American Institution Research Articles

Parent-led Communication Therapy for Young Bilingual Autistic Children: A Scoping Review.

A scoping review of the literature was undertaken using JBI guidelines to map the evidence of parent-led therapy (PLT) for young autistic children (≤ 6years) raised in bilingual environments. Reviewers used Covidence to screen located sources. Sixteen papers met inclusion criteria. A strong acceleration of reports of PLT for young autistic children measured in bilingual environments was observed, with 93.8% of papers (n = 15) published since 2015. Reporting of participants' language environments (home language(s)/L1s and societal language(s)/L2s) was inconsistent. A large majority of these studies, 87.5% (n = 14) were conducted in North America or in collaboration with a North American institution. Diverse PLT programs and methodologies were identified. There is variation in demographic information collected and outcomes reported. Evidence gaps in the literature are identified and the value of undertaking systematic review on this topic is considered. This scoping review points to the necessity of further empirical research and practice that centres parents in early and specific support for autistic children raised in bilingual environments. Suggestions for improving reporting standards of language profiles are provided.

Angela C. Sutton, Pirates of the Slave Trade: The Battle of Cape Lopez and the Birth of an American Institution by John S. Sledge

Angela C. Sutton, Pirates of the Slave Trade: The Battle of Cape Lopez and the Birth of an American Institution by John S. Sledge

“I just chill and keep quiet ya’ know”: understanding Black college students’ silence during in-class racial conversations at an AANAPISI/HSI

ABSTRACT Communication scholars have considered silence in (higher) education as indicative of a range of cultural attitudes and an exercise of power. Some communication scholars consider student silence in classrooms as problematic, wherein a lack of participation in the learning process via student voice constitutes an act of resisting educators and education. Others conceptualize it as a way to challenge oppression or as a part of students' cultural identity. This study examines 21 Black college students' impetus for communicating silence during in-class discussions at a large Asian American Native American Pacific Islander-serving institution (AANAPISI) and a Hispanic-serving institution (HSI) 4-year university on the U.S. West Coast. Given the anti-Black phenomena in recent years (e.g., police violence, anti-Black education laws, Black Lives Matter protests), this study investigates the reasoning behind Black students' reasons for communicating silence within in-class discussions of race/racial phenomena. This study found Black students communicate in-class silence for three overarching reasons: (1) silence due to feeling underrepresented, (2) silence to avoid (negative) peer attention, and (3) silence due to fear of instructor retaliation. Findings inform how instructors can better approach racial discussions by mitigating Black student racial labor, foster civility, and move toward improving cross-racial learning during in-class interactions.

Robotic surgery across Latin America: a bibliometric analysis of research trends from 2009 to 2022.

The rise of robotic surgery throughout the world, particularly in Latin America, justifies an objective evaluation of research in this field. This study aimed to use bibliometric techniques to identify the research trends and patterns of robotic surgery in Latin America. The research strategy used the terms "Robotic," "Surgery," and the name of all the Latin American countries, in all fields and collections of Web of Science database. Only original articles published between 2009 and 2022 were included. The software Rayyan, Bibliometric in the R Studio, and VOSViewer were used to develop the analyses. After screening, 96 articles were included from 60 different journals. There was a 22.51% annual increase in the scientific production of robotic surgery in the period studied. The more frequent topics by specialty were: Urology (35.4%), General Surgery (34.4%), and Obstetrics and Gynecology (12%). International cooperation was observed in 65.62% of the studies. The Latin American institution with the highest production of manuscripts was the Pontificia Universidad Católica de Chile. Mexico, Chile, and Brazil were, in descending order, the nations with the highest number of corresponding authors and total citations. When considering the total number of articles, Brazil ranked ahead of Chile. Scientific production regarding robotic surgery in Latin America has experienced accelerated growth since its beginning, supported by the high degree of collaboration with leading countries in the field.

Educational gag orders as white property of interest: reinscribing higher education's ethos in radical tradition

PurposeIt is critical for those who are engaged in the work of resisting the movement of academically restrictive policy to understand that it is a deliberate act on the part of conservatives to outlaw critical race theory (CRT) specifically, because it is a theoretical mechanism for discrediting the rhetorical foundations of their policy movement. The knee-jerk institutional courses of action to now defund initiatives and curriculum related equity, diversity and inclusion (EDI) represent what has always been a deeply rooted investment in white supremacy on the part of the institutions (Baldwin, 2021; Patel, 2021; Squire, 2021).Design/methodology/approachThe author explores and defines the CRT tenets of interest convergence (Bell, 1980) and whiteness as property (Harris, 1993) in relation to EI (Fricker, 2007; Dotson, 2011) as frameworks for examining three EGOs in the region where these policies have become most dominant. All three are critical tools of analysis for understanding the stake the White conservative political elite have in EGOs, and the magnitude of EI these policies represent, and stand endorse in their rhetoric. Definitions of EI often rely on the work of Amanda Fricker’s (2013) text on the subject, but this paper is invested in the expansions of this theorization for speaking to the nature of the injustice that EGOs represent as a matter of historical trend, with grave implications for futures marked by continued oppression. Whiteness as property and interest convergence are points for explicating the dialectic and material aspects of issues of race and equity in this country; namely, how knowledge processes inherent to higher education sound even more alarms as EGOs become commonplace for college campuses.FindingsTo support the arguments laid out, the author provides a historical review of the settler-colonial foundations of higher education as an american institution. This is meant to provide contour to the image of postsecondary education that exists today. In accordance with this paper’s allegiance to CRT, many of the texts would be considered revisionist history (Delgado and Stefancic, 2023), which stray from dominant narratives of american comfort and speak more accurately to the experiences of minoritized populations. The author then applies the same analysis to the sociopolitical contexts of EGOs, and to policy language itself. Each section is closed with an explanation of its connection to tenets of CRT and EI so as to provide a thread to follow into the subsequent discussion section.Research limitations/implicationsIn the first presentation of the early writings of this work, the author was lucky enough to be in community with Barbara Applebaum at the annual meeting for the American Educational Studies Association and engage in discourse surrounding EI and CRT applications to EGOs. In conversations surrounding the will in the willful ignorance that is exemplified in the movement of EGOs, the author had shared with Dr Applebaum the early thinking on how that will was the same force that brought together converging interests, which have continually forecasted interest divergence. This is commonly referred to as “political backlash.” The author had said something along the lines of: “if we follow the interest convergence, we can get in front of the subsequent political moves to turn the clocks on what was once celebrates progress.” This conversation planted the seed for what is the thesis of this paper. Interest convergence and divergence happen at the will of white populations because of the american truth of whiteness as property. In the context of higher education, this means that because educational pursuit has largely been white property, it has served as an arena for white populations to converge and diverge their interests with those of the minoritized. For example, the policies that drained federal funding for higher education in the 1970s were passed on the tails of a Civil Rights Movement that shook the very foundation of this country and expanded access to postsecondary education for racially minoritized groups (Berret, 2015).Originality/valueEnsuring that this social construction is a matter of status quo has largely been the work of postsecondary institutions, and EGOs represent the most recent attempt at epistemically imposed inferiority. Explicit attention to the fact of higher education’s complicity and overall investment in the socialization of oppression is necessary to engage in transformative practice that resists anachronism. If higher education researchers and practitioners do not recognize the stake in both the presence and resistance to EGOs, there would likely be acts of resistance that will belie an act of interest convergence – and later divergence – on the part of the state.

The Failure of Cis Feminism

Faced with the proliferation of TERF rhetoric outside academia, this article proposes a case study of an anti-trans, anti-gender, anti–sex work graduate student at a progressive American institution to challenge feminism to address the ways in which it is providing a space of unchallenging silence for TERF views to remain a nonissue and receive academic support and accreditation. An examination of this specific student highlights a narrative of radicalization occurring during her studies at the university. A challenge for cis feminists to self-reflect and step up, this article argues that cis feminism has for now failed to address the transphobia in its midst, thus forcing trans students and scholars to lose faith in feminism and to find care and support elsewhere.

In focus: perplexing increase of urinary stone disease in children, adolescent and young adult women and its economic impact.

Urinary stone disease (USD) historically has affected older men, but studies suggest recent increases in women, leading to a near identical sex incidence ratio. USD incidence has doubled every 10 years, with disproportionate increases amongst children, adolescent, and young adult (AYA) women. USD stone composition in women is frequently apatite (calcium phosphate), which forms in a higher urine pH, low urinary citrate, and an abundance of urinary uric acid, while men produce more calcium oxalate stones. The reasons for this epidemiological trend are unknown. This perspective presents the extent of USD with data from a Canadian Province and a North American institution, explanations for these findings and offers potential solutions to decrease this trend. We describe the economic impact of USD. There was a significant increase of 46% in overall surgical interventions for USD in Ontario. The incidence rose from 47.0/100,000 in 2002 to 68.7/100,000 population in 2016. In a single United States institution, the overall USD annual unique patient count rose from 10,612 to 17,706 from 2015 to 2019, and the proportion of women with USD was much higher than expected. In the 10-17-year-old patients, 50.1% were girls; with 57.5% in the 18-34 age group and 53.6% in the 35-44 age group. The roles of obesity, diet, hormones, environmental factors, infections, and antibiotics, as well as the economic impact, are discussed. We confirm the significant increase in USD among women. We offer potential explanations for this sex disparity, including microbiological and pathophysiological aspects. We also outline innovative solutions - that may require steps beyond typical preventive and treatment recommendations.

The Boston Pops: An American Institution and Its European Roots

ABSTRACT This article traces the historical origins and influences that led the early leaders of the Boston Symphony Orchestra (BSO) to offer both “symphony concerts” and “popular concerts” on the same stage. Although scholars of nineteenth-century orchestral music align the end of “mixed” repertory with the rise of non-touring orchestral institutions based in urban centers, that tradition continued far into the twentieth century. Exploring the history of the BSO affords a deeper understanding into the division of the so-called “classical” orchestral repertory from the “popular,” and the emergence of orchestral pops series in cities across the United States.

Measuring the Delay in the Referral of Unstable Vertebral Metastasis to the Spine Surgeon: A Retrospective Study in a Latin American Institution.

The delay in the referral of patients with potential surgical vertebral metastasis (VM) to the spine surgeon is strongly associated with a worse outcome. The spinal instability neoplastic score (SINS) allows for determining the risk of instability of a spine segment with VM; however, it is almost exclusively used by specialists or residents in neurosurgery or orthopedics. The objective of this work is to report the delay in surgical consultation of patients with potentially unstable and unstable VM (SINS >6) at our center. We performed a 5-year single-center retrospective analysis of patients with spine metastasis on computed tomography (CT). Patients were divided into Group 1 (G1), potentially unstable VM (SINS 7-12), and Group 2 (G2), unstable VM (SINS 13-18). Time to surgical referral was calculated as the number of days between the report of the VM in the CT and the first clinical assessment of a spinal surgeon on the medical records. We analyzed 220 CT scans, and 98 met the selection criteria. Group 1 had 85 patients (86.7%) and Group 2 had 13 (13.3%). We observed a mean time to referral of 83.5 days in the entire cohort (std = 127.6); 87.6 days (std = 135.1) for G1, and 57.2 days (std = 53.8) for G2. The delay in referral showed no significant correlation with the SINS score. We report a mean delay of 83.5 days in the surgical referral of VM (SINS >6, n = 98). Both groups showed cases of serious referral delay, with 25% of patients having the first surgical consultation more than three months after the CT study.

Evaluation of Pedestrian Comfort for a Footbridge with Hinged Piers

To study the standardized evaluation method of vibration comfort of pedestrian bridges, the effect of the transient response term is ignored based on the generalized single degree of freedom (SDOF) method with reference to the American Institution of Steel Construction inc (AISC 11) specification. The resonance conditions between the crowd and the bridge structure are also considered, and the pedestrian bridge structure is simplified to an SDOF system. Then, the peak acceleration of the structure under crowd excitation is directly calculated using the generalized crowd load, and the comfort evaluation is carried out according to the German EN03 code and the Chinese code. For a new pedestrian bridge with hinged piers, human-induced vibration tests were carried out to obtain the structural acceleration time response data under various crowd load excitation conditions, and the acceleration values calculated with the numerical simulation method, the frequency response function method, the generalized SDOF method, and the proposed method were compared with field measurements. The results show that for the normal excitation condition with a crowd density less than or equal to 0.2 person/m2, the acceleration maximum error for the proposed method is between 4.22% and 13.28%. The error is only 6.35% compared with the finite element simulation results. The method can derive peak acceleration by performing only modal tests, eliminating errors caused by different testers and errors due to deflection measurements. It saves considerable time cost and economic cost, and improves the speed of pedestrian bridge comfort evaluation. Therefore, the method proposed for the first time in this study can accurately assess the human-caused vibration comfort of pedestrian bridges with articulated piers. Although the hinged-pier and column steel pedestrian bridge meets the code requirement of a vertical first-order frequency greater than 3 Hz, it is recommended to add TMD vibration damping measures to the bridge in order to improve pedestrian comfort.

Optimization of framed structures subjected to blast loading using equivalent static loads method

In this study, the optimum design of a three-dimensional framed steel structure subjected to blast loading is considered. The main idea of this research is to develop a practical formulation for the design optimization problem and to study the effect of including blast loads in the design process. The optimization problem is formulated to minimize the total weight of the structure subjected to American Institution of Steel Construction (AISC) strength requirements and blast design displacement constraints. The design variables for beams and columns are the discrete values of the W-shapes selected from the AISC tables. A car carrying 250 lbs of trinitrotoluene with a 50 ft standoff distance from the front face is modeled as the source of the blast loading. Pressure–time histories are calculated on the front, sides, roof, and rear faces of the structure. Since the problem functions are not differentiable with respect to the design variables, the gradient-based optimization algorithms cannot be used to solve the problem. Therefore, metaheuristic algorithms are used to solve the optimization problem. Linear and nonlinear dynamic analyses are carried out in the optimization process. The problems are solved using metaheuristic optimization with the equivalent static loads method (MOESL). In MOESL, the dynamic load is transformed into equivalent static loads (ESLs) then the linear static analysis is carried out in the optimization process. The problems are 4-bay × 4-bay × 3-story frames under serviceability and blast loading. It is shown that a penalty on the optimum structural weight is substantial for designing structures to withstand blast loads.

TV News and the Military: Exploring Media Frames of an American Institution

This exploratory study analyzes television news transcripts ( N = 300) to examine how broadcast news networks (ABC, CBS, and NBC) and cable news networks (CNN, Fox, and MSNBC) cover military veterans and service members in news programming. Findings show that the stories and sources of broadcast news networks focused on veterans and service members or their families, while cable news networks relied on legislative issues, politicians and other elite sources. Other findings and recommendations are discussed.

The American Newsroom: A History, 1920–1960

The American newsroom was a major force and institution in the United States throughout the twentieth century and part of any journalist's daily life. But most civilians have seldom been in a newsroom, and the only reference most have comes from popular culture, primarily film and television. Will Mari's fascinating book gives anyone a definitive glimpse into not only the physical environment so important to any news operation but also the emotional, professional, and strategic aspects of a “storied gathering spot for news workers … where journalists gathered together, fostering a relational newsroom culture, where values and routines were learned from peers and the terms of work negotiated with superiors” (p. 3). Even if this book was just a recitation of the work in a newsroom from 1920 to 1960, it would still be an interesting addition to the history of journalism. But Mari does much more than that. He paints a picture of the newsroom as far more than a physical workplace by illustrating, through diligent research and a variety of examples, how the newsroom was a complex and aspirational “context, within which American journalism formed” (p. 235). He chronicles the “web of relationships—the centering place for those relationships, a place where a confusing mass of reality was condensed into processed, produced news and distributed to the reading public” (ibid.). His book is filled with stories about the various news workers living in communities collaborating and competing to produce the news: copyboys, copygirls, photographers, reporters, and their junior and senior peers as well as their editors. In chapters about technology and unionization, he shows how both influenced the American newsroom and brought the United States into the twenty-first-century information economy. His material on how the newsroom changed from a blue-collar to a white-collar environment explains a good deal about the kind of news citizens heard about from 1920 to 1960. And Mari's comments on the racism of the century, which permeated any American institution, including the newsroom, do not go unnoticed.

Uterine Transplants

There is an inevitable point where ethics meets medicine and the question of why becomes subject to debate. In 2019, the Cleveland Clinic became the first North American institution to successfully deliver offspring from a uterine transplant (UTx) and —while this suggests infinite implications for infertile and transgender women— the associated medical, emotional, and financial risks challenge the reasons for why it should be operationalized in hospitals. Reasons for undergoing UTx are two-fold: (1) having the ability to carry offspring and (2) furthering the anatomical transition process in male-to-female gender affirmation procedures. Emerging literature argues that there should be “an individual right of people to exercise control and shape their role in reproduction” and sexuality, while others say that the dire aftereffects leave the patient in a better state before UTx. In this piece, we dissect the benefits and disadvantages of having UTx and recommend whether or not it should be practiced. We argue that surgeons should be more conservative in their practices and defer their use of UTx procedures until further research is done to diminish procedural risks.

Racial Disparities in the Treatment of Acute Myeloid Leukemia. ELN Risk Stratification Analysis of Overall Survival According to Race

Introduction and background: Acute myeloid leukemia (AML) is a rare disease that critically disrupts the function of the bone marrow. Genetic mutations and cytogenetic changes are the main culprits of this process. As the bone marrow fails to perform its usual activity, blood production is crucially affected. Patients with AML need immediate access to medical facilities to treat such an acute disease. It has been postulated that a black population may have worse outcomes in AML. The less favorable outcome may result from miscellaneous factors, with social-economical disparities being the most important. In light of the systemic racism in health care and society in general, minorities may have less access to prime health care centers. Many studies suggest racial differences in survival among whites and black populations. But few have compared outcomes based on the ELN genetic risk stratification. It's important to realize that uneven outcomes may also result from more adverse genetic profiles in specific subgroups. In our study, we analyzed the results of the treatment of AML in a single American institution separated by race and ELN risk. Material and Methods: In this study, we retrospectively evaluated the outcomes of all patients with AML at our institution. We collected the data from patients treated with AML from June 2020 to June 2022. The most relevant information collected were: self-declared race, age, blood counts, cytogenetics, Next Generation Sequence information, Charlson Comorbidity Index(CCI), type of treatment, the best response to therapy, time to progression, and overall survival. We evaluated a total of 39 patients. Seventeen individuals were classified as adverse risk and twenty-two as an intermediate or good risk. Overall survival and statistical analysis were performed in all patients, and a special subanalysis was also done in the adverse risk group. Twenty-two patients self-declared as whites and 17 as black. Results: Among all ELN risk groups(figure 2), the estimated mean time until death was 417.21 days for blacks and 476.81 days for whites. At 400 days, the probability of survival was approximately 0.40 (or 40%) for blacks and 0.55 (or 55%) for whites. As the p-value (0.996) was greater than 0.05, we concluded that there was insignificant evidence of a difference in survival times for whites and blacks in all ELN risk groups. In a subanalysis of the ELN adverse risk population(figure 1), the estimated mean time until death was 326.00 days for non-whites and 285.96 days for whites. At 200 days, the probability of survival was approximately 0.68 (or 68%) for blacks and 0.43 (or 43%) for whites. As the p-value (0.187) was greater than 0.05, we again concluded that there was insignificant evidence of a difference in survival times for whites and blacks, even in adverse risk ELN subgroups. Conclusions and recommendations: Our study has identified no statistical difference in survival between whites and blacks in our single university institution population. Moreover, the evaluation in the adverse risk patients showed that at 200 days, the probability of survival in blacks is numerically higher than in whites. These results contradict the idea that a white population tends to have better outcomes than a black population regarding AML. The study's obvious limitation is the small sample population and the short follow-up period. Given equal access to care, as in our institution, outcomes were similar regardless of race. Further studies should be performed to evaluate the differences in outcomes among black and whites to validate our findings. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Role of Vismodegib in the Treatment of Locally Advanced Periocular and Orbital Basal Cell Carcinoma: A Single Latin American Institution Experience

Role of Vismodegib in the Treatment of Locally Advanced Periocular and Orbital Basal Cell Carcinoma: A Single Latin American Institution Experience

Reliability of ultrasound ovarian-adnexal reporting and data system amongst less experienced readers before and after training.

BACKGROUNDThe 2018 ovarian-adnexal reporting and data system (O-RADS) guidelines are aimed at providing a system for consistent reports and risk stratification for ovarian lesions found on ultrasound. It provides key characteristics and findings for lesions, a lexicon of descriptors to communicate findings, and risk characterization and associated follow-up recommendation guidelines. However, the O-RADS guidelines have not been validated in North American institutions or amongst less experienced readers.AIMTo evaluate the diagnostic accuracy and inter-reader reliability of ultrasound O-RADS risk stratification amongst less experienced readers in a North American institution with and without pre-test training.METHODSA single-center retrospective study was performed using 100 ovarian/adnexal lesions of varying O-RADS scores. Of these cases, 50 were allotted to a training cohort and 50 to a testing cohort via a non-randomized group selection process in order to approximately equal distribution of O-RADS categories both within and between groups. Reference standard O-RADS scores were established through consensus of three fellowship-trained body imaging radiologists. Three PGY-4 residents were independently evaluated for diagnostic accuracy and inter-reader reliability with and without pre-test O-RADS training. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under the curve (AUC) were used to measure accuracy. Fleiss kappa and weighted quadratic (pairwise) kappa values were used to measure inter-reader reliability. Statistical significance was P < 0.05.RESULTSMean patient age was 40 ± 16 years with lesions ranging from 1.2 to 22.5 cm. Readers demonstrated excellent specificities (85%-100% pre-training and 91%-100% post-training) and NPVs (89%-100% pre-training and 91-100% post-training) across the O-RADS categories. Sensitivities were variable (55%-100% pre-training and 64%-100% post-training) with malignant O-RADS 4 and 5 Lesions pre-training and post-training AUC values of 0.87-0.95 and 0.94-098, respectively (P < 0.001). Nineteen of 22 (86%) misclassified cases in pre-training were related to mischaracterization of dermoid features or wall/septation morphology. Fifteen of 17 (88%) of post-training misclassified cases were related to one of these two errors. Fleiss kappa inter-reader reliability was ‘good’ and pairwise inter-reader reliability was ‘very good’ with pre-training and post-training assessment (k = 0.76 and 0.77; and k = 0.77-0.87 and 0.85-0.89, respectively).CONCLUSIONLess experienced readers in North America achieved excellent specificities and AUC values with very good pairwise inter-reader reliability. They may be subject to misclassification of potentially malignant lesions, and specific training around dermoid features and smooth vs irregular inner wall/septation morphology may improve sensitivity.

“Townsends” YouTube Channel

“Townsends” YouTube Channel

The Cabinet: George Washington and the Creation of an American Institution by Lindsay M. Chervinsky

Reviewed by: The Cabinet: George Washington and the Creation of an American Institution by Lindsay M. Chervinsky Ari Helo The Cabinet: George Washington and the Creation of an American Institution. By Lindsay M. Chervinsky. (Cambridge, Mass., and London: Harvard University Press, 2020. Pp. xii, 416. Paper, $17.95, ISBN 978-0-674-27103-6; cloth, $29.95, ISBN 978-0-674-98648-0.) Let me first offer my most crucial criticism of this wonderfully readable book: the author fails to explicate what is new in her research work. What are the essential corrections or supplements to the huge research literature in political history on George Washington and his cabinet? The book is well written and thoroughly documented, but for those familiar with Stanley Elkins and Eric McKitrick's monumental The Age of Federalism (New York, 1993), Lindsay M. Chervinsky's book offers only good supplementary reading. One is also inclined to ask the purpose of the first one hundred pages of introductory information. After dozens of pages about the War of Independence, the reader is back again in colonial times on page 100. Moreover, while detailing Washington's various wartime headquarters correspondence committees and the Confederation executive departments' workings during and after the War of Independence, the author offers no hint that such developments might have connections to any larger Western history of modern bureaucracies or even colonial-era governmental experience. The world-famous British Bill of Rights (1689) is referred to as "a bill of rights," and is discussed in such a general manner that one might come away believing that before the Glorious Revolution the British Parliament had nothing to do with taxation (p. 95). Even early colonial assemblies levied taxes. One might also wonder why the author does not bring up the core principle of the British (and European) parliamentary system, namely, that the government must enjoy the confidence of the majority of the legislature, a crucial feature of the parliamentary form of government that America never adopted. Some of Chervinsky's formulations might well have been more cautious, such as "The cabinet worked to sideline Congress and to bring the state governments under federal oversight during this process" (p. 263). Before the Fourteenth Amendment (1868), the Constitution gave full license to the states to decide on all such issues as slavery and women's rights (regarding both property and political rights). Even religious freedom was secured only from the federal government's infringements. Many states did not yet guarantee such a right for their inhabitants, free or slave. [End Page 368] Now to the positive aspects of this fascinating story of Washington's cabinet and its workings from November 1791 until the end of his term in March 1797: First, it is wonderful, for a change, to encounter a history book about the early republic in which the author is genuinely interested in the subject and not only in moralistic judgments about slavery. Perhaps a paragraph or two would have been in order on that subject—marginal here in the sense that the cabinet had no constitutional powers to do anything about it. However, this book is truly about the cabinet, and it is admirably detailed on who said what on each and every subject brought to its attention. Once the author gets to the actual story from page 100 onward, her skillful prose truly catches the reader's attention. One learns about Washington's early hesitation in even forming any cabinet, of which the founders at the Philadelphia Convention in 1787 gave very different opinions and eventually failed to either subscribe to such an innovation or truly reject it. Chervinsky's prose brings all the familiar developments to life again, the Thomas Jefferson–Alexander Hamilton controversies, the cabinet's occasional power struggles with Congress, the Whiskey Rebellion, the Jay Treaty mayhem, and others. Particularly mind-boggling is the telling of Edmund Randolph's eventual doom. All in all, The Cabinet is a very interesting read and, as is often the case with good traditional history books, makes wonderful pleasure reading as well. Ari Helo University of Helsinki Copyright © 2022 The Southern Historical Association

A chronological review of 500 minimally invasive liver resections in a North American institution: overcoming stagnation and toward consolidation.

Although interest in expanding the application of minimally invasive liver resection (MILR) is high the world over, most of the extensive experience in MILR has been reported from Far East Asia and Europe and its adoption in North America is limited. The aim of this study was to review the experience of MILR in a single North American institute over a 15-year period, highlighting both the obstacles encountered and strategies adopted to overcome the stagnation in its uptake. This study included 500 MILR cases between 2006 and 2020. Patient demographics, disease characteristics, surgical technique, and perioperative outcomes are summarized. The major hepatectomy rate and conversion rate were assessed according to case numbers (first 100, 101-300, and 301-500 cases) to assess chronological trends. Of 500, 402 MILRs were done by pure laparoscopic (80.4%), 67 were hand assisted (13.4%), and 31 were robotic (6.2%). The majority (64%) of cases were performed for malignancy (n = 320; 100 Hepatocellular carcinoma, 153 Colorectal metastases, 27 Intrahepatic cholangiocarcinoma, and others, 40, 64%). A total of 71 cases were converted to open (14.2%). The annual case number gradually increased over the first few years; however, case numbers stayed around 30 between 2009 and 2017. In this period, despite accumulating MILR experience, open conversion rates increased despite no change in major hepatectomy rate. After this period of long-term stagnation, we introduced crucial changes in team composition and laparoscopic instrumentation. Our MILR case number and major hepatectomy rate thereafter increased significantly without increasing conversion or complication rates. Our recovery from long-term stagnation by instituting key changes as detailed in this study could be used as a guidepost for programs that are contemplating transitioning their MILR program from minor to advanced resections. Establishing a formal MILR training model through proper mentorship/proctorship and building a dedicated MILR team would be imperative to this strategy.