bluuebunny/crossref_metadata_2025 huggingface dataset:
The Value of Music in Melanesia: Creation, Circulation, and Transmission Under Changing Economic and Intellectual Property Conditions
Authors: Leach James , Stern Monika
Published: March 2020

This article examines the principles governing the ownership and circulation of music in Melanesia. It demonstrates how musical practice is part of what connects people in kin-based, local, and regional systems of reciprocity, recognition, and social reproduction. The article outlines the principles that underlie these systems and shows how they are often starkly at odds with assumptions about value and transaction in capitalist, commodity-focused economies. The contrast is epitomized in the differences between connections forged under Melanesian political economy and those in western intellectual property law, specifically copyright. The article makes the case for understanding the value of contemporary as well as traditional forms of music in this frame, focusing on relationality and obligation in both rural and urban contexts.
Grammar and Meaning
Authors: Asudeh Ash
Published: March 2020

This paper discusses three aspects of the study of linguistic meaning—lexical semantics, compositional semantics, and pragmatics—and their relation to grammar. Lexical semantics concerns the meanings of words and relations between these meanings, and how these meanings are realized morphosyntactically. Compositional semantics concerns how the meanings of larger grammatical units—phrases, sentences, discourses—are computed from the meanings of their parts, given their grammatical arrangement. Pragmatics concerns the relation between context and meaning, given the knowledge of interlocutors. Each of these aspects of meaning is related to grammatical aspects of linguistic structure (morphology, syntax, prosody), although pragmatics displays weaker strictly grammatical effects than the other two aspects of meaning, for which the relationship with grammar is intrinsic.
Generative Approaches
Authors: Lohndal Terje , Haegeman Liliane
Published: March 2020

This chapter provides an introduction to syntax from a generative perspective. Due to space constraints, the chapter zooms in on mainstream derivational (‘transformational’) approaches, essentially along the lines developed by Chomsky and many others. The chapter highlights the long-standing and constant ingredients of the mainstream theory, and it does so by emphasizing and illustrating the characteristic theory-driven deductive argumentation. After introducing and motivating hierarchical structure and the structural relation c-command, the chapter explores the concept of abstract structure by studying long-distance dependencies. In particular, it is shown how copies left by moved constituents play a role in interpretive processes. Furthermore, a case study of VP ellipsis provides arguments that although the ellipsis site is not associated with any overt material, it nevertheless has internal structure. In sum, the chapter seeks to illuminate the nature of the interplay between data and theory construction within generative approaches.
Change in Grammar
Authors: Hundt Marianne
Published: March 2020

The chapter discusses morphological and syntactic change against the backdrop of different theoretical (formal versus functional/usage-based) and methodological approaches (introspection versus corpus data). Specifically, it addresses the question whether grammatical change happens suddenly in a catastrophic resetting of parameters or whether change happens in a more piecemeal, incremental fashion. The case studies that are used to illustrate syntactic demise, innovation, and grammatical revival come from the area of mood (an inflectional category) and modality, notably the grammaticalization of modal verbs. Semi-modals such as (had) better are discussed as examples of constructionalization. Taken together, grammatical changes in mood and modality are ideally suited to exemplify more long-term typological developments in English from a synthetic to a largely analytic language.
Literary Variation
Authors: Jeffries Lesley
Published: March 2020

This chapter investigates grammatical variation in literary texts. It introduces key concepts in stylistics and discusses topics that stylisticians have been concerned with at the interface between literature and grammar, such as the use in literary texts of non-standard forms of the language and the iconic use of grammar to produce literary meaning and effects. Stylistics is now very much more than the application of linguistic description to the language of literature and has developed theories and models of its own. But at the core of the discipline remains text (both spoken and written) and the notion that text producers have choices as to how they put language into texts. This chapter explains the grammatical aspects of such choices and the literary effects they can have.
Information Structure
Authors: Kaltenböck Gunther
Published: March 2020

This chapter provides an overview of central concepts in the study of information structure and their application to grammatical structures of English. The first part focuses on the notions of given and new information, more specifically presupposition, assertion, and the activation of discourse referents, as well as on the concepts of topic and focus. The second part investigates how these concepts conventionally manifest themselves in morphosyntactic structure. This includes a brief discussion of the general principles of end-focus, end-weight, and lexico-grammatical construal as well as specific information packaging constructions, viz. fronting and postponement structures, argument reversal, and clefting. The chapter ends with a brief look at the position of information structure in the study of grammar more generally.
Regional Varieties of English
Authors: Siemund Peter
Published: March 2020

This chapter discusses non-standard grammatical features of regional varieties of English in relation to their Standard English functional equivalents. It pursues a cross-linguistic typological approach in the classification and interpretation of these features. This approach helps to reveal the often highly systematic relationship between standard and non-standard variants as well as the universal basis of the underlying cognitive principles. Illustration is drawn from reflexive marking, pronominal gender and case, tense and aspect, negation and negative concord, subject–verb agreement, and clause structure, which here includes ditransitive constructions, embedded inversion, and the formation of relative clauses.
Mood and Modality
Authors: Ziegler Debra
Published: March 2020

Mood in English and other languages has been defined as the inflectional expression of the grammatical categories of the indicative and subjunctive, categories which originally were distinguished in the need to discern fact (indicative) from non-fact (subjunctive). Modality, on the other hand, was a term used by Palmer (1986) to refer to the semantics of mood. The residue of such distinctions may still be found today in the bare subjunctive infinitive or ‘plain form’ (Huddleston and Pullum 2002), and a few idiomatic expressions (e.g., if I were you). However, the binary mood system of indicative versus subjunctive has been largely superseded over time by the modal verb system in English having a range of meanings from non-epistemic obligation and ability to various shades of epistemic possibility or probability. The categorization and diachronic development of such verbs present a perennially problematic area for the study of modality in English grammar.
Inflection and Derivation
Authors: Spencer Andrew
Published: March 2020

The chapter presents an overview of phenomena which pose important problems of description and analysis. I focus on the inflectional system, which has undergone severe attrition and shows idiosyncrasies typical of such systems. For nominals I describe the personal pronoun paradigm and the ‘possessive -s’ clitic/phrasal affix. The controversial categorial status of adverbs in -ly is discussed, while for verbs, all the subcategories prove to be highly problematical. For instance, only 50 irregular verbs distinguish past tense from past participle (e.g. wrote/written), so it is not even clear whether the past participle category is a highly restricted subcategory, with the vast majority of verbs showing past tense/past participle syncretism, or whether this is a case of ‘overdifferentiation’, like the forms am, are, were of the verb BE. On the other hand, the polyfunctionality of the completely regular -ing suffix, which derives verb, noun, and adjective forms, also poses serious unresolved problems. Auxiliary verbs and related phenomena alternate between periphrastic, clitic, and genuinely morphological (affixal) constructions. The chapter concludes with consideration of those aspects of derivational morphology which seem to be indisputably productive, hence part of the grammar, including (certain types of) event nominalization, some cases of double object alternation, and morphosemantic mismatches of the kind electrical engineering ⇒ electrical engineer.
Genre Variation
Authors: Dorgeloh Heidrun , Wanner Anja
Published: March 2020

This chapter gives a critical survey of research traditions and findings in the study of genre variation, both from a grammar and a text linguistic perspective. After introducing foundational concepts, the chapter discusses the dimension of spoken versus written language, including the question of medial versus conceptual orality, the distinction between narrative and non-narrative genres as well as characteristics of computer-mediated communication, weaving in data and insights from studies in both linguistics and rhetoric. Shifting to a focus on specific grammatical constructions, the chapter then moves on to three areas of syntactic inquiry that are illuminated by genre considerations: variation in grammatical complexity, the representation of agents, and word order variation. The chapter ends with reflecting on the competence/performance distinction and thoughts on the idea that spoken language follows a different grammar than written language.
Technical
Authors: Freedgood Elaine , Schmitt Cannon
Published: March 2020

Technical language is not literary in the eyes of many critics; it tends to exclude readers and so we often leave it unread on the page, as ornament or reality effect. This chapter suggests that technical language is literary language and that understanding what it signifies both literally and in relation to what we (too confidently) think of as “standard” language can take us down various philological, critical, and political paths of reading. Our exemplary text is The Return of the Native, in which Hardy deploys a “Wessex” dialect that is always surrounded by standard English. Indeed, dialect is a particularly problematic technical language because it is so local, and often connotes the claustrophobia of the regional. At the same time, it imparts to us a knowledge of place and the means of survival in various places that does crucial work, in literature as well as out of it.
Electronic
Authors: Pressman Jessica
Published: March 2020

Electronic reading has changed dramatically over the last three decades, and so too has electronic literature. Electronic literature is born-digital, with computational aesthetics that are essential to its poetics and the experience of reading it. Ten years ago, “electronic literature” was largely limited to screens and interaction with their interfaces. Today, a cell phone, virtual-reality headgear, or even a public square works just as well as an environment for reading electronic literature. This essay examines electronic reading by way of electronic literature, through consideration of three recent works of electronic literature—Jacob Garde and Aaron Reed’s The Icebound Concordance, J. R. Carpenter’s The Gathering Cloud, and José Aburto’s “Paper Alive” and “Blot Alive”—that each promote recognition of how reading is no longer the sole activity of the human and how electronic reading involves a participatory network of actors and media forms.
Across Borders
Authors: Griswold Wendy
Published: March 2020

This chapter addresses the rise of international digital media and other forms of globalization. It considers in particular how the advent of digital media have affected the “reading class,” the educated, socially advantaged group of people who read in their leisure time. It uses Nigeria as an empirical case for examining the relationship between reading, on the one hand, and globalization and digitization, on the other.
Assigned
Authors: Lynch Deidre
Published: March 2020

Enlightenment theorists of education and advocates for children’s literature like John Locke and William Godwin associated reading with the rights-bearing, independent subject who stands at the center of liberal political tradition. This identification would be reiterated over time, including in the early twentieth century by some architects of the discipline of English studies. This essay considers the fault lines in such accounts of reading as an exercise of self-determination. It considers how such book-boosterism tends to falter when it confronts compulsory schooling or the actual process by which literacy is acquired. Child readers, whose books are assigned, that is, foisted upon them by others, trouble the profile these discussions assume of the reader as an independent consumer. At the same time, the solitary child dreaming over a book—and doing so at a remove from the schoolroom—has since Romanticism become one of Anglo-American culture’s privileged emblems of imaginative liberty.
The Spanish Armed Forces
Authors: Martínez Rafael
Published: March 2020

At the end of the twentieth century (after a long history of coups d’état, a military uprising, a civil war, and a four-decade dictatorship), the Spanish public had serious doubts about the democratic nature of the armed forces. In contrast, in 2015 they were the second-best valued institution in the country. This is not just the result of a reform in the military administration. Both have changed: society and the military. To try to understand this change we will analyse the evolution of Spanish public opinion about the armed forces and national security since the end of the twentieth century and the perception of the Spanish military after undertaking international missions, its main activity.
Spain in the EU
Authors: Molina Ignacio
Published: March 2020

Spain has been a firmly pro-integrationist country and, despite some deficits in the coordination machinery for European affairs and a series of developments after 2001 that may have led to an erosion of its position as compared with other member states, Madrid’s capacity to influence decisions in Brussels is not negligible. Its domestic-policy preferences have been stable and the country is traditionally considered as an effective player in some key areas. To better understand how important the EU policy and Europeanization are for Spain and which strategies have been used by it over more than thirty years of negotiations at the supranational level, this chapter is divided into four sections: (a) the strong political basis of membership among citizens and parties, (b) the national EU policy process with attention to the central government and other secondary actors, (c) Spain’s main priorities in Brussels and (d) its policy-shaping ability over time.
Europeanization of Political Structures and Public Policies
Authors: Arregui Javier
Published: March 2020

This chapter focuses on the impact of European Union governance on the Spanish polity. More specifically, the research question that guides the chapter is the following: What consequences and effects have Spain’s membership of the EEC/EU had on the institutional evolution of the Spanish Political System? The chapter deals mainly with the impact on the main political arenas, policy structures as well as on the contents of the more Europeanized public policies. The chapter shows that there has been significant Europeanization of the main Spanish political arenas (legislature, executive, and judiciary) over the last decades. Moreover, the chapter also shows that the EU integration process has introduced a gradual adaptation process and relevant innovations within Spanish public policies, particularly those related to the construction of the European market as well as with the construction of the Economic Union.
The Causes and Legacy of the Great Recession in Spain
Authors: Royo Sebastián
Published: March 2020

After over two decades of prolonged economic growth, Spain suffered its worst economic crisis in decades between 2008 and 2014. The political, social, and economic consequences of this crisis were very severe: unemployment increased sharply reaching over 27 per cent; inequalities deepened; and the two-party political system was transformed by the emergence of new parties. The implementation of structural reforms, which intensified as a result of the European Union financial sector bailout of 2012, led to economic recovery. As a result, credit was restored, strong economic growth resumed, and the political system did not implode. Yet, persistently high unemployment (particularly as regards youth and long-term) as well as inequality (and to a certain extent poverty) still persist a decade after the crisis. This chapter looks at the genesis of the crisis and examines the responses to the crisis, as well as its economic, social, and political consequences.
Jesus Christ
Authors: Reeling Brouwer Rinse H.
Published: March 2020

Around 1915 Barth saw in the name of Jesus Christ the unity of a God we do not have, with a human being that we are not. In both editions of his Epistle to the Romans, this intuition was expressed, but not yet thought through. When Barth became acquainted with post-Reformation orthodoxy in Göttingen, however, he discovered a way to understand his intuitions in light of the doctrinal decisions of the early church. From Christological debates between the Lutherans and the Reformed, he learned in the 1930s that there cannot be just one representation of the overwhelming reality of the Lord, and that a theologian needs to argue along several different lines. In his doctrine of reconciliation, Barth sketched these different lines in discrete part-volumes. The more formal category of the Word gave way to the all-embracing presence of the Lord Jesus Christ.
Israel
Authors: Lindsay Mark
Published: March 2020

Ever since 1967, when Friedrich-Wilhelm Marquardt first proclaimed Karl Barth’s Church Dogmatics to be the discovery of Judaism for Christianity, Barth’s theology of Jews, Judaism, and Israel has been a matter of increasing interest and contention. Having moved well beyond the earlier presumption of Israel’s absence from Barth’s thinking, conversations have now turned to the much more interesting questions of why and how he afforded Israel and Judaism such prominence. With due regard to his episodic ambiguity in these matters, this chapter argues that Karl Barth came gradually to the realization that he was compelled to speak of Israel and the Jewish people, not reactively or reluctantly, but because neither Christianity nor the church are possible without or apart from them.
Sacraments
Authors: Hunsinger George
Published: March 2020

In this chapter, four sets of coordinates are used to chart how Barth viewed ‘sacrament’ and ‘sacraments’ in Church Dogmatics. They are: (a) witness and mediation (with their objective and subjective poles); (b) instrumentalism and parallelism; (c) the relation of divine and human activity; and (d) the threefold office of Christ. These coordinates prove useful in analysing how Barth viewed Word and sacrament not only in the early volumes of Church Dogmatics, but also in volume IV, where he significantly changed his mind. It is shown that in discussing ‘sacrament’ and ‘sacraments’, Barth paid more attention to witness than mediation; that he tended towards instrumentalism rather than occasionalism (although not conclusively so); that he worked with a non-synergistic account of divine and human activity from the beginning of his dogmatics through to the end; and that he heavily emphasized Christ’s prophetic office over his royal office and—especially—over his priestly office.
Catholic Laity in the Latin American Church
Authors: Pelton Robert S.
Published: March 2020

Before Vatican II, pastoral theology reflected a clear distinction between the ordained and non-ordained members of the Church, but a gradual nuancing of this issue was taking place in Latin America as early as the 1950s. In those areas, there had been rather intensive study of “modern” European theologians. Through their writings and pastoral visits to the region of America, these progressive European theologians began to strongly influence Latin American theology —especially in Chile and Brazil. This influence was shown through the beginnings of small Christian communities, and through an emphasis on doing “contextual” theology. This is a theology that emphasizes the experiential in the light of tradition, which eventually led to Latin American liberation theology. The Church of Latin America has long been a leader in innovations that incorporate the role of Scripture in everyday life: the preferential and evangelizing option for the poor, small Christian communities (also known as CEBs or BECs), lay apostolates and lay missionaries, and other endeavors to put the Church at service to the People of God. “Laying boots on the ground” has become truly essential to carrying out the Church’s mission in the world and pastoral ambience contributes strongly to this growing appreciation of the Catholic laity. Combined with the importance of theologically reflecting within the context of regional realities, this approach can provide hope for a challenged but youthful and vibrant Catholic Church of Latin America.
Marshaling the Faithful
Authors: Wright-Ríos Edward
Published: March 2020

It often is assumed that Catholicism in Mexico prior to independence was a corporate matter, whereas afterward it became an increasingly individual affair. When scholars have explored collective expressions of modern religious culture, they typically have focused on indigenous brotherhoods in rural communities. The present chapter, in contrast, offers a comprehensive picture of the full spectrum of associations, devotional organizations, and sodalities and the religious practices they championed. Simultaneously, the clergy and the laity, as well as urban and rural Catholics, labored to infuse the faith with meaning in a modernizing society. It was at times a dynamic fraught with tension, and considerable change occurred, but Mexican Catholics of the nineteenth and twentieth centuries remained fully committed to collective religious expression. Of particular importance, not surprisingly, were also the gender dynamics of institution building and devotion.
Millenarian Movements
Authors: Myscofski Carole A.
Published: March 2020

Latin American millenarian movements, rooted in the Christian expectation of Jesus’ thousand-year kingdom, creatively integrated Catholic folklore and apocalyptics with indigenous concepts of dualism and cyclic regeneration. Hopes for spiritual revitalization in indigenous communities, religious renewal among peasant groups, and ecclesiastical autonomy among dissident parties inspired rebellion when the colonial and post-colonial governments created intolerable social and religious conditions for disenfranchised peoples. This chapter analyzes religious movements whose regional expressions dramatized their beliefs in the returning priest-king among the Maya, visions of the Virgin Mary in Mexico, the restoration of Inca rule among Andeans, and a triumphant messianic kingship for Brazilians.
Scholastic Theology, Justice, and the Conquest of the Americas
Authors: Lantigua David M.
Published: March 2020

This chapter examines the scholastic idea of justice presented in the lectures, writings, and advocacy of key Spanish theologians during the early conquests of Amerindian peoples in the sixteenth century. Indebted to the medieval tradition and associated with the University of Salamanca, these Spanish theologians espoused a scholastic method of inquiry grounded in fundamental principles of justice and natural law. Their brand of early modern scholastic humanism displayed an increased sensitivity to historical consciousness and ethno-religious conflict through critical reflection on important sociopolitical questions in the Atlantic World related to the rights of non-Christians, just war, evangelization, and political authority. The chapter demonstrates how scholastic theology in the context of empire provided resources to challenge the injustice of violent colonial institutions and imperialistic humanism by affirming the rights of innocent peoples to spiritual and political freedom. It concludes with a brief overview of the Spanish-scholastic political legacy for the Latin American tradition of human rights.
The Sacred Art of Counter-Conquest
Authors: Hughes Jennifer Scheper
Published: March 2020

From works of monumental architecture to vernacular expressions of “folk” religion, objects of material religion secure and orient lived faith in Latin America. Sacred power in Latin America emanates from a particular web of connection between image, altar, and chapel. These material manifestations of the sacred reflect the pain and paradox of their colonial origins and thus must be contextualized and historicized in relation to the structures of colonial power and domination that define the context of their creation. This chapter traces the historical emergence of Latin American Christian material religious cultures in the circumstance of indigenous and African struggle and survival. A tremendous ritual, spiritual, and cultural labor was required to imbue adopted artistic forms, and the imposed Christian religion itself, with sacred meaning and power. This act of redemption was, by necessity, a labor of contraconquista, the sacred art of counter-conquest. Lay Catholic devotional labor functions to create continuity between monumental and vernacular works of Christian art and architecture, lending coherence to seemingly disparate forms.
Pentecostalism and Neo-Pentecostalism in Latin America
Authors: Garrard Virginia , Doran Justin M.
Published: March 2020

Pentecostalism, a Christian renewal movement that emphasizes ecstatic bodily worship and charismatic practices, transformed Latin American Christianity over the course of the twentieth century. While they were influenced by the disruptive North American Holiness movements from which their piety originated, converts adapted Pentecostal Christianity to local economic and political realities that generated new, Latin American forms of Pentecostalism. This chapter traces the dynamics of Pentecostal transformation in Latin America across two case studies: Guatemala and Brazil. Both countries underwent enormous shifts in religious demographics and practices that reveal similar trends amid substantial diversity in the Pentecostalization of Latin America. Guatemala’s Pentecostal boom occurred through the country’s tumultuous thirty-year conflict between leftist guerrillas and an intractable military government. Pentecostalization crescendoed while military general Efrain Ríos Montt, a Pentecostal, came to power and oversaw the violent deaths of as many as 200,000 civilians who were predominantly indigenous Maya. Vast numbers of conversions to Pentecostalism followed, revealing its power to re-enchant destroyed and seemingly hopeless worlds. Brazilian Pentecostalism maintained a subdued, conservative critical presence within Brazilian society until neo-Pentecostal evangelists asserted themselves in the public sphere, taking on popular African diasporic religions, Spiritism, and established Catholicism in equal measure. After democracy was re-established, neo-Pentecostal churches—magnified by their immense fortunes garnered from prosperity theologies—reshaped the Brazilian relationship between Christian piety, national culture, and secular government. Today, Pentecostal and neo-Pentecostal churches sustain a transnational culture that connects Christians across Latin America, dynamically reshaping both social relations and Latin American Christianity itself.
Preferential Option for the Spirit
Authors: Carranza Brenda
Published: March 2020

When the Catholic Charismatic Renewal movement (CCR) arrived in Brazil in the late 1960s, evangelical Pentecostalism was in full swing. The so-called believers looked for lost sheep in the Catholic flock. In the midst of public performances and animated songs, Pentecostals promised a moral life, physical healing, and liberation from the clutches of the Devil. Pentecostalism considered daily afflictions as a spiritual battle and regarded Catholicism as a degradation of authentic Christianity. Public confrontations between Catholics and Pentecostals were frequent. Some Pentecostal attacks were fanatical, with allusions to the Bible; others accused Catholics of idolatry for their devotion to Our Lady and to the saints. As such, the CCR faced enormous resistance to spreading the movement within the Catholic universe; for some, the CCR represented a domestic enemy as well as a gateway to manifest discontent with the Church. This process of Catholic pentecostalization is the focus of this chapter. In particular, this discussion considers how charismatic Catholicism developed through the use of media and a gospel-inspired culture to draw large crowds, as well as to export the movement to other parts of the world. This chapter also discusses how—within the Catholic Church —charismatic spirituality shaped new clergy, reinvented faith-based life among the laity, and renewed pastoral work with the young. Additionally, in Brazil’s national congress, political mechanisms, options, and strategies brought Pentecostals and Charismatics together. Arguably, the CCR brought to Catholicism a discourse of religious modernization—a discourse that has become hegemonic in the Church. Finally, this chapter reflects on the social impact that Christian Pentecostalism has had on the public sphere in Brazil and its unfolding in the religious field.
The Course of Catholic History in Latin America
Authors: Cervantes Fernando
Published: March 2020

The chapter presents a general narrative of 500 years of Christian history in Latin America, placing particular emphasis on the most controversial developments and debates. Among them are the “struggle for justice” and questions concerning acculturation and “syncretism” in the sixteenth century; the links between popular piety and Baroque spirituality and their clash, first with Jansenism and then with Bourbon reformism in the seventeenth and eighteenth centuries; the challenges of independence, liberalism, and the secular state in the nineteenth century; social Catholicism in the first half of the twentieth century; liberation theology and the growth of Protestantism in the late twentieth and early twenty-first centuries. The chapter pays particular attention to the resilience and legacy of early mendicant evangelization in the formation of an often-neglected Christian culture that can be described as both indigenous and genuinely Christian.
Activist Christians, the Human Rights Movement, and Democratization in Latin America
Authors: Rowell Nick
Published: March 2020

This chapter is a critical literature review of recent social science research describing and analyzing the participation of Christian churches in various phases of the human rights movement in Latin America. Spanning the period from 1964 to the present, such human rights activism took place in the contexts of authoritarian rule, civil war, democratic transitions, and the consolidation of democracy. The chapter focuses on the influence of Christian church leaders, laity, organizations, and resources on the origins, growth, and maturation of human rights-oriented social movement organizations (SMOs). Drawing on Douglas McAdam, Sidney Tarrow, and Charles Tilly’s work on political process theory, this literature emphasizes the invaluable role of religious organizations in providing space, resources, protection, and framing to nascent human rights movements in the region during the 1960s-70s. Even so, the literature also grapples with the diverse range of political stances taken by Christian church leaders and activists, both within and across national-level cases. With the maturation of the movement and the transition to democracy, political process theory remained relevant, but failed to capture some of the key challenges and opportunities experienced by Christian activists, as opposed to social activists in general. Thus, scholarship shifted focus to organized religion’s capacity to build social capital and sustain meaningful Christian social and human rights activism.
Simulation at the Frontier of the Zone of Proximal Development: A Test in Acute Care for Inexperienced Learners
Authors: Groot Fedde , Jonker Gersten , Rinia Myra , ten Cate Olle , Hoff Reinier G.
Published: March 2020

Purpose

Vygotsky’s zone of proximal development (ZPD) refers to the space between what learners have mastered and what they should master in the next developmental stage. Physicians’ tasks are ZPD activities for medical students, with high-acuity tasks such as resuscitation representing activities at the ZPD’s frontier. This type of task can be taught and assessed with simulation but may be demanding and stressful for students. Highly challenging simulation may lead to a negative simulated patient outcome and can affect the participant’s emotional state, learning, and motivation. This study aimed to increase understanding of the psychosocial and educational impact of simulation at the frontier of the ZPD.

Method

The authors conducted 11 phenomenological interviews between September 2016 and May 2017, to describe medical students’ experiences with a challenging residency-level simulation test of acute care competence at the start of the final undergraduate year at University Medical Center Utrecht. Interviews took place within 2 weeks after the participants’ simulation experience. The authors analyzed transcripts using a modified Van Kaam method.

Results

Students experienced a significant amount of stress fueled by uncertainty about medical management, deterioration of critically ill simulated patients, and disappointment about their performance. Stress manifested mainly mentally, impeding cognitive function. Students reported that awareness of the practice setting, anticipation of poor performance, the debriefing, a safe environment, and the prospect of training opportunities regulated their emotional responses to stress. These stress-regulating factors turned stressful simulation into a motivating educational experience.

Conclusions

Simulation at the ZPD’s frontier evoked stress and generated negative emotions. However, stress-regulating factors transformed this activity into a positive and motivating experience.
Should Wellness Be a Core Competency for Physicians?
Authors: Stergiopoulos Erene , Hodges Brian , Martimianakis Maria Athina (Tina)
Published: March 2020

There has been a recent rise in calls for action around wellness and physician health. In medical education, wellness has been proposed as a physician competency. In this article, the authors review the history of the “wellness as a competency” concept within U.S. and Canadian residency programs and medical schools. Drawing from literature on the discourses of wellness and competence in medical education, they argue that operationalizing wellness as a physician competency holds profound implications for curricula, admissions, evaluation, and licensure. While many definitions of “wellness” and “competency” are used within medical training environments, the authors argue that the definitions institutions ultimately use will have significant impacts for trainees who are considered “unwell.” In particular, medical learners with disabilities—including those with mental health, chronic health, learning, sensory, and mobility disabilities—may not conform to dominant conceptions of “wellness,” and there is a risk they will become further stigmatized or even be considered unsuitable to practice in the profession. The authors conclude that framing wellness as a competency has the potential to legitimize support-seeking and prioritize physician health, yet it may also have the potential unintended effect of excluding certain learners from the profession. They propose a universal design approach to understand wellness at a systems level and to remove barriers to wellness for all medical learners.
Long-term Behavior of Single-level Thoracic and Lumbar Fractures Treated With Pedicle Screw Fixation
Authors: Rodrigues Cláudia , Sousa Arnaldo , Barros Luís H. , Silva Eurico , Figueiredo José , Rodrigues-Pinto Ricardo
Published: March 2020

Study Design:

This was a retrospective cohort study to objectively analyze the behavior of single-level thoracic (T), thoracolumbar (TL), and lumbar (L) fractures treated with posterior instrumentation alone and to understand which factors influence the ability to restore and maintain normal spinal alignment.

Summary of Background Data:

Posterior screw fixation of dorsal and lumbar spine fractures allows fracture stabilization, correction of kyphotic deformity and restoration of vertebral height. The load-sharing classification identifies fractures that may need anterior instrumentation.

Materials and Methods:

Patients submitted to pedicle screw fixation of single-level T, TL, and L fractures were retrospectively analyzed. Data on patient demographics, neurological injury [American Spinal Injury Association (ASIA) score], and comorbidities were collected. Fractures were classified according to their anatomic region (T, TL, or L) and using the AO Spine and the load-sharing classifications. Local kyphosis angle, Cobb angle (CA), and changes in anterior vertebral height (AVH) were measured, to quantify intraoperative correction and loss of correction at 6 weeks and at last follow-up. A multivariate analysis was performed to identify the factors influencing the intraoperative correction and the loss of correction over time.

Results:

From a total of 230 fractures, 115 patients with a mean age of 51.48 years were included. Pedicle screw fixation achieved a significant intraoperative correction of the CA, local kyphosis angle, and AVH. This correction was partially lost over time, but, at last follow-up, radiographic parameters were still significantly better than preoperatively. A regression model identified that age and body mass index influenced the correction of CA; ASIA classification influenced the correction of AVH.

Conclusion:

Posterior screw fixation allows for the restoration of spinal alignment, but this correction is less effective in elderly people and in patients with higher body mass index and higher degree of neurological injury.

Level of Study: Level III.
Positive Status of Epstein-Barr Virus as a Biomarker for Gastric Cancer Immunotherapy: A Prospective Observational Study
Authors: Xie Tong , Liu Yiqiang , Zhang Zhening , Zhang Xiaotian , Gong Jifang , Qi Changsong , Li Jian , Shen Lin , Peng Zhi
Published: March 2020

Immunotherapy has exhibited promising but controversial results in gastric cancer; determining criteria for choosing the appropriate target population is still problematic. Epstein-Barr virus (EBV)-associated gastric carcinoma (EBVaGC) exhibits distinctive genomic aberrations and clinicopathologic features, the positive status of EBV is a potential biomarker. We prospectively recruited 9 patients who were diagnosed with stage-IV EBVaGC, and all of the patients were treated by immune-checkpoint inhibitors. The median age of the patients was 62 years old. The clinicopathologic characteristics demonstrated a male predominance and poor differentiation status of EBVaGC. Lymph nodes were demonstrated to represent the most common metastatic site. Immunochemistry and polymerase chain reaction analysis revealed that all of the patients were proficient mismatch repair, and microsatellite instability-stable and programmed cell death-ligand 1 were detected in 7 patients. Three patients with positive programmed cell death-ligand 1 showed partial response, 5 patients showed stable disease, 1 patient without measurable lesion showed decreasing ascites and tumor marker level after immunotherapy. The longest duration of response was 18 months by the time of the last follow-up. EBVaGC exhibits distinctive clinicopathologic characteristics, and EBV-positive status may be a potential biomarker for gastric cancer immunotherapy.
What We Know About Massively Multiplayer Online Role-Playing Games
Authors: Chen Anderson , Mari Sundus , Grech Sabina , Levitt James
Published: March 2020

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders defines internet gaming disorder without differentiating games from their respective genres, such as first-person shooter versus real-time strategy versus online gaming. Our review of the literature on massively multiplayer online role-playing games (MMORPGs) suggests that MMORPGs are different from other games because they are the most addictive, and therefore deserve to be looked at separately. MMORPGs are internet platforms for online users to interact with each other in a virtual story line. The overview of the existing literature delineates the positive and negative aspects of MMORPGs and also the available evidence on neuroscientific and neuroanatomical correlates between internet gaming disorder and other addictions. Evidence shows that a player’s characteristics and motivations can determine his or her risk of developing problematic play. Problematic MMORPG use may lead to mental disorders such as depression and addiction, and can negatively affect quality of life, and vice versa. Conversely, some players may benefit from being part of a social community and from using it as a learning platform or as a safe space to explore gender-identity issues. Brain circuitry and metabolism are changed through problematic MMORPG use, with the affected areas including the ventral striatum and left angular gyrus.
PHASE 2 STUDY OF THE SAFETY AND EFFICACY OF BRIMONIDINE DRUG DELIVERY SYSTEM (BRIMO DDS) GENERATION 1 IN PATIENTS WITH GEOGRAPHIC ATROPHY SECONDARY TO AGE-RELATED MACULAR DEGENERATION
Authors: Kuppermann Baruch D. , Patel Sunil S. , Boyer David S. , Augustin Albert J. , Freeman William R. , Kerr Kevin J. , Guo Qiang , Schneider Susan , López Francisco J. ,   on behalf of the Brimo DDS Gen 1 Study Group
Published: March 2020

Purpose:

To evaluate the safety and efficacy of Brimonidine Drug Delivery System (Brimo DDS), a biodegradable intravitreal implant, in the treatment of geographic atrophy (GA) secondary to age-related macular degeneration.

Methods:

Phase 2, randomized, multicenter, double-masked, 24-month study. Study eyes were treated (Day 1; Month 6 retreatment) with Brimo DDS 132 µg (n = 49), Brimo DDS 264 µg (n = 41), or sham procedure (n = 23). The primary timepoint for efficacy analysis was Month 12.

Results:

Mean GA area growth at Month 12 was 1.78 mm2, 1.59 mm2, and 2.19 mm2 in the Brimo DDS 132 µg, 264 µg, and sham groups, respectively. Geographic atrophy area growth was consistently smaller with Brimo DDS 132 and 264 µg than sham; between-group differences were significant (P ≤ 0.032) at Month 3. In patients with baseline lesion area ≥6 mm2 (two-thirds of patients), GA lesion area and effective radius growth was reduced with Brimo DDS 132 and 264 µg at Month 12 (P ≤ 0.050 vs. sham). Treatment-related adverse events were usually injection procedure–related.

Conclusion:

Brimo DDS demonstrated a favorable safety profile and reduced GA lesion area growth at Month 3. Lesion growth at Month 12 was reduced in patients with baseline GA lesion area ≥6 mm2. The results support Phase 3 development.
Reconstruction of the Orbit and Anophthalmic Socket Using the Dermis Fat Graft: A Major Review
Authors: Jovanovic Nina , Carniciu Anaïs L. , Russell William W. , Jarocki Adrienne , Kahana Alon
Published: March 2020

Purpose:

To perform a comprehensive review of dermis fat graft (DFG) in socket reconstruction and illustrate the technical nuances and outcomes using a retrospective case review.

Methods:

A literature search of 143 texts was reviewed. A retrospective case series of 34 patients following primary or secondary DFG after enucleation at a single institution (2009–2019) was performed. Clinical outcomes were statistically analyzed. Variables investigated included age, sex, race, surgical indication, muscle reattachment, complications, motility, eyelid position, prosthesis fit, and need for additional surgery.

Results:

The history of DFG, use in socket reconstruction, primary and secondary indications, and surgical techniques are described. Thirty-two adults and 2 pediatric cases of DFG were reviewed; 18.75% indications were primary and 81.25% were secondary. Good eyelid position was observed in 83.3% of patients with primary DFG versus 37.5% with secondary DFG (p = 0.07). Postoperative complications occurred in 58.8% of patients, were typically mild, and resolved with minimal or no intervention. No statistically significant differences were found between occurrence of any particular complication in primary versus secondary DFG placement (p = 0.36) or between primary and secondary DFG placement and the need for additional surgery (p = 1.0). Among the 67.7% patients who had implant exposure or extrusion as an indication for DFG, 39.1% required additional surgery within 2 years. Advanced age was not associated with higher complication rates (p = 0.12).

Conclusions:

DFG is an excellent option for socket reconstruction, particularly in cases involving pediatric patients, complicated orbits, history of multiple previous surgeries, and inflamed, contracted, or scarred sockets.
Conjunctival Melanoma: Features and Outcomes Based on the Fitzpatrick Skin Type in 540 Patients at a Single Ocular Oncology Center
Authors: Shields Carol L. , Yaghy Antonio , Dalvin Lauren A. , Vaidya Sarangdev , Pacheco Richard R. , Perez Alejandro L. , Ramesh Sunidhi , George Kevin , Arias Diego E. , Shiuey Eric J. , Lally Sara E. , Shields Jerry A.
Published: March 2020

Purpose:

To determine the association of Fitzpatrick skin type (FST) with conjunctival melanoma.

Methods:

Retrospective case series of 540 patients with conjunctival melanoma to assess clinical features and outcomes per FST.

Results:

The FST was Type I (n = 126, 23%), II (n = 337, 62%), III (n = 56, 10%), IV (n = 8, 2%), V (n = 12, 2%), and VI (n = 1, <1%). A comparison (FST I vs. II vs. III, IV, V, and VI) revealed Types I and II associated with older mean patient age (63.9 vs. 60.7 vs. 51.1 years, p < 0.001), greater percentage of female patients (68% vs. 44% vs. 42%, p < 0.001), lower frequency of complexion associated melanosis (1% vs. 2% vs. 13%, p < 0.001), smaller tumor thickness (2.1 vs. 2.8 vs. 3.6 mm, p = 0.01), and less eyelid involvement (13% vs. 13% vs. 28%, p = 0.02). Kaplan–Meier estimates for 5-year risk showed no difference by Types for visual acuity loss ≥3 lines, local tumor recurrence, exenteration, metastasis, or death.

Conclusion and relevance:

Most patients with conjunctival melanoma show FST I or II, and this demonstrated no association with 5-year rate of vision loss, tumor recurrence, exenteration, metastasis, or death.