitral institutions at the current arbitra­tion situation in Spain has been briefly outlined. Based upon the results of the study, the author comes to the conclusion that despite a significant progress in im­proving of legal regulation of institutional arbitration and the commercial arbitration as a whole, Spain has still quite a long way to go in order to create an effi­cient system of commercial arbitration and to become an attractive jurisdiction for international commer­cial arbitration as well.

Pain as a disease in the new International Classification of Diseases (ICD-11): Latin American expert consensus.

Aims: Pain diagnoses in the 10th version of the International Classification of Diseases (ICD-10) did not adequately support the current management of pain. Therefore, we aimed to review the new 11th revision (ICD-11) in order to analyze its usefulness for the management, coding, research and education of chronic pain from a Latin American perspective. Methods: The Latin American Federation of Associations for the Study of Pain convened a meeting of pain experts in Lima, Peru. Pain specialists from 14 Latin American countries attended the consensus meeting. Results: In ICD-11, chronic pain is defined as pain that persists or recurs longer than 3 months and is subdivided into seven categories: chronic primary pain and six types of chronic secondary pain. Chronic primary pain is now considered a disease in itself, and not a mere symptom of an underlying disease. Conclusion: The novel definition and classification of chronic pain in ICD-11 is helpful for better medical care, research and health statistics. ICD-11 will improve chronic pain management in Latin American countries, for both the pain specialist and the primary care physician.

Therapeutic governance in Hong Kong’s anti-narcotics war, 1959–1980s

This article examines the medical front of the anti-narcotics war in post-war Hong Kong. Situating Hong Kong in the American global drug war, this article traces colonial Hong Kong’s development of addiction treatment and cooperation with American medical experts in conducting a controversial experiment, methadone maintenance. It argues that the colonial government constructed a new form of therapeutic governance to medicalize social issues as behavioural problems. Through large-scale rehabilitation and methadone maintenance, the colonial government claimed to transform addicts in the island colony into useful subjects and justified its radical intervention into social life. To American experts, Hong Kong was an ideal laboratory to examine the controversial treatment. Hong Kong’s methadone experiment became an international success and a model reimported into the United States in the 1980s. A medical history of the anti-narcotics war not only offers a new way to reassess the social reform in the 1970s but also helps us understand the contemporary hard-line approach against drugs in Hong Kong and post-colonial Asia.

Advanced Breast Cancer Guidelines in Latin America: Assessment, Adaptation, and Implementation of Fifth Advanced Breast Cancer Consensus Guidelines.

As the fifth international consensus on advanced breast cancer (ABC5) established guidelines for the management of this disease, the aim of this article was to present the applicability of the consensus recommendations and to generate knowledge to improve access. Sixty-one recommendation statements were selected and discussed by 15 breast cancer experts from Latin America (LA). After the discussion, the level of consensus was determined through a vote. In addition to this, the level of access to each of the recommendations presented, according to the country and health system, was exposed. Latin American experts had a high level of agreement with the ABC5 consensus recommendations (range, 83%-100%). Twelve of 61 statements are not available for all patients in LA. Among the limitations to access, the following ones are described: limited access to certain technologies (stereotactic body radiotherapy, positron emission tomography-computed tomography), the high costs of drugs that limits access to treatment with CDK4/6 inhibitors, pertuzumab, or poly(ADP-ribose) polymerase inhibitors, and the lack of molecular tests for access to therapeutic targets, as well as the difficult geography and cultural diversity of our continent. Despite the great relevance of the recommendations of the ABC5 consensus guidelines, we highlight that we still need to improve access for all patients, regardless of the country or health system they are in, for which we call to action to policy makers and patient groups to improve clinical outcomes of patients with advanced breast cancer in our region.

BRAF-Mutated Melanoma Journey in Latin America: Expert Recommendations From Diagnosis to Treatment.

• Gather a panel of Latin American experts in testing and treating BRAF-melanoma. • Describe the current landscape of BRAF-mutated melanoma in Latin America. • Outline the current gaps in testing and recommend improvements for testing and treating BRAF-mutated melanoma in the region. Melanoma prevalence in Latin America is lower than in high- and middle-income countries. However, recent data indicate that the region's incidence and mortality are rising, with more stage IV patients being diagnosed. According to international clinical practice guidelines, conducting BRAF-mutation testing in patients with stage III or stage IV melanoma and high-risk resected disease is imperative. Still, BRAF-mutation testing and targeted therapies are inconsistently available in the region. Americas Health Foundation convened a meeting of Latin American experts on BRAF-mutated melanoma to develop guidelines and recommendations for diagnosis through treatment. Some recommendations for improving diagnostics through improving access and reducing the cost of BRAF-mutation testing, enhancing efficiency in pathology laboratories, and creating country-specific local guidelines. The panel also gave treatment recommendations for neo-adjuvant therapy, adjuvant therapy, and therapy for patients with metastatic disease in Latin America.

The American political and academic elite on the end of the conflict in Ukraine

By the end of 2023, the American ruling circles got rid of illusions about the possibility of inflicting a decisive defeat on Russia during the Russian-Ukrainian conflict. From the point of view of the American political and academic elite, this conflict is clearly dragging on, diverting American resources from other US foreign policy priorities. According to many American experts and practical politicians, the United States has managed to extract serious benefits from the events in Ukraine, and it is time to limit its participation in this conflict before it becomes another "endless war" for the United States.

ПОГЛЯДИ АМЕРИКАНСЬКОГО СУСПІЛЬСТВА НА ВИВЕДЕННЯ СПОЛУЧЕНИМИ ШТАТАМИ ВІЙСЬК ІЗ АФГАНІСТАНУ В 2021 Р.

The aim of the article is to analyze and compare the differences and similarities in the reactions of various groups of American society to the end of the military campaign in Afghanistan. The groups in question are the general public, whose opinion is measured through social surveys, various political experts and think tanks, as well as the American politicians of a wide spectrum of views. The scientific novelty of the article is that the authors research the phenomenon of American public opinion on the aforementioned issue from various angles. The article describes in detail the views of the American public in general and its ideologically differentiated groups; the views of political experts as well as the politicians themselves. The methodological basis of the article. The authors use the analysis method as a general scientific method to explore the opinions of various public groups, including American war veterans, political experts, and politicians. Another method (peculiar for historical analysis) is the comparative-historical method, which is used to compare different societal perspectives on this historical event to discern similarities and differences between those perspectives. The systematic approach is also used to describe the view of American society as a system. The principle of objectivity is also applied to promote the unbiased nature of the authors’ conclusions. Results. The article helps to understand the reaction of different societal groups, including politicians and experts, on the US Armed Forces withdrawal from Afghanistan in 2021. Conclusions of the authors of this article demonstrate that the majority of the ordinary citizens as well as of the politicians were dissatisfied with the realities of the process of the evacuation of troops and civilians from Afghanistan. The actions of the American government in this regard also received critical appraisal. On the other hand, the majority of the population generally supported the end of the war. The political experts and members of think tanks were divided among themselves on the question of what influence this withdrawal may have on the US popularity and image in the world.

Green industry: how to make production eco-friendly

The relevance of the study is determined by the fact that green industry is a new area of the economy aimed at preserving the well-being of society through the efficient use of Earth resources. The development of humankind is impossible without the impact on the environment and the use of natural resources: factories are built, waste is incinerated, minerals are mined, forests are cut, and smoking factories are launched. Almost all human actions affect the ecosystem of the Earth; hence, the article discusses whether it is possible to make this impact less harmful. Studies are given on the harm caused by large-scale production to the environment and how to reduce it; how the environmental policy of cities is changing and enterprises are transformed; what is a ‘green industry’ and how to organize production according to its principles. The empirical basis of the study is the research report of the World Health Organization; American scientists and experts of the Swiss company IQAir, the data of the rating of the US Blacksmith Institute (Pure Earth NGO) for the study of the toxic cities, as well as Eric Hobsbawm’s scientific works. The practical significance of the research is aimed at the rational use and organization of work with natural resources, their economical consumption, the use of environmentally friendly technologies in production and in life, and the creation of sustainable conditions for investment in such projects not only by the government authorities, but also by the private sector.

Black American Agricultural Experts and the Vernacularization of American Science in Liberia Prior to Decolonization in Africa

Black American Agricultural Experts and the Vernacularization of American Science in Liberia Prior to Decolonization in Africa

Deep learning-based radiomics allows for a more accurate assessment of sarcopenia as a prognostic factor in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common malignancies and is a major cause of cancer-related mortalities worldwide (Forner et al., 2018; He et al., 2023). Sarcopenia is a syndrome characterized by an accelerated loss of skeletal muscle (SM) mass that may be age-related or the result of malnutrition in cancer patients (Cruz-Jentoft and Sayer, 2019). Preoperative sarcopenia in HCC patients treated with hepatectomy or liver transplantation is an independent risk factor for poor survival (Voron et al., 2015; van Vugt et al., 2016). Previous studies have used various criteria to define sarcopenia, including muscle area and density. However, the lack of standardized diagnostic methods for sarcopenia limits their clinical use. In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP) renewed a consensus on the definition of sarcopenia: low muscle strength, loss of muscle quantity, and poor physical performance (Cruz-Jentoft et al., 2019). Radiological imaging-based measurement of muscle quantity or mass is most commonly used to evaluate the degree of sarcopenia. The gold standard is to measure the SM and/or psoas muscle (PM) area using abdominal computed tomography (CT) at the third lumbar vertebra (L3), as it is linearly correlated to whole-body SM mass (van Vugt et al., 2016). According to a "North American Expert Opinion Statement on Sarcopenia," SM index (SMI) is the preferred measure of sarcopenia (Carey et al., 2019). The variability between morphometric muscle indexes revealed that they have different clinical relevance and are generally not applicable to broader populations (Esser et al., 2019).

“Разворот в Азию”: АУКУС в восприятии политикума США

The article is devoted to forecasting the ways of further evolution of the Western partnership called AUKUS, taking into account the geopolitical plans of J. Biden administration, and based on an analysis of the approaches of the most influential groups among the American political elite to the project. In the context of the American strategy “Pivot to Asia”, differences in views of these groups on the content of AUKUS and its prospects are shown. Special attention is paid to the study of the American experts’ and politicians’ ideas about the potential of using nuclear submarines in the Indo-Pacific region by Australia with regard to “containing” China, as well as technological cooperation between the partnership member countries in order to expand a common industrial base. While the Conservative Republicans believe that it is necessary to focus only on creating a fleet of submarines for Australia (the “first pillar”), Conservative Democrats and Moderate Republicans demand to concentrate exclusively on technological cooperation not merely of the three AUKUS countries (the “second pillar”), but also attracting other players to it – Japan, New Zealand, South Korea, Canada. Only the Centrist Democrats, who are the most loyal supporters of the administration, are confident that the alliance countries will be able to “pull through” the implementation of both “pillars” of the project. The authors underscore that the coalition of the “second pillar” looks preferable today. It is concluded that the radical divergence of the elite groups’ views makes the future fate of the AUKUS quite uncertain, and the partnership can acquire different configurations depending on the balance of forces within the U.S. political establishment.

БРАЗИЛИЯ И ЕЕ РОЛЬ В ФОРМИРОВАНИИ МИРОВОГО ПОРЯДКА XXI ВЕКА

In this article, the author tries to determine Brazil’s place and role in global politics and define which order model is acceptable for the current stage in the development of international relations. He studies the issue of Brazil’s willingness to take a place among the leading world powers and the country’s capability to become a leading regional integration center in Latin America. The author traces the evolution of the views of the Brazilian government on the country’s place in the emerging world order since the bipolar system collapse, and also ascertains the evaluation of Brazil’s current foreign policy agenda on the part of Latin American experts. Finally, the author addresses the issues of particular relevance in recent months – the further functioning of the BRICS track following the Johannesburg summit, where the parties’ leaders developed the criteria for candidates’ entry and defined the first new members to join the BRICS club starting with 2024. The author concludes that though Brazil is currently not yet ready to become a new great power, it still seeks to develop into a key player within the new international relations system, positioning itself not only as a regional center, but also as a fully-fledged actor.

“Политическая война” 2.0 (США vs Россия – на пороге перемен)

The article reflects on the political war between the United States and Russia that started in 2022 with the launch of the Russian special military operation in Ukraine. The author compares those events to the political war that occurred between the U.S. and the USSR in the 20th century, concluding that once again the American side has chosen to begin with a reactive and defensive approach to the conflict. This approach is primarily aimed at safeguarding the American population (as well as the population of American allies) from Russian influence. In order to achieve that, American public diplomacy institutes (key actors in terms of waging war for the people’s minds and hearts) focused on deconstructing Russian narratives and discrediting Russian information sources. At the same time, the ability of Russian public diplomacy institutes and media to reach Western audiences was paralysed by sanctions and other restrictions. However, the purpose of building resilient defenses to protect American public from foreign influence was mostly achieved through the system of governmental control over the internal information space. This system connects governmental structures responsible for countering disinformation with tech companies and leading social media, and thus allows censorship of every topic coming from any source if deemed concerning national security. After safeguarding the internal information space, in 2024, the United States moved towards extending the defensive approach to political war towards allies, aiming at building the same resilient defenses for their publics. Meanwhile, during the past years, the American public diplomacy, which suffered from atrophy, underfunding and lack of leadership since the end of the Cold War, was being reformed in a way that enhances its effectiveness, strengthens capabilities for dealing with target audiences and integrates a more politically oriented approach. Thus, while ensuring the protection of its population from the adversary’s influence, the U.S. have also been upgrading its arsenal of effective instruments required for political war and effective influencing of foreign public opinion. Bearing in mind the previous experience of political war between the two states, the author concludes that after securing the information space of allies and completing the modernization of public diplomacy capabilities, the Washington is likely to move from defensive to offensive tactic in political warfare. Moreover, those offensive and proactive actions will be most likely realized collectively, together with allies. A theoretical basis for such an approach is being currently developed through the emergence of “reputational security” concept in American expert discourse. This concept not only elevates the issues of reputation (of the states, democracy, liberal values) to the category of national security issues, but also pushes for collective action in terms of protecting one’s own reputation and undermining the reputation of an adversary.