Large and rapid power shifts resulting from exogenous economic growth are considered sufficient to cause preventive wars. Yet most large and rapid shifts result from endogenous military investments. We show that when the investment decision is perfectly transparent, peace prevails. Large and rapid power shifts are deterred through the threat of a preventive war. When investments remain undetected, however, states may be tempted to introduce power shifts as a fait accompli. Knowing this, their adversaries may strike preventively even without conclusive evidence of militarization. In fact, the more effective preventive wars are, the more likely they will be launched against states that are not militarizing. Our argument emphasizes the role of imperfect information as a cause of war. It also explains why powerful states may attack weaker targets even with ambiguous evidence of their militarization. We illustrate our theory through an account of the 2003 US-led invasion of Iraq.

Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov , NCT03471494 . Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.

International Relations (IR) is uneasy about its status as a 'science'. Throughout a long history of attempts to legitimate the field as 'scientific', IR scholars have imported multifarious positions from the Philosophy of Science (PoS) in order to ground IR on an unshakable foundation. Alas, no such unshakable foundation exists. The PoS is itself a contested field of study, in which no consensus exists on the proper foundation for science. By importing foundational divisions into IR, the 'science' debate splits the discipline into contending factions and justifies the absence of dialogue between them. As all foundations require a leap of faith, imperial foundational projects are always vulnerable to challenge and therefore unable to resolve the science question in IR. In this article, we seek to dissolve rather than solve the 'science' debate in IR and the quest for philosophical foundations. We argue that IR scholars should adopt an 'attitude towards' rather than a 'position in' the irresolvable foundational debate. Specifically, we advocate an attitude of 'foundational prudence' that is open-minded about what the PoS can offer IR, while precluding imperial foundational projects, which attempt to impose a single meta-theoretical framework on the discipline. This requires knowing what PoS arguments can and cannot do. As such, foundational prudence is post-foundational rather than anti-foundational. A prudent attitude towards philosophical foundations encourages theoretical and methodological pluralism, making room for a question-driven IR while de-escalating intradisciplinary politics.

All patient subsets presented with decreased lymphocyte counts, but only patients with advanced fibrosis presented with a significant increase in the CD4(+)/CD8(+) ratio.

Hepcidin liver expression is inappropriately low in alcoholic patients with active alcoholism and preserved hepatic function, and we conclude that this is the mechanism for alcohol consumption-associated iron overload in humans.