Lowest Common Denominator Research Articles

Sugarcane RD&E: over managed and underperforming?

In general, few productivity improvements in sugarcane have occurred during the past three decades. At the same time, production costs have increased and production statistics reflect decreased yields globally. In comparison to the ‘golden years’ of new technology and improved germplasm in the second half of the previous century, little more than optimisation of existing practises has emerged from the past two decades. Given the slowdown in new technology delivery, it is not surprising that many industries have placed more scrutiny on how they manage their Research & Development institutions and investments. The result of this ‘slowdown’ has created a perception that poor management of research projects and programs by scientists is at the core of the problem. This has led to the introduction of ‘real’ managers with the subsequent management of R&D as if it is a ‘normal’ production and sales business through well established ‘business models’. Strong emphasis has been placed on project selection, project management and minimising risk. Research, especially in the discovery phase, is a very high-risk endeavour and a high proportion of all projects fail. Institutions that have a low appetite for risk quickly run out of new technology innovation. Because of the inability to predict, a discovery project cannot easily accommodate management issues such as budgeting, milestone definition and timeframes. Managers generally prefer D and Extension over R because of the higher predictability and lower perceived failure rate. The key to proper management of R&D is a recognition that researchers and managers operate under very different codes of conduct. If this is not properly managed, then conflict between researchers and the rest of the business follows. It has become customary to view RD&E as a unit following a ‘systems’ approach. Despite obvious advantages of this approach, it often fails to recognise the most significant shortfall(s) in the value chain. This practice can unnecessarily inflate the cost, slow project progress and is dependent on consensus that tends to favour the lowest common denominator or more vocal team members. Consensus and innovation tend to be opposing objectives, as innovation requires thinking with an ‘outside the box’ mindset. Consequently, innovation can be stifled using this approach. Peer review is a great tool to measure progress in projects and selecting projects for development. It is not suited for selection of new innovative ideas. With no obvious improvement in technology delivery and adoption, it is timely to ask whether the current approaches are achieving their objectives. In addressing this question it is important to look at the global evolution of R&D models and modern trends in highly innovative businesses. Instead of trying to ensure that every research project entering the technology funnel delivers a product, a greater emphasis is needed to create an innovative environment where all role players are focussed on key strategic objectives, and all research results are seen as key learnings for future deployment.

Legal issues for transgender people: a review of persistent threats.

Background The legal status of transgender (trans) people is in constant flux. Over the past 70 years, gradually increasing transgender visibility, national and global advocacy, and, more recently, widespread Internet access, communication, and broadening support from allies, have all contributed to successful campaigns that have improved transgender lives and legitimised transgender. Still, traumatic interactions with the legal system or policing agencies remain plentiful. This is a very general overview of the most common legal issues confronting trans people. It aims to inform medical and mental health providers about the trepidation with which their patients and clients must engage legal systems, and the scope of their concerns, which ultimately affect their health. This review relies upon reports generated by advocacy organisations based on population surveys in several countries, the projects undertaken by legal and human rights advocacy groups, the topics most frequently discussed in academic texts examining transgender legal issues, and draws upon the author's personal advocacy experience. The most complicated and persistent issues are identity recognition, family law and relationship issues, adverse discrimination and anti-transgender violence and its aftermath. Criminal law, almost universally, treats trans people according to the lowest common denominator, their genital status, which supposedly supports expediency and "safety". Global legal and human rights efforts remain desperately needed to lift transgender people from the margins of society and provide them with equal opportunities to lead healthy and fulfilling lives. Access to appropriate and meaningful health care is a crucial element necessary to affirm the humanity of any person.

Design + Heritage: Change Over Time Editor's Note

Design + HeritageChange Over Time Editor's Note Pamela Hawkes (bio) Click for larger view View full resolution Figure 1. Cambridge Public Library. Original design on the left by Ware and Van Brunt in 1888, renovated by Ann Beha Architects, with expansion on the right by William Rawn Associates, 2011. (Photo by Robert Benson) [End Page 206] For more than a century, contemporary design and heritage preservation have been portrayed as antagonists—by community members and the popular media, by designers, preservationists, and academics. If designers propose innovative forms or materials, neighbors and local landmark commissioners claim that the designs "don't belong here" and dismiss them as mere expressions of the designers' "ego." Designers rant about "hysterical preservationists" whose primary goal seems to be gaining control over every square foot of historic cities—if not the planet—thereby shackling creativity and reducing design expression to the lowest common denominator.1 Each side can provide ample evidence for its claims; most readers will know these arguments by heart. This issue of Change Over Time is built on the thesis that historic preservation and contemporary design are not antithetical to each other; they can be catalysts and symbiotic partners. This series of essays complements "Design + Heritage," a sold-out symposium held March 16 and 17, 2017, at PennDesign.2 Cosponsored by the University of Pennsylvania's Historic Preservation Program and the James Marston Fitch Charitable Foundation, the conference sessions challenged the country's leading designers, scholars, educators, and stewards of heritage to debate the topic through case studies and lively discussion.3 The relationship between design and preservation is fundamental. Any work on historic sites, from maintaining an historic condition to modifying the physical form and program to accommodate contemporary needs, requires more effort than meets the eye. Restoration, stabilization, and active repurposing all entail design decisions. While appreciation for the past has too often been triggered by the loss of landmarks and neighborhoods, there is no question that our understanding of heritage is heightened, transformed, and renewed by the evidence of contemporary life around it. And how do "modern" and "contemporary" design gain definition and power except in contrast with what has come before? In this issue's first article, Steven Semes illustrates how, in the early twentieth century, Italian architect and conservation advocate Gustavo Giovannoni pioneered a nuanced view of heritage, encompassing even diradamento, the selective removal of fabric to improve light and air in living quarters and to enhance key elements. Fifty years ago, when the National Historic Preservation Act was passed in the United States, architects and other design professionals did not view existing buildings as worthy creative challenges. Leaders of the American Institute of Architects (AIA) were horrified when First Lady Jacqueline Kennedy and architect John Carl Warnecke proposed retaining [End Page 207] the eighteenth- and nineteenth-century town houses facing the White House, rather than demolishing them for massive new federal office buildings around Lafayette Square. Ralph Thomas Walker, member of the District of Columbia Fine Arts Commission, former AIA president, and once declared "architect of the century" by the New York Times,4 proclaimed that it was folly "To keep on using bad architecture and trying to preserve it because there is practically nothing except the Decatur House on that side of the square that is worth preserving—the rest is junk architecturally—it is junk!"5 The reuse of existing sites makes up a large portion of design practices today. In recent decades, leading architects have embraced opportunities to connect with heritage sites and the powerful stories that can be told through new and old fabric. These range from Bernard Tschumi's reinterpretation of the Acropolis at the Parthenon Museum in Athens, to Sir Norman Foster's symbolic renewal of the Reichstag in Berlin, to James Corner Field Operations' transformation of an abandoned New York Central Railway spur in central Manhattan into the High Line Park. Just last year, the Pritzker Prize, architecture's equivalent of the Nobel, was awarded to RCR Arquitectes. In the announcement of the award, the Pritzker jury cited RCR's "unyielding commitment to place and its narrative, to create spaces that are in discourse with their respective contexts...

Replies to My Critics

I would like to thank the Editors of the British Journal of Aesthetics for organizing this symposium and the participants for their thoughtful comments. It is gratifying to see that my book has elicited such a wide range of responses. Hannah Ginsborg makes an important point that is rarely articulated or articulated so well: that music’s capacity to tell stories or express complex emotions is entirely consistent with its capacity for integration with words (a sung text, as in song or opera) and gesture (as in ballet or opera). Her argument suggests that historical debates about the essence of music were hindered by the search for a lowest common denominator within the sounding work itself. Ginsborg’s approach favours the perspective of listeners, who are free to hear music in ways that may vary widely. This offers a satisfying alternative to the either/or frameworks adopted by Wagner and Hanslick, who were intent on distinguishing between what music by itself can and cannot do.

A solution to the single-question crowd wisdom problem

Once considered provocative, the notion that the wisdom of the crowd is superior to any individual has become itself a piece of crowd wisdom, leading to speculation that online voting may soon put credentialed experts out of business. Recent applications include political and economic forecasting, evaluating nuclear safety, public policy, the quality of chemical probes, and possible responses to a restless volcano. Algorithms for extracting wisdom from the crowd are typically based on a democratic voting procedure. They are simple to apply and preserve the independence of personal judgment. However, democratic methods have serious limitations. They are biased for shallow, lowest common denominator information, at the expense of novel or specialized knowledge that is not widely shared. Adjustments based on measuring confidence do not solve this problem reliably. Here we propose the following alternative to a democratic vote: select the answer that is more popular than people predict. We show that this principle yields the best answer under reasonable assumptions about voter behaviour, while the standard 'most popular' or 'most confident' principles fail under exactly those same assumptions. Like traditional voting, the principle accepts unique problems, such as panel decisions about scientific or artistic merit, and legal or historical disputes. The potential application domain is thus broader than that covered by machine learning and psychometric methods, which require data across multiple questions.

Extra-Jurisdictional Remedies Involving Patent Licensing

In the last several years, competition agencies around the world have imposed or considered imposing extra-jurisdictional remedies on patent holders, particularly owners of standard-essential patents (SEPs) upon which the patent holder has made a commitment to license on fair, reasonable, and non-discriminatory (FRAND) terms. For example, in January 2013, the U.S. Federal Trade Commission (FTC) entered into a consent agreement with Motorola Mobility and its parent, Google, that, except in limited circumstances, prohibits the companies worldwide from seeking injunctive relief against infringers of any FRAND-assured SEP in its global portfolio. Similarly, the Korea Fair Trade Commission and the Taiwan Fair Trade Commission are reportedly considering imposing worldwide restraints on Qualcomm’s enforcement of its global patent portfolio in order to remedy alleged competition violations involving the company’s patent licensing practices. Imposing worldwide remedies can conflict with principles of international comity and result in significant substantive conflicts with the antitrust agencies of other countries given the wide variety of approaches taken globally on antitrust matters involving intellectual property rights (IPRs), particularly with respect to honoring an IPR holder’s core right to exclude. This has the potential to produce significant negative effects on competition and welfare, particularly if conduct that is widely considered to be generally procompetitive is the object of the worldwide prohibition. Even when attacking universally condemned activity such as price fixing, global remedies risk overdeterrence when national authorities do not coordinate to adjust the penalties they impose. Moreover, as explained below, extra-jurisdictional remedies are likely unnecessary to resolve any alleged harm to consumers in the jurisdiction imposing them. Each competition agency forgoing global remedies does not prevent competition law solutions to global harms, and is appropriate to mitigate the risk of overdeterrence. Honoring principles of comity also can mitigate a race to the bottom in competition law enforcement by preventing the lowest common denominator approach to competition law remedies from governing across the board. Indeed, some, including officials at the highest levels of the U.S. government, have raised concerns that foreign governments may be “using numerous mechanisms, including [antitrust laws] to lower the value of foreign-owned patents” in order to benefit those within their countries who implement foreign technology ; that is, the competition authority may be enforcing competition law not solely to protect their consumers from potentially anticompetitive licensing practices, but also to benefit local implementers or a “national champion” in a way that is inconsistent with the procompetitive goals of the competition laws of other jurisdictions. While competition officials across the globe have emphatically denied such claims, imposing welfare reducing global remedies on patent licensing, in addition to reducing competition and welfare, will also draw increased criticism and threaten to harm an agency’s credibility with stakeholders, the international antitrust community, and the public. This article discusses the various approaches taken thus far, as exemplified by four recent decisions: one by the FTC against Google/MMI; two by the European Commission (DG Comp) against Motorola and Samsung, respectively; and one by China’s National Development and Reform Commission (NDRC) against Qualcomm. In contrast with the FTC’s investigation, the latter three limit remedies to the patent holder’s domestic practices in the licensing of their domestic patents (i.e., activity and patents within the territory of the investigating authority), illustrating nicely remedies that are consistent with principles of international comity.

Written Standards and the Social Licence for Financial Markets

Recent years have seen a rediscovery of the fact that a healthy financial and economic system cannot be based on the lowest common behavioural denominator of what is technically permissible under the black letter of the law. Something more is needed – variously described as ‘sound culture’, ‘professionalism’, ‘a sense of vocation’, ‘ethics’, ‘morality, and ‘best practice’. However, it is less clear how these can be achieved if it is not by reference to law or other forms of written standards (such as codes of conduct) since market participants need to understand what standards of behaviour are expected and encouraged to adhere to those standards. Yet use of law and other written standards potentially takes us back to behaviour referenced to the black letter of the law. This paper seeks to help answer the question of how law, regulation and written codes can stimulate behaviour that reflects a standard that transcends them. Among other things, taking the example of the UK financial sector, it looks across the range of written standards (from ‘hard’ law to private codes) that exist in the sector, and the enforcement mechanisms associated with them, to consider how written standards can come to affect behavioural standards. By using a ‘written standards map’ of those financial sector standards, it considers the inter-relationship (a) between tightly prescriptive legal and regulatory rules and those that are more aspirational (such as a legal requirement to achieve ‘fairness’) and (b) between written standards backed by ‘hard’ legal sanctions and those which depend upon softer or private enforcement mechanisms.

Nietzsche, Sport, and Contemporary Culture

The word ‘sport’ next to Nietzsche’s name may raise eyebrows among many Nietzsche readers. ‘What an odd pairing?’ one may ask. We prefer Nietzsche and arts or something from the domain of the Geist. Sport is embedded in mass culture and Nietzsche detests anything that has to do with masses; fandom, an important part of sport culture, is nothing Nietzsche would look at favourably but call it a manifestation of the herd instinct. Besides, clubs and sports organizations control this sporting culture through political and economic apparatuses. On the other hand, modern sports, far from producing higher types and the overhuman, appeal to the lowest common denominator, the person on the street and all athletes are equal. All of these objections notwithstanding, one may still speak of a sporting spirit that embodies play, ecstasy in the sense of Dionysian, inventiveness, agonism, grand spectacle, festivity, a specific type of aesthetics and a form of askesis of the body, and a specific outlet for enactment of active justice and a Gestalt of power relations. Playfulness and game-making are crucial in sports, and play is key to Nietzsche’s thought. Sport is a form of letting go, losing oneself in the game, and can be construed as a field for Dionysian forces. Agonism, a significant aspect of Nietzsche’s thought, applies to all competitive sports. Furthermore, sport constitutes one of the major types of spectacles in our age. Finally, sport belongs to the regime of the body, a form of askesis, which Nietzsche would have supported as opposed to the ascetic idealism. In what ways do Nietzsche’s ideas on interpretation shed light on sport and its various aspects as listed above? What hermeneutic tools do we have to interpret sport as a field of culture? These were the guiding questions for this essay.

Transgovernmental networks and rationalist outputs? The partial social construction of EU foreign policy

ABSTRACTThe European Union (EU) foreign policy has gone beyond intergovernmentalism. It is largely formulated by (Brussels-based) national officials, in a process characterised by a high number of cooperative practices, diffuse sentiments of group loyalty and possibly argumentative procedures. Yet, in many cases, the most likely output of this process reflects the lowest common denominator of states’ positions or the preferences of the biggest states. The article intends to investigate this puzzle. In the first part, it corroborates its existence by using answers from an original database of 138 questionnaires and 37 interviews with EU negotiators. Next, it argues that cooperative practices remain often subordinated to nationally oriented ways of doing things. Consequentialist practices perform an anchoring function, in that they define the parameters around which (social) practices operate. The last section looks more closely at the sites of and meanings attached to EU foreign policy-making. By discussing national diplomats’ conspicuous leeway in Brussels, it also argues that negotiating practices are performed through a mix of partial agency and persistence of national dispositions. On the whole, changing practices is difficult, even in dense and largely autonomous settings such as EU foreign policy. The social construction of EU foreign policy occurs only to a partial extent.

Discussion Paper: Commissioning of medical education in the post-registration arena

Medical education is expensive. In some circumstances, this expense has led to new models of funding post-registration education. One such approach is commissioned or tendered education. Th is model is based on a purchaser–provider split, where centrally funded authorities commission or seek tenders for post-registration medical education from education providers. Despite the growth of commissioning of medical education, there has been little public debate on its advantages or disadvantages. Th ere are a number of advantages of a commissioning model. It can act as an incentive to quality improvement, and it drives competition between providers. In addition, commissioning decisions can be devolved so that local purchasers can decide what forms of medical education they wish to pay for. It also acts as a means of increasing choice. Th ere are also disadvantages to the commissioning model. Th e process of commissioning is in itself expensive. In addition, competition might act as a barrier to integration and induce destabilisation in the system of medical education. Th is model may also suggest that there is a price for everything and that all components of medical education must be reduced to their lowest common denominator of cost. It would work best if pure market forces were unleashed, but the truth is that medical education is rarely a pure market.

Multilateralism in East Asia: Less than the Sum of Its Parts?

The East Asian region is famous for many things, among the more surprising of which is the relatively ineffective nature of its multilateral institutions. Although many scholars claim that organizations such as Association of Southeast Asian Nation (ASEAN) have been effective parts of regional diplomacy, this article suggests that the so-called ASEAN Way has provided a template for regional under achievement and ineffectiveness. As a consequence, and despite a recent flurry of regional initiatives, none of them has been anything like as significant or effective as the European Union was at the height of its powers. This is the unsurprising consequence of institutional design and the politics of the lowest common denominator. The rise of China is unlikely to change this. On contrary, not only has ASEAN solidarity fractured in the face of an increasingly assertive China, but China’s own instrumental attitude to institutional development means that under-performance is likely to remain the regional norm as an array of ineffective institutions compete for authority and relevance.

Is Longer-Distance Migration Slowing? An Analysis of the Annual Record for England and Wales since the 1970s

This paper is prompted by the widespread acceptance that the rates of inter-county and inter-state migration have been falling in the USA and sets itself the task of examining whether this decline in migration intensities is also the case in the UK. It uses annual inter-area migration matrices available for England and Wales since the 1970s by broad age group. The main methodological challenge, arising from changes in the geography of health areas for which the inter-area flows are given, is addressed by adopting the lowest common denominator of 80 areas. Care is also taken to allow for the effect of economic cycles in producing short-term fluctuations on migration rates and to isolate the effect of a sharp rise in rates for 16–24 years old in the 1990s, which is presumed to be related to the expansion of higher education. The findings suggest that unlike for the USA, there has not been a substantial decline in the intensity of internal migration between the first two decades of the study period and the second two. If there has been any major decline in the intensity of address changing in England and Wales, it can only be for the within-area moves that this time series does not cover. This latter possibility is examined in a companion paper using a very different data set. Copyright © 2016 John Wiley & Sons, Ltd.

Which cost of alcohol? What should we compare it against?

This paper explores and develops issues raised by recent debates about the cost of alcohol to England and Wales. It advances two arguments. First, that the commonly used estimates for alcohol harm in England and Wales are outdated, not fully reliable and in need of revisiting. These estimates rely on data that are between 4 and 12 years out of date and sensitive to questionable assumptions and methodological judgements. Secondly, it argues that policymakers, academics and non-governmental organizations should be more careful in their use of these numbers. In particular, it is imperative that the numbers quoted fit the argument advanced. To help guide such appropriate usage, the different types of cost of alcohol are surveyed, alongside some thoughts on the questions they help us to answer and what they imply for policy. For example, comprehensive estimates of the total social cost of alcohol provide an indication of the scale of the problem, but have limited policy relevance. External cost estimates represent a 'lowest common denominator' approach acceptable to most, but require additional assumptions to guide action. Narrower perspectives, such as fiscal, economic or health costs, may be relevant in specific contexts. However, optimal policy should take a holistic view of all the relevant costs and benefits. Similarly, focusing solely on tangible costs may be less controversial, but will result in an under-estimate of the relevant costs of alcohol.

Strength matters: Self-presentation to the strongest audience rather than lowest common denominator when faced with multiple audiences in social network sites

On social network sites (e.g. Facebook), individuals self-present to multiple audiences simultaneously 24 h a day. Prior research has inferred this results in a lowest common denominator effect (LCDE) whereby people constrain their online presentation to the standards of their strictest audience. However, this existing work neglects to address differences in the ‘value’ (social/economic) of the audience. Through the lens of self-presentation theory, we argue that it is not the strictest audience that constrains behavior but the strongest (i.e. that which has the highest score for standards and value combined). We call this the strongest audience effect (SAE). The aim of this research is to examine and contrast the LCDE and SAE. A survey of young Facebook users (n = 379) provides support for the SAE when compared to LCDE, with the strength of the strongest audience predicting behavioral constraint and also social anxiety. Additional insights are generated into which audiences are perceived as the strongest. This study contributes a novel and more holistic lens to understand self-presentation in the presence of multiple audiences in social network sites.

Mitigating climate change in a federal country committed to the Kyoto Protocol: how Swiss federalism further complicated an already complex challenge

When policy scholars assess the effects of federalism on climate change mitigation, they often look at countries that rejected binding commitments (in particular, the USA) and find that federalism enabled sub-national entities to partly fill national regulatory voids. In accordance with a similar case study on Austria, we find the exact opposite for Switzerland, a country that committed itself to an 8 % cut in 1990 greenhouse gas emissions under the Kyoto Protocol. To reveal the detrimental effects of federalism, we focus our case study on the integration of climate change concerns into building policies, a policy field fully in the hands of Swiss sub-national authorities known as cantons. Apart from a few pioneer cantons, we found mainly federal departments concerned with integrating climate change mitigation into cantonal building policies and cantonal as well as federal actors struggling with the numerous pitfalls of Swiss federalism in their own ways. On the one hand, various federal departments tried repeatedly to facilitate a nationwide greening of cantonal building policies, and their interventions often resulted in lowest common denominator solutions that were difficult to improve once in place. On the other hand, Swiss federalism gave a few pioneer cantons the freedom to green their building policies early on, but their policies hardly diffused to other cantons. Resembling our main finding of the Austrian case study, we conclude that the 15 % emission decline in the Swiss building sector during 2008–2012 compared to 1990 levels happened despite, not because of Swiss federalism. This warrants caution against high hopes in assuming that decentralised or polycentric governance can fully compensate for failed national (or international) climate policies.

CONVERGENCE AND DIVERGENCE IN THE INVESTMENT TREATY UNIVERSE - SCOPING THE POTENTIAL FOR MULTILATERAL CONSOLIDATION

How far are we from a m ultilateral investment treaty? In this paper we answer this question by empirically assessing convergence and divergence in the pool of existing bilateral investment treaties (BITs) scoping the potential for multilateral consolidation. To do so, we introduce a novel automated coding procedure, which investigates investment treaty content across 1628 English-language BITs and their 22,500 articles. We show that treaties are split into older, short and shallow agreements and newer, deep and complex ones. This creates possibilities for consolidation around a lowest common denominator. A multilateral treaty with the 27 most prevalent features (out of a total of 66 coded features) would already substitute the content of 50% of all BITs and one with the 36 features could replace 80% of agreements. In contrast, consolidating practice around deeper agreements balancing investment protection and State sovereigntyexplicitly is politically more desirable, but also more ambitious. Only a minority of treaties contain non-investment protection features and their design diverges increasingly as States adopt varying architectures to solve similar policy challenges.As a result, further consolidation at the regional level and partial multilateralizations become necessary stepping-stones, if a future multilateral investment agreement is to converge practice around deeper BITs.

Failing Forward? The Euro Crisis and the Incomplete Nature of European Integration

The European Union (EU) project of combining a single market with a common currency was incomplete from its inception. This article shows that the incompleteness of the governance architecture of Europe’s Economic and Monetary Union (EMU) was both a cause of the euro crisis and a characteristic pattern of the policy responses to the crisis. We develop a “failing forward” argument to explain the dynamics of European integration using recent experience in the eurozone as an illustration: Intergovernmental bargaining leads to incompleteness because it forces states with diverse preferences to settle on lowest common denominator solutions. Incompleteness then unleashes forces that lead to crisis. Member states respond by again agreeing to lowest common denominator solutions, which address the crisis and lead to deeper integration. To date, this sequential cycle of piecemeal reform, followed by policy failure, followed by further reform, has managed to sustain both the European project and the common currency. However, this approach entails clear risks. Economically, the policy failures engendered by this incremental approach to the construction of EMU have been catastrophic for the citizens of many crisis-plagued member states. Politically, the perception that the EU is constantly in crisis and in need of reforms to salvage the union is undermining popular support for European integration.

A numerical similarity approach for using retired Current Procedural Terminology (CPT) codes for electronic phenotyping in the Scalable Collaborative Infrastructure for a Learning Health System (SCILHS)

BackgroundInteroperable phenotyping algorithms, needed to identify patient cohorts meeting eligibility criteria for observational studies or clinical trials, require medical data in a consistent structured, coded format. Data heterogeneity limits such algorithms’ applicability. Existing approaches are often: not widely interoperable; or, have low sensitivity due to reliance on the lowest common denominator (ICD-9 diagnoses). In the Scalable Collaborative Infrastructure for a Learning Healthcare System (SCILHS) we endeavor to use the widely-available Current Procedural Terminology (CPT) procedure codes with ICD-9. Unfortunately, CPT changes drastically year-to-year – codes are retired/replaced. Longitudinal analysis requires grouping retired and current codes. BioPortal provides a navigable CPT hierarchy, which we imported into the Informatics for Integrating Biology and the Bedside (i2b2) data warehouse and analytics platform. However, this hierarchy does not include retired codes.MethodsWe compared BioPortal’s 2014AA CPT hierarchy with Partners Healthcare’s SCILHS datamart, comprising three-million patients’ data over 15 years. 573 CPT codes were not present in 2014AA (6.5 million occurrences). No existing terminology provided hierarchical linkages for these missing codes, so we developed a method that automatically places missing codes in the most specific “grouper” category, using the numerical similarity of CPT codes. Two informaticians reviewed the results. We incorporated the final table into our i2b2 SCILHS/PCORnet ontology, deployed it at seven sites, and performed a gap analysis and an evaluation against several phenotyping algorithms.ResultsThe reviewers found the method placed the code correctly with 97 % precision when considering only miscategorizations (“correctness precision”) and 52 % precision using a gold-standard of optimal placement (“optimality precision”). High correctness precision meant that codes were placed in a reasonable hierarchal position that a reviewer can quickly validate. Lower optimality precision meant that codes were not often placed in the optimal hierarchical subfolder. The seven sites encountered few occurrences of codes outside our ontology, 93 % of which comprised just four codes. Our hierarchical approach correctly grouped retired and non-retired codes in most cases and extended the temporal reach of several important phenotyping algorithms.ConclusionsWe developed a simple, easily-validated, automated method to place retired CPT codes into the BioPortal CPT hierarchy. This complements existing hierarchical terminologies, which do not include retired codes. The approach’s utility is confirmed by the high correctness precision and successful grouping of retired with non-retired codes.

Goodbye, Thank You, and Hello!

Change sometimes comes slowly, sometimes with astonishing speed. It has been a privilege to serve as the editor of The American Journal of Cosmetic Surgery (AJCS) for the past 7 years, and it’s hard to believe that it has been this long. The AJCS has been published by Allen Press for even longer. This issue represents the last installment of our long and fruitful partnership. Just as the American Academy of Cosmetic Surgery (AACS) has undergone profound changes in the last 2 years, moving from an internal management, physical office space model of internal association management to a virtual office run by a contractual management firm, so now will The Journal also be altering its structure. We are moving to SAGE Publications. This move, undertaken by our management team, transfers ownership of the journal to an independent, academic publisher responsible for more than 850 journals and 800 books across a spectrum of medical, scientific, business, humanities, and social science fields. In preliminary meetings with SAGE staff I have been impressed by their commitment to making The AJCS a distinguished resource for cosmetic surgery research and education. Plans include digitizing the entire back catalogue of the journal, open access to past and future articles, and creating a partnership with the AACS that will continue to ensure the integrity and value of the cosmetic surgery scientific enterprise. We will also be upgrading the details of our instructions to authors, establishing more comprehensive ethical guidelines in keeping with contemporary clinical research standards, and broadening the horizons of our contributors, reviewers, and readers. Allen Press has been a wonderful partner in the journal enterprise, and this departure is not about any fissures in our relationship, but rather is a not uncommon event in the publishing world. By shifting ownership of The AJCS to this larger multinational corporation, it is anticipated that we can enhance the reach and stature of the journal while at the same time reducing overhead costs for the AACS. Both are desirable outcomes in the increasingly fragmented and competitive world of scientific publishing. For the past couple of years my own inbox has received daily invitations to serve as editor of, reviewer for, or contributor to a new, self-proclaimed, “international” “worldwide” “open access” journal of some kind, increasingly narrow and specialized, or so broad as to be laughable, and most frequently built on a business model of “pay to publish,” where the authors are required to subsidize their publication. In this process, peer review is frequently minimal, negligible, or absent. Scientific or clinical standards of accuracy, precision, and trustworthiness are held to the lowest common denominator. The free flow of relevant, important, and valuable information is clogged by this sludge of valueless dreck. The entire enterprise of scientific publishing is currently undergoing a revolution. More “scientific” articles are published daily than were annually a few decades ago. Simultaneous publication, while still considered unethical, continues unabated. Plagiarism, outright fraud, and financially conflicted results are being published without proper references, acknowledgment of conflicts, or proper

International sanctions before and beyond UN sanctions

United Nations sanctions are authorized by the international body that is legally charged with the maintenance of international peace and security, the UN Security Council. They are grounded in provisions of the UN Charter. However, only a fraction of all international sanctions are mandated by the UN. One of the findings of this article, which is based on data collected by the Targeted Sanctions Consortium (TSC), is that the large majority of UN sanctions are preceded by non-UN sanctions, particularly sanctions by the United States and the European Union. Furthermore, it is common practice, particularly by the US and the EU, to add sanction provisions of their own to UN sanctions. As a result, for most UN sanctions, there are also non-UN sanctions against the same targets. Such combined sanction regimes add restrictions imposed by only some governments to those that all countries have to implement. Combined sanction regimes are therefore potentially more effective in achieving the targeted outcome than UN sanctions, which represent the lowest common denominator achievable among the members of the UN Security Council. On the other hand, combined sanction regimes might suffer from a type of ‘sanctions fatigue’. A growing number of states outside of the West are openly opposed to unilateral sanctions. Adding non-UN sanctions to UN sanctions might reduce their willingness to support UN sanctions. The TSC data, however, does not support such a contention. Rather, the data indicates that combined sanction regimes are more effective than stand-alone UN sanctions. Still, the US and EU governments—as the main drivers of sanctions policy in general and UN sanctions in particular—need to be aware of this criticism in order not to unwittingly undermine the UN sanctions instrument