Digital Commons Network^™

Biomechanics And Clinical Implications Of Fontan Upsizing, Vijay Govindarajan, Akshita Sahni, Emily Eickhoff, Peter Hammer, David M Hoganson, Rahul H Rathod, Pedro J Del Nido

Faculty, Staff and Student Publications

Background: The Fontan operation, a palliative procedure for single ventricle patients, has evolved to improve outcomes and reduce complications. While extracardiac conduit (ECC) is favored for its simplicity and potential hemodynamic benefits, concerns arise about conduit size adequacy over time. Undersized ECC conduits may cause hemodynamic inefficiencies and long-term complications, while oversizing can lead to flow disturbances, stagnation, and thrombosis, necessitating surgical revision or upsizing to optimize hemodynamics.

Objectives: The study aimed to predict the impact of upsizing by developing a patient-specific workflow using cardiac magnetic resonance-based imaging and computational fluid dynamics to assess Fontan hemodynamic changes and determine the …

Expanded-Access Use Of Elamipretide Improves Quality Of Life In Patients With Rare Mitochondrial Disorders Characterized By Ophthalmic Symptoms: A Case Series, Sharique Ansari, Mary Kay Koenig

Faculty, Staff and Student Publications

This case series presents the use of elamipretide in two patients with different progressive mitochondrial disorders (chronic progressive external ophthalmoplegia [CPEO] plus and neuropathy, ataxia, and retinitis pigmentosa [NARP] syndrome) characterized by ophthalmic traits. Elamipretide was well tolerated and both patients demonstrated improvement in symptoms while on therapy.

Reduction Of Overactive Bladder Medications In Spinal Cord Injury With Self-Administered Neuromodulation: A Randomized Trial, Argyrios Stampas, Radha Korupolu, Kyung Hyun Lee, Betsy Salazar, Rose Khavari

Faculty, Staff and Student Publications

Purpose: Our goal was to evaluate if self-administered bladder neuromodulation with transcutaneous tibial nerve stimulation could safely replace overactive bladder medications in people with spinal cord injury.

Materials and methods: We performed a 3-month, randomized, investigator-blinded, tibial nerve stimulation vs sham-control trial in adults with spinal cord injury and neurogenic bladder performing intermittent catheterization and taking overactive bladder medications. The primary outcome was a reduction in bladder medications while maintaining stable bladder symptoms and quality of life based on pre/post Neurogenic Bladder Symptom Score and the Incontinence Quality of Life questionnaire, respectively. Secondary outcomes included changes in pre/post cystometrogram, 2-day …

Compensation For Metabolic Dietitians Practicing In The United States: 2023 Genetic Metabolic Dietitians International Professional Status Survey, Krista Viau, Sommer Gaughan, Jessica Kopesky, Beth Ogata, Heather Saavedra, Mary Sowa, Erin Macleod

Faculty, Staff and Student Publications

Background: Genetic Metabolic Dietitians International (GMDI) conducted a professional status survey of metabolic dietitians working in the United States to describe job satisfaction and establish salary and compensation benchmarks specific to metabolic dietitians.

Methods: The survey was anonymously administered in a web-based format via REDCap between October and November 2023. Registered dietitians working with inborn errors of metabolism (IEM) were eligible to participate.

Results: A total of 178 surveys were received and 147 were included in the final analysis. Most respondents were female (96 %), worked in a clinical setting (83 %), and held a graduate degree (75 %), while …

Systolic Blood Pressure, Cardiovascular Health, And Neurocognition In Adolescents., Stephen R Hooper, Marc B Lande, Joseph T Flynn, Coral D Hanevold, Kevin E Meyers, Joshua Samuels, Richard C Becker, Stephen R Daniels, Bonita E Falkner, Michael A Ferguson, Julie R Ingelfinger, Lisa J Martin, Mark Mitsnefes, Phillip Khoury, Jangdong Seo, Elaine M Urbina

Faculty, Staff and Student Publications

Background: We studied whether increased systolic blood pressure (SBP), as determined by auscultatory SBP, ambulatory SBP, and the number of cardiovascular health risk indicators, are associated with neurocognition in adolescents.

Methods: This cross-sectional study included 365 adolescents (mean age, 15.5 years) from 6 academic medical centers in the United States. The sample was 59.5% male, 52.6% White, with 23.9% of the caregivers having less than or equal to a high school degree. Primary exposures included the following: auscultatory SBP, ambulatory SBP, and the number of cardiovascular risk factors. Neurocognitive outcomes comprised nonverbal IQ, attention, and parent ratings of executive functions. …

Motivations For And Against Participation In Neonatal Research: Insights From Interviews Of Diverse Parents Approached For Neonatal Research In The United States, Elliott Mark Weiss, Pamela K Donohue, Susan H Wootton, Emily Stevens, Stephanie L Merhar, Mihai Puia-Dumitrescu, Amanda Mercer, Ellie Oslin, Kathryn M Porter, Benjamin S Wilfond

Faculty, Staff and Student Publications

Objective: To describe parents' motivations for and against participation in neonatal research, including the views of those who declined participation.

Study design: We performed 44 semi-structured, qualitative interviews of parents approached for neonatal research. Here we describe their motivations for and against participation.

Results: Altruism was an important reason parents chose to participate. Some hoped participation in research would benefit their infant. Burdens of participation to the family, such as transportation to follow up (distinct from risks/burdens to the infant), were often deciding factors among those who declined participation. Perceived risks to the infant were reasons against participation, but parents …

Connecting, Serving, And Adapting: Perspectives On The Transition To Adulthood From Latino Young Adults With Asd, Parents, And Providers, Antonio F Pagán, Juliana L Vanderburg, Katherine A Loveland, Ron E Acierno, Thomas D Meyer

Faculty, Staff and Student Publications

Advancing interventions and supports for individuals with autism spectrum disorder (ASD) requires understanding that ASD is a lifelong developmental difference. However, little is known about the unique experiences of autistic young adults, parents, and community providers in the Latino community. The purpose of this study was to improve access to inclusive community based setting by identifying and learning about barriers and needs experienced by young adults, parents, and community providers of autistic individuals across the lifespan, but particularly during the transition to adulthood. Ten community providers, eighteen parents of autistic children, and five young adult self-advocates participated in focus groups. …

A Multi-Institutional Study Of Magnetic Resonance/Ultrasound Fusion-Guided Nanoparticle-Directed Focal Therapy For Prostate Ablation, Steven E Canfield, Arvin K George, Joshua S Jue, Sara C Lewis, Matthew S Davenport, Varaha S Tammisetti, Mahir Maruf, Leonardo D Borregalaes, Yara Kadria-Vili, Jon A Schwartz, Jennifer West, Naomi J Halas, Ardeshir R Rastinehad

Faculty, Staff and Student Publications

Purpose: Focal therapy aims to provide a durable oncologic treatment option for men with prostate cancer (PCa), while preserving their quality of life. Most focal therapy modalities rely on the direct tissue effect, resulting in a possible nontargeted approach to ablation. Here, we report the results of the first human feasibility trial utilizing nanoparticle-directed focal photothermal ablation for PCa.

Materials and methods: A prospective, open-label, single-arm, multicenter study of men with localized PCa in Gleason Grade Group 1 to 3 was conducted. Men received a single infusion of gold nanoparticles (AuroShells), followed by magnetic resonance (MR)/ultrasound (US) fusion-guided laser excitation …

Research Prioritization In Hernia Surgery: A Modified Delphi Achqc And Vhoc Expert Consensus, William W Hope, Karla Bernardi, Julie L Holihan, Michelle Loor, Mike K Liang, Benjamin T Miller

Faculty, Staff and Student Publications

Purpose: Numerous clinical practice guidelines and consensus statements have been published in hernia surgery, however, there is still a need for high-quality evidence to address remaining unanswered questions. The aim of this study was to conduct research priority setting through a modified Delphi process to identify a list of top research priorities in hernia surgery.

Methods: A structured literature review of clinical practice guidelines was performed by the steering committee. Topics considered clinically significant, practical to study and lacking strong evidence were extracted and refined into a comprehensive list, then entered into a two-round Delphi survey for prioritization at the …

Resolution Of Painful Trichodysplasia Spinulosa With Topical Cidofovir: Case Report, Stephen K Tyring

Faculty, Staff and Student Publications

Purpose: Trichodysplasia spinulosa (TS) is a rare, disfiguring skin condition which presents with widespread asymptomatic or pruritic, skin-colored papules with white protruding keratin spiculations in immunocompromised individuals. Due to its rarity, there is little data to guide treatment decisions. The purpose of this article is to report a case of TS that completely resolved after treatment with topical cidofovir.

Materials and methods: A 19-year-old immunosuppressed female presented with widespread painful, itchy bumps on the nose and face. Upon examination, there were erythematous papules with hyperkeratinized spicules affecting the central face. Biopsy of the lesions was consistent with TS which was …

Nasal Virus Infection Induces Asthma Exacerbation Through B-Cell-Dependent Recruitment Of Inflammatory Monocytes, Kody A Waldstein, Arman Issimov, Maria Ganama, Valerie Jinge, Stephen Tilley, Xiaoyang Hua

Faculty, Staff and Student Publications

Background: Upper respiratory viral infections (URVIs) are responsible for 80% of asthma exacerbation episodes. However, the underlying mechanisms remain poorly understood.

Methods: In this study, we used a mouse model of URVI and examined the impact of URVI on asthma phenotypes and the underlying mechanisms.

Results: Previously, we have reported that nasal-restricted infection with respiratory syncytial virus (RSV) only produces mild sino-nasal inflammation and mucus production, without causing direct lung infection. However, such nasal-restricted infection dramatically enhanced TH2 and TH17 inflammatory responses in the lungs and increased airway hyperresponsiveness (AHR) in mice with house dust mite (HDM)-induced asthma. Additionally, nasal-restricted …

Cardiomegaly Status After Open Repair Of An Arch Aneurysm

Faculty, Staff and Student Publications

This report describes a patient with a thoracic aortic aneurysm who presented with chest pain and dyspnea. Preoperative studies revealed a massive cardiomediastinal silhouette. Within hours after the operation, a profound reduction in cardiomegaly was observed. Herein, we describe the distinctive imaging and technical aspects of the surgical procedure.

Brain Gray Matter Changes In Children At Risk For Sudden Unexpected Death In Epilepsy, Raman Sankar

Faculty, Staff and Student Publications

Background: Potential failing adult brain sites, stratified by risk, mediating Sudden Unexpected Death in Epilepsy (SUDEP) have been described, but are unknown in children.

Methods: We examined regional brain volumes using T1-weighted MRI images in 21 children with epilepsy at high SUDEP risk and 62 healthy children, together with SUDEP risk scores, calculated from focal seizure frequency. Gray matter tissue type was partitioned, maps normalized, smoothed, and compared between groups (SPM12; ANCOVA; covariates, age, sex, and BMI). Partial correlations between regional volumes and seizure frequency were examined (SPM12, covariates, age, sex, and BMI); 67% were at high risk for SUDEP. …

Redox Regulation Of Proteostasis

Faculty, Staff and Student Publications

Oxidants produced through endogenous metabolism or encountered in the environment react directly with reactive sites in biological macromolecules. Many proteins, in particular, are susceptible to oxidative damage, which can lead to their altered structure and function. Such structural and functional changes trigger a cascade of events that influence key components of the proteostasis network. Here, we highlight recent advances in our understanding of how cells respond to the challenges of protein folding and metabolic alterations that occur during oxidative stress. Immediately after an oxidative insult, cells selectively block the translation of most new proteins and shift molecular chaperones from folding …

Outcomes After Open Repair Of Aortic Aneurysms And Dissections In Cannabis Consumers, Harleen K Sandhu

Faculty, Staff and Student Publications

Objective: To investigate the influence of cannabis consumption on the mid- and long-term surgical outcomes of patients with aortic aneurysms or dissections.

Methods: All individuals aged 18 years and older with more than 6 months of cannabis use at the time of surgical repair for cardiovascular disease (aortic aneurysms or aortic dissection) between 2007 and 2023 were eligible. Patients were stratified into 2 groups based on their preoperative history of cannabis use: cannabis users and noncannabis users. The primary end point was complications or death within 30 days of intervention. Secondary outcomes included late complications and reinterventions. Data were combined …

Safety And Clinical Outcomes Of Endovascular Therapy Versus Medical Management In Late Presentation Of Large Ischemic Stroke, Volker Puetz, Jean Raymond, Marc Ribo, Patrik Michel, Shinichi Yoshimura, Osama O Zaidat, Simon Winzer, Santiago Ortega-Gutierrez, Sunil A Sheth, James E Siegler, Anne Dusart, Diogo C Haussen, Hilde Henon, Bettina L Serrallach, Mahmoud H Mohammaden, Markus A Möhlenbruch, Marta Olive-Gadea, Ajit S Puri, Nobuyuki Sakai, Piers Klein, Liisa Tomppo, Francois Caparros, João Nuno Ramos, Mouhammad Jumaa, Syed Zaidi, Tomas Dobrocky, Nicolas Martinez-Majander, Stefania Nannoni, Flavio Bellante, Aaron Rodriguez-Calienes, Sergio Salazar-Marioni, Pekka Virtanen, Daniel Po Kaiser, Rita Ventura, Jessica Jesser, Alicia C Castonguay, Muhammad M Qureshi, Hesham E Masoud, Milagros Galecio-Castillo, Manuel Requena, Riikka Lauha, Wei Hu, Eugene Lin, Zhongrong Miao, Daniel Roy, Hiroshi Yamagami, David J Seiffge, Davide Strambo, Peter A Ringleb, Robin Lemmens, Urs Fischer, Thanh N Nguyen, Johannes Kaesmacher

Faculty, Staff and Student Publications

Introduction: The benefit of endovascular therapy (EVT) among stroke patients with large ischemic core (ASPECTS 0-5) in the extended time window outside of trial settings remains unclear. We analyzed the effect of EVT among these stroke patients in real-world settings.

Patients and methods: The CT for Late Endovascular Reperfusion (CLEAR) study recruited patients from 66 centers in 10 countries between 01/2014 and 05/2022. The extended time-window was defined as 6-24 h from last-seen-well to treatment. The primary outcome was shift of the 3-month modified Rankin scale (mRS) score. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality. Outcomes were analyzed …

Telehealth In Emergency Medicine Residency Training: A Model Curriculum, Bruce M Lo, Samuel D Luber

Faculty, Staff and Student Publications

Emergency physicians are well‐positioned to take a leadership role in telehealth, particularly in emerging categories such as triage, direct acute unscheduled care, and virtual observation. However, the growth of telehealth has outpaced curricular development in emergency medicine (EM) residency programs. This manuscript presents a model longitudinal telehealth curriculum, developed by the consensus of education experts, including representatives from the telehealth interest groups from EM's two primary specialty societies: the American College of Emergency Physicians and the Society for Academic Emergency Medicine. The curriculum describes overarching goals and components that may serve as a foundation for individual institutions seeking to train …

Outcomes Of Mechanical Thrombectomy In Anticoagulated Patients With Acute Distal And Medium Vessel Stroke, Dhairya Lakhani, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Benjamin Yq Tan, Robert W Regenhardt, Jeremy J Heit, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, Muhammed Amir Essibayi, David Altschul, Nestor R Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Mohammad Ali Aziz-Sultan, Constantin Hecker, Hamza Shaikh, David S Liebeskind, Alessandro Pedicelli, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Adrien Guenego, Adam A Dmytriw, Mad Mt Investigators

Faculty, Staff and Student Publications

Background: Stroke remains a major health concern globally, with oral anticoagulants widely prescribed for stroke prevention. The efficacy and safety of mechanical thrombectomy (MT) in anticoagulated patients with distal medium vessel occlusions (DMVO) are not well understood.

Methods: This retrospective analysis involved 1282 acute ischemic stroke (AIS) patients who underwent MT in 37 centers across North America, Asia, and Europe from September 2017 to July 2023. Data on demographics, clinical presentation, treatment specifics, and outcomes were collected. The primary outcomes were functional outcomes at 90 days post-MT, measured by modified Rankin Scale (mRS) scores. Secondary outcomes included reperfusion rates, mortality, …

Evaluating Novel In Silico Tools For Accurate Pathogenicity Classification In Epilepsy-Associated Genetic Missense Variants, Eduardo Pérez-Palma

Faculty, Staff and Student Publications

Objective: Determining the pathogenicity of missense variants in clinical genetic tests for individuals with epilepsy is crucial for guiding personalized treatment. However, achieving a definitive pathogenic classification remains challenging, with most missense variants still classified as variants of uncertain significance (VUS) and with the availability of many computational tools which may provide conflicting predictions. Here, we aim to evaluate the performance of state-of-the-art computational tools in pathogenicity prediction of missense variants in epilepsy-associated genes. This will assist in selecting the most appropriate tool and critically assess their use in clinical setting.

Methods: We assessed the performance of nine in silico …

Prevention Is Better Than Cure: Rethinking Court Behaviour And Design, De Maartje Visser

Research Collection Yong Pung How School Of Law

Using a relational dynamics perspective, this commentary considers how to buttress courts' ability to practice their role as guardians of the constitution. It suggests that we should pay more attention to empowering the general public to provide meaningful social support for courts through constitutional literacy efforts. Such literacy efforts should focus on the place of the court within the separation of powers and the value of judicial independence. At the same time, it may be prudent to redact the list of tasks given to constitutional courts and divest responsibility for some activities to other institutions.

Anger And Disgust Shape Judgments Of Social Sanctions Across Cultures, Especially In High Individual Autonomy Societies, Per A. Andersson, Andree Hartanto, Et Al

Research Collection School of Social Sciences

When someone violates a social norm, others may think that some sanction would be appropriate. We examine how the experience of emotions like anger and disgust relate to the judged appropriateness of sanctions, in a pre-registered analysis of data from a large-scale study in 56 societies. Across the world, we find that individuals who experience anger and disgust over a norm violation are more likely to endorse confrontation, ostracism and, to a smaller extent, gossip. Moreover, we find that the experience of anger is consistently the strongest predictor of judgments of confrontation, compared to other emotions. Although the link between …

The Case For Stronger Scrutiny Of The Deductibility Of Crypto Losses, Vincent Ooi

Research Collection Yong Pung How School Of Law

Crypto losses have the potential to adversely impact the tax base, particularly if they are deducted against income from other profitable sources. There is a key question of fairness as to whether crypto losses should be cross-subsidised by income from other sources that may have nothing to do with cryptoassets at all. This article argues for stronger scrutiny of the deductibility of crypto losses at the stage of determining whether such losses can be set off against income from other sources or at the stage of the shifting of the losses across time and between companies. It explains why crypto …

The Case For Stronger Scrutiny Of The Deductibility Of Crypto Losses, Vincent Ooi

Research Collection Yong Pung How School Of Law

My paper, The Case for Stronger Scrutiny of the Deductibility of Crypto Losses, which was recently published by The Journal of Tax Administration, discusses the issue of crypto losses and risks to the tax base. It submits that tax authorities and national legislatures should step up their scrutiny of the deductibility of crypto losses and proposes some ways in which this can be done in practice.

Alternative Agrifood Systems And The Economic Sustainability Of Farmers' Cooperatives: The Chinese Experience, Zhanping Hu, Qian Forrest Zhang

Research Collection School of Social Sciences

Most registered farmers' cooperatives in China are de facto private enterprises; while many bring economic gains to farmers, they do not function as cooperatives. Among the small minority that started as authentic cooperatives, however, most struggled to provide economic benefits to members, unable to achieve economic sustainability. The failure of true farmers' cooperatives in China has been widely studied; the success of the few that did become economically sustainable, however, remains poorly understood. Using a sample of 70 farmers' cooperatives across the country and comparing three “extreme cases”—cooperatives that are both authentic and economically successful—with the rest, this study argues …

Was 2024 A Good Year For You? Let’S Review Your Yardsticks…, Seow Hon Tan, Su Ching Lim

Research Collection Yong Pung How School Of Law

This op-ed encourages all to reflect on their year and examine whether they have lived meaningfully according to their yardstick of meaning, the legacy they want to leave behind, and whether their talents and credentials are empowering and enabling, rather than restricting them. It is written as part of a research project examining success and flourishing in Singapore.

Is The Hague Academy Of International Law A European Institution?, Pasha L. Hsieh

Research Collection Yong Pung How School Of Law

This essay reviews the centenary development of the Hague Academy of International Law with particular emphasis on its research and teaching related to regional approaches to international law. Charles Henry Alexandrowicz's lectures at the Hague Academy in the 1960s contended that the European-developed recognition system narrowed the universality of international law to Eurocentric dimensions and marginalised international legal developments in Asia. Drawing on Alexandrowicz's main claim, the essay argues that the rise of Asia has become a geopolitical reality but has yet to be recognised in international legal scholarship. First, Alexandrowicz's theoretical analysis should be understood through both international law …

Computer Use Frequency And Cardiovascular Health In Middle-Aged And Older Adults, Meilan Hu, Shu Fen Diong, K. T. A. Sandeeshwara Kasturiratna, Andree Hartanto

Research Collection School of Social Sciences

With increased computer usage amongst midlife and older adults, concerns are emerging with regards to the potential adverse health effects of computer use given the sedentary habits it may encourage. The current study aims to investigate the relationship between computer use and cardiovascular risk in midlife and older adults. From the National Survey of Midlife Development in the United States II: Biomarker Project (2004–2009) and the National Survey of Midlife Development in the United States (MIDUS II), 2004–2006, we examined five cardiovascular risk biomarkers—high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, interleukin-6, and C-reactive protein—in relation to self-reported general …

Factor Structure Of The Ces-D-20 Scale In Young Adults In Singapore: An Examination Of Six Alternative Structures And Measurement Invariance By Sex, Nadyanna M. Majeed, K. T. A. Sandeeshwara Kasturiratna, Nicole Ruiying Chen, Andree Hartanto

Research Collection School of Social Sciences

Building on past research that has indicated cultural variations in the factor structure of the 20-item Center for Epidemiologic Studies Depression Scale (CES-D-20), as well as several limitations validating the CES-D-20 within a Singapore context, this study investigated the CES-D-20's factor structure and sex-based measurement invariance in Singapore. A large young adult sample in Singapore (N = 1008) was utilised, and the original CES-D-20 was administered to all participants. The findings confirmed the four-factor model's robustness over five other alternative models (RMSEA = .05, SRMR = .04), where each of the 20 items loaded significantly onto its respective factor (all …

Advances In Research On Anthropogenic Drivers Of Climate Change, Andrew Jorgenson, Hassan El Tinay, Jared Fitzgerald, Jennifer Givens, Taekyeong Goh, Xiaorui Huang, Orla Kelly, Annika Marie Rieger, Ryan P. Thombs

Research Collection School of Social Sciences

This chapter provides an overview of advances in social science research on the anthropogenic drivers of climate change. Anthropogenic drivers refer to the social systems and human actions causing GHG emissions, and societal factors shaping and conditioning those actions. The authors summarize the contemporary drivers research literature on (1) economic growth, (2) income and wealth inequality, (3) environmental load displacement and ecologically unequal exchange, (4) militarization, and (5) corporations. In addition to summarizing recent work, the authors identify future directions for each of these areas of research, as well as ways in which they can be better integrated.

(In)Visible China: Understanding Chinese Global Orders, Hassan Karrar, William A. Callahan, Carwyn Morris, Stephen Whiteman

Research Collection School of Social Sciences

Where is China going? What does its alternative global order look like? We hear a lot about China’s grand projects like the Belt and Road Initiative, but how are they experienced on the ground in Africa, South America, and Asia?The Chinese Global Orders project brings together twenty-two scholars from five continents to explore these questions. As these four commentaries show, it seeks to pluralize the discussion by exploring “Chinese” beyond the PRC nation-state, “Global” as a space beyond the international, and “Orders” as a plural set of norms.The project seeks to do more than just describe Global China’s material impact, …