bluuebunny/crossref_metadata_2025 huggingface dataset:
108: FLUORESCENCE ANGIOGRAPHY IN COLONIC INTERPOSITION AS RECONSTRUCTION AFTER ESOPHAGEAL RESECTION
Authors: Joosten H , Gisbertz S , Eshuis W , Heineman D , Daams F , Van Berge Henegouwen M
Published: April 2022

Background and aim

Colonic interposition is an alternative for gastric conduit reconstruction after esophagectomy. Postoperative anastomotic leakage occurs in 15–30% of the patients and may partially be attributed to reduced blood supply to the colon and ileum after vascular ligation.

Fluorescence angiography (FA) can visualize tissue perfusion and guide the surgeon in selecting the anastomotic site. We aimed to give an overview of the postoperative outcomes and the first experiences of FA in colonic interposition.

Methods

This cohort study included all consecutive patients who underwent a colonic interposition between January 2015 and February 2021 in the Amsterdam UMC. Colonic interposition was performed for three different indications: inability to use the stomach because of previous gastric surgery or extensive tumour involvement, cancer recurrence in the gastric conduit requiring resection or because of complications after initial esophagectomy with failure and resection of the gastric conduit (i.e. ischaemia).

Since 2018 FA was performed prior to anastomotic reconstruction by administration of indocyanine green (ICG) injection (0.1 mg/kg/bolus). Imaging was performed by hand-held Spy-phi (Stryker, Kalamazoo, MI, U.S.A.).

Results

Twenty six patients were included(18 male, mean age 64), of whom thirteen (50%) underwent intra-operative FA assessment. Within the FA group two (15%) cervical anastomotic leakages occurred, whereas in the non FA group two anastomotic leakages and one graft necrosis (19%) occurred (P = 0.61). There was a change of management due to the FA assessment in two patients in the FA group (15%) which lead to a more extensive resection. In both cases no anastomotic leakage occurred. Mean ± SD operative time in the FA group versus the non FA group was 375 ± 87 versus 400 ± 112 minutes respectively (P = 0.56).

Conclusion

This is the first study that shows the potential role of FA enabling the surgeon to intra-operatively optimize perfusion in colonic interpositions. Further research is warranted to better elucidate this role.
130: PATTERN OF LYMPH NODE METASTASES IN GASTRIC CANCER—A SIDE-STUDY OF THE MULTICENTER LOGICA-TRIAL
Authors: De Jongh C , Triemstra L , Van Der Veen A , Brosens L , Luyer M , Stoot J , Ruurda J , Van Hillegersberg R
Published: April 2022

Background and aim

The relation between tumor characteristics and the pattern of lymph node (LN) metastases in gastric cancer is unclear, especially following neoadjuvant chemotherapy (NAC). Therefore, the aim of this study is to analyze the pattern of LN metastases of gastric cancer.

Methods

Individual LN stations were separately collected (no. 7–9, 11 and 12a) or clearly marked at the resection specimen (no. 1–6), and were analyzed for all patients included in the LOGICA-trial. The LOGICA-trial was a multicenter randomized trial comparing laparoscopic versus open gastrectomy in ten hospitals. Total and distal D2-gastrectomy were performed for resectable gastric cancer (cT1–4aN0–3bM0). The pattern of metastases per LN station was related to tumor location, cT-stage, Lauren classification and NAC-treatment. In addition, the distribution of LN metastases over the individual LN stations was assessed for four subgroups based on tumor location, cT-stage, Lauren classification and NAC-treatment, and several combinations of these characteristics.

Results

Between 2015–2018, 212 patients underwent D2-gastrectomy, of whom 158 (75%) received NAC. LN metastases were present in 121 patients (57%). Proximal tumors metastasized predominantly to proximal LN stations (no. 1, 2, 7 and 9; OR > 1, P < 0,05), and distal tumors to distal LN stations (no. 5, 6 and 8; OR > 1, P > 0,05). However, distal tumors still metastasized to proximal LN stations, and vice versa. Each individual LN station (no. 1–9, 11 and 12a) showed metastases, regardless of the tumor location, cT-stage, histological subtype and NAC-treatment, including station 12a for cT1N0-tumors. Although LN metastases were present more frequently in cT3–4- versus cT1–2-stage (59% versus 51%; P = 0,259) and in diffuse versus intestinal tumors (66% versus 52%; P = 0,048), the pattern of LN metastases was similar for these subgroups. A sensitivity analysis was performed with only the NAC-treated patients to test the robustness of these results, which showed a similar pattern of LN metastases after NAC.

Conclusion

Although the pattern of LN metastases is related to tumor location in gastric cancer, metastatic spread occurred in all LN stations (no. 1–9, 11 and 12a), regardless of the tumor location, cT-stage (including cT1N0-tumors), histological subtype and NAC-treatment. Therefore, all LN stations (including 12a; D2-lymphadenectomy) should be routinely dissected during gastrectomy.
146: THE NEED OF CDH1 GERMLINE MUTATION SCREENING IN PATIENTS WITH GASTRIC CANCER IN THE WEST
Authors: Alloggio M , Bencivenga M , Sacco M , Tomezzoli A , Tedaldi G , Torroni L , Verlato G , De Manzoni G
Published: April 2022

Background and aim

Although the international guidelines recommend the CDH1 germline mutations screening in patients at risk of carrying pathogenic mutations, few data exist about the compliance to systematic screening programs carried out in surgical centres.

Methods

In the present manuscript we report the results of CDH1 germline mutations screening, undertaken in patients with gastric cancer and their relatives at high volume surgical centre of Verona University from January 2011 to July 2020. In this study HDGC 2015 Guidelines criteria were used.

Results

During a 10 years period, we screened 72 subjects; among them, we found a pathogenic germline genetic alteration in 37 (51,4%). 15 patients underwent to surgery due to clinically detectable tumours or positive biopsies during endoscopic surveillance; of note the youngest case of early SRC tumours detected during endoscopy was aged 15 years old. 11 underwent prophylactic gastrectomy: 8 out of 11 (72,7%) presented neoplastic foci in the specimen. During surgical operation, 7 patients required an additional oesophageal resection due to the presence of gastric mucosa at the extemporary frozen section, despite the proximal section was made above the cardia.

Conclusion

Based on our experience, we can conclude that the CDH1 genetic screening should be absolutely offered to high-risk Western patients, in agreement with the international guidelines. Prophylactic total gastrectomy should be considered in selected cases also under 20 years of age.
190: ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) AND ROBOTIC SENTINEL NODE NAVIGATION SURGERY FOR EARLY GASTRIC CANCER: FIRST EXPERIENCE AND PRELIMINARY RESULTS
Authors: Bottari A , Fortuna L , Coratti F , Cianchi F , Staderini F
Published: April 2022

Background and aim

Early gastric cancer (EGC) is defined as a cancer limited to mucosa (T1a) and submucosa (T1b). The 5-year survival rates are respectively 96% and 83% for T1a and T1b. Despite endoscopic submucosal dissection (ESD) is considered the standard treatment for EGC, literature reports a quite considerable rate of lymph-node metastasis (2% to 18%). Combined surgical-endoscopic treatment can achieve accurate resection of EGC, solving the problem of lymphadenectomy which cannot be performed endoscopically. Near infrared (NIR) fluorescence imaging with indocyanine green (ICG) was recently introduced for lymphatic mapping in several tumors. The aim of the study is to evaluate the feasibility and safety of ESD in combination with robotic ICG guided sentinel node navigation surgery (SNNS).

Methods

ICG was endoscopically injected intraoperatively into the submucosal layer around the tumor. Intraoperative NIR imaging with ICG was carried out with a near-infrared camera system built into the robotic platform. The first lymph node which had taken up ICG appeared as a green spot and was identified as the sentinel node (SN). SN was then sent for extemporaneous histopathological examination. When ICG fluorescence extended to the second nodal stations a ICG guided robotic basin lymphadenectomy was performed. Basin lymph nodes were sent for definitive histopathological analysis. If no tumoral cells were identified in the SN, an ESD with standard technique was conducted. If the SN pathological examination revealed tumoral cells, a robotic radical resection and D2 lymphadenectomy was completed.

Results

Seven ESDs with SNNS and basin lymphadenectomy basin were performed. No gastric perforations or other intraoperative complications were registered. Mean operative time was 148.6 minutes. All the procedures histologically resulted in complete excisions. No lymph nodes metastasis was demonstrated in either the SN or the basin lymph nodes. A mean of 12 lymph-nodes was collected. Mean hospitalization time was 2.8 days.

Conclusion

In our preliminary experience, combined ESD and SNNS could be recommended as a safe and effective treatment for EGC in patients with potential risk of LN metastasis or in patients with multiple comorbidity in order to avoid more invasive organ resections.
201: THE YIELD OF DIAGNOSTIC LAPAROSCOPY WITH PERITONEAL LAVAGE IN GASTRIC ADENOCARCINOMA: A MULTICENTRE RETROSPECTIVE COHORT STUDY
Authors: Van Hootegem S J , De Pasqual C A , Van Der Wilk B J , Van Der Sluis P C , Phillips A W , Lagarde S M , Wijnhoven B P
Published: April 2022

Background and aim

Diagnostic laparoscopy (DL) with peritoneal lavage has been adopted as a standard staging procedure for patients with gastric cancer. Evaluating the effectiveness of DL is important given the ongoing improvement of diagnostic imaging. Studies on DL from Europe are scarce and mostly include a small number of patients. This multicentre retrospective cohort study assessed the yield of DL in patients with potentially curable gastric cancer.

Methods

Patients with adenocarcinoma of the stomach treated between January 2016 and December 2018 were identified from an institutional database from two high volume European Upper-GI surgical centres. Patients who underwent a diagnostic laparoscopy with peritoneal lavage for potentially curable disease after clinical staging with imaging (stage cT1-4 N0-3 M0) were included.

Results

Overall, in 78 of 327 included patients (23.8%) metastatic disease was diagnosed. Macroscopic metastases were seen in 32 of 327 (9.8%) patients, of which 26 were peritoneal lesions. Sixteen of these also had positive peritoneal cytology. A further 41 of 327 patients (12.5%) had positive peritoneal cytology in the absence of macroscopic metastases and five patients (1.5%) were deemed to have locally irresectable disease. Only one of the eighteen patients (6%) staged cT1–2 N0 had positive cytology and three of seven patients (43%) with stage cT1–2 N+ had macroscopic metastases.

Conclusion

Diagnostic laparoscopy should routinely be performed in all patients with gastric cancer including patients with cT1–2 disease.
205: ADJUNCTIVE SURVEILLANCE MODALITIES AND ONCOLOGIC OUTCOME: A REPORT FROM THE ENSURE STUDY
Authors: Elliott J A , Markar S R , Klevebro F , Johar A , Goense L , Lagergren P , Zaninotto G , Van Hillegersberg R , Van Berge Henegouwen M I , Nilsson M , Hanna G B , Reynolds J V
Published: April 2022

Background and aim

Established and emerging therapies for recurrent esophageal cancer may impact survival and health-related quality-of-life (HRQL), however surveillance protocols after primary curative treatment are inconsistent. Specifically, whether advantages exist for adjunctive surveillance modalities is unknown and was the focus of this study.

Methods

ENSURE was an international multicenter observational study of consecutive patients undergoing curative-intent surgery for esophageal and esophagogastric junction cancers (2009–2015) across 20 European and North American cancer centers (NCT03461341). The initial report from ENSURE assessed the impact of intensive imaging surveillance on the primary outcome measure of overall survival (OS); secondary outcomes included treatment, disease-specific survival, recurrence pattern, and HRQL. In the present study, multivariable linear, logistic and Cox proportional hazards regression analyses were performed to determine the independent impact of adjunctive surveillance modalities on oncologic outcome.

Results

Results 4,682 patients were studied (72.6% adenocarcinoma, 69.1% neoadjuvant therapy). Routine biochemistry, nutritional profiling, tumor markers, surveillance endoscopy and flexible nasolaryngoscopy were routinely assessed in 37, 33, 15, 19 and 7% of Centers, respectively. Routine biochemistry and tumour markers were associated with reduced risk of symptomatic recurrence, however neither modality was associated with survival benefit. Endoscopic surveillance was independently associated with increased probability of isolated local or anastomotic recurrence (OR1.49 [1.05–2.14]), and reduced probability of symptomatic recurrence (OR0.17 [0.12–0.25]), but not with improved OS. On subgroup analysis, endoscopic surveillance was associated with reduced symptomatic recurrence (OR0.19 [0.12–0.29]) and increased probability of tumour-directed therapy among patients with adenocarcinoma (OR1.65 [1.14–2.38]), but not those with SCC. Endoscopic surveillance was associated with improved OS (HR0.73 [0.55–0.98]) among patients with Barrett’s oesophagus, while flexible nasolaryngoscopy was associated with improved OS among patients with SCC (HR0.19 [0.05–0.80]). Nutritional surveillance was independently associated with increased tumor-directed therapy, improved HRQL (P = 0.015) and OS (HR0.89 [0.80–0.99]), while a multimodal surveillance approach was also associated with improved OS (HR0.83 [0.72–0.95]).

Conclusion

These data suggest that a multimodal and tailored surveillance approach may improve oncologic outcomes following curative-intent surgery for esophageal and esophagogastric junction cancer. These findings may inform guideline development and shared decision-making with patients.
206: COULD THE PITTSBURGH SEVERITY SCORE GUIDE THE TREATMENT OF ESOPHAGEAL PERFORATION? EXPERIENCE OF A SINGLE REFERRAL CENTER
Authors: Moletta L , Capovilla G , Pierobon E S , Provenzano L , Ciccioli E , Carrillo L , Valotto G , Zanchettin G , Salvador R , Costantini M , Merigliano S , Valmasoni M
Published: April 2022

Background and aim

Esophageal perforation (EP) is characterized by high morbidity and mortality. In recent years, non-operative management has proved to be successful in selected patients. However, there is a lack of data supporting the superiority of one approach over the others and there is no consensus on the treatment algorithm. The Pittsburgh Severity Score (PSS) is a scoring system based on clinical factors at the time of EP presentation, intended to guide treatment. The aim of the study is to verify PSS usefulness in stratifying EP severity and in guiding clinical decisions.

Methods

All patients referred to our Unit for EP between January 2005 and January 2020 were enrolled. Patients were stratified according to their PSS into 3 groups (PSS ≤ 2; 3–5 and > 5): the postoperative outcomes were compared. The predictive value of the PSS was evaluated by simple linear and logistic regression for the following outcomes: need for surgery, complications, in-hospital mortality, ICU and hospital stay, time to refeeding and need for reintervention.

Results

Seventy-three patients were referred for EP (M/F: 46/27). Perforations were more frequently iatrogenic (41.1%) or spontaneous (37.0%). The median PSS was 4 (IQR 2–6). Surgery was required in 60.3% of cases. The median PSS was significantly lower in the conservative group (P < 0.01). PSS was significantly associated with ICU admission, hospital stay, need for surgery and reintervention, post-perforation complications and mortality. After regression analysis, PSS was significantly predictive of post-perforation complications (P < 0.01); in-hospital mortality (P = 0.01); ICU admission (P < 0.01); need for surgical treatment (P < 0.01) and need for reintervention (P = 0.02). The receiver-operator curve (ROC) analysis showed that a PSS ≥ 3 had good sensitivity and specificity for the main postoperative outcomes considered.

Conclusion

PSS is useful in stratifying patients in risk groups with different morbidity and mortality. It is also useful in guiding the therapeutic conduct, selecting patients for nonoperative management. Prospective studies are needed to confirm the role of the PSS in the treatment of esophageal perforation.
Ecological variability based on lipid biomarkers in astrobiologically interesting wetlands from the Argentinian central Andes
Authors: Carrizo Daniel , Vignale Federico A , Sánchez-García Laura , Farías María E
Published: April 2022

Andean wetlands hold extremophilic communities adapted to live in harsh conditions. Here, we investigated the microbial ecology of three high-altitude hypersaline ponds from La Puna region (Argentina) showing an increasing extent of desiccation by analyzing their lipid sedimentary record. We recreated the microbial community structure and the carbon metabolisms in each lacustrine system based on the molecular distribution of lipid biomarkers and their compound-specific carbon and hydrogen isotopic signatures. We detected lipid compounds considered to be biomarkers of cyanobacteria, sulfate-reducing bacteria, purple sulfur bacteria, and archaea in the three Andean ponds, as well as diatoms in the intermediate salinity system. The relative abundance of purple sulfur and sulfate-reducing bacteria decreased with salinity, whereas cyanobacteria and archaea decreased their relative abundance in the mid-saline pond to increase it again and became both prevailing at the highest salinity. Carbon fixation in the three ponds was driven by a combination of the reductive tricarboxylic acid cycle, the reductive pentose phosphate cycle, and the reductive acetyl-CoA pathway. This work is the first to describe molecular and isotopic lipid fingerprints in wetlands from the central Andean Puna, and serves as a basis for further biogeochemical studies in the area.
A newly discovered Anglo-Lusignan truce (8 January 1222)
Authors: Pélissié du Rausas Amicie , Vincent Nicholas
Published: April 2022

In 1220 Queen Isabella, King John’s widow and mother to King Henry III, married the Poitevin lord, Hugh of Lusignan. The match generated tensions at the English court, which were partly resolved by a newly discovered truce of 1222, presented here. The existence of this document had been widely assumed but never proved. The document itself reveals the territorial deal brokered by Henry III: one of the earliest in a long series of written agreements between the Lusignans and the Plantagenets. More generally, it sheds light on thirteenth-century truce-making, marital diplomacy and Anglo-French politics.
What will and won’t happen when abortion is banned
Authors: Oberman Michelle
Published: April 2022

For the past 50 years, abortion opponents have fought for the power to ban abortion without little attention to how things might change when they won. The battle to make abortion illegal has been predicated on three nebulous assumptions about how abortion bans work. First, supporters believe banning abortion will deter it. Second, they hope bans will send a message about abortion—specifically, that abortion is immoral. And third, they expect bans to be competently implemented and enforced. Drawing on empirical work from within and outside of the U.S., this Article offers an evidence-based assessment of each of these assumptions. Part One examines the question of deterrence by exploring findings from countries with relatively high and relatively low abortion rates. After explaining why restrictive abortion laws alone do not reduce aggregate abortion rates, I consider the matter of individual deterrence. By identifying those most likely to be deterred by U.S. abortion bans, I illustrate how abortion bans intersect with structural inequalities to disproportionately impact poor women of color and their children. Part Two tests the idea that abortion bans send a message. I consider the bans’ meaning in context with U.S. laws and policies affecting families, exposing the difference between laws discouraging abortion, and those encouraging childbirth. Then, drawing from literature on the expressive function of the law, I assess the limits on the message-sending capacity of abortion bans in a society divided over abortion and over its commitment to children living in poverty. Part Three turns to the expectation that abortion bans will be competently enforced, noting the legitimacy struggles arising from law enforcement patterns, along with the administrative challenges inherent in overseeing the various exceptions to abortion bans. This article concludes by considering why the consequences and limitations of abortion bans should matter to supporters and opponents, alike.
Dynamics and Impacts of Transposable Element Proliferation in the Drosophila nasuta Species Group Radiation
Authors: Wei Kevin H.-C. , Mai Dat , Chatla Kamalakar , Bachtrog Doris
Published: April 2022

Transposable element (TE) mobilization is a constant threat to genome integrity. Eukaryotic organisms have evolved robust defensive mechanisms to suppress their activity, yet TEs can escape suppression and proliferate, creating strong selective pressure for host defense to adapt. This genomic conflict fuels a never-ending arms race that drives the rapid evolution of TEs and recurrent positive selection of genes involved in host defense; the latter has been shown to contribute to postzygotic hybrid incompatibility. However, how TE proliferation impacts genome and regulatory divergence remains poorly understood. Here, we report the highly complete and contiguous (N50 = 33.8–38.0 Mb) genome assemblies of seven closely related Drosophila species that belong to the nasuta species group—a poorly studied group of flies that radiated in the last 2 My. We constructed a high-quality de novo TE library and gathered germline RNA-seq data, which allowed us to comprehensively annotate and compare TE insertion patterns between the species, and infer the evolutionary forces controlling their spread. We find a strong negative association between TE insertion frequency and expression of genes nearby; this likely reflects survivor bias from reduced fitness impact of TEs inserting near lowly expressed, nonessential genes, with limited TE-induced epigenetic silencing. Phylogenetic analyses of insertions of 147 TE families reveal that 53% of them show recent amplification in at least one species. The most highly amplified TE is a nonautonomous DNA element (Drosophila INterspersed Element; DINE) which has gone through multiple bouts of expansions with thousands of full-length copies littered throughout each genome. Across all TEs, we find that TEs expansions are significantly associated with high expression in the expanded species consistent with suppression escape. Thus, whereas horizontal transfer followed by the invasion of a naïve genome has been highlighted to explain the long-term survival of TEs, our analysis suggests that evasion of host suppression of resident TEs is a major strategy to persist over evolutionary times. Altogether, our results shed light on the heterogenous and context-dependent nature in which TEs affect gene regulation and the dynamics of rampant TE proliferation amidst a recently radiated species group.
Hypophosphatemia in critically ill patients undergoing Sustained Low-Efficiency Dialysis with standard dialysis solutions
Authors: Di Mario Francesca , Regolisti Giuseppe , Maggiore Umberto , Pacchiarini Maria Chiara , Menegazzo Brenda , Greco Paolo , Maccari Caterina , Zambrano Cristina , Cantarelli Chiara , Pistolesi Valentina , Morabito Santo , Fiaccadori Enrico
Published: April 2022

Background

In patients admitted to the Intensive Care Unit (ICU), Kidney Replacement Therapy (KRT) is an important risk factor for hypophosphataemia. However, studies addressing the development of hypophosphatemia during prolonged intermittent KRT modalities are lacking. Thus, we evaluated the incidence of hypophosphatemia during Sustained Low-Efficiency Dialysis (SLED) in ICU patients; we also examined the determinants of post-SLED serum phosphate level (s-P) and the relation between s-P and phosphate supplementation and ICU mortality.

Methods

We conducted a retrospective analysis on a cohort of critically ill patients with severe renal failure and KRT need, who underwent at least three consecutive SLED sessions at 24–72 h time intervals with daily monitoring of s-P concentration. SLED with Regional Citrate Anticoagulation (RCA) was performed with either conventional dialysis machines or continuous-KRT monitors and standard dialysis solutions. When deemed necessary by the attending physician, intravenous phosphate supplementation was provided by sodium glycerophosphate pentahydrate. We used mixed-effect models to examine the determinants of s-P and Cox proportional hazards regression models with time-varying covariates to examine the adjusted relation between s-P, intravenous phosphate supplementation and ICU mortality.

Results

We included 65 patients [mean age 68 years (SD 10.0); mean Acute Physiology and Chronic Health Evaluation II score 25 (range 9–40)] who underwent 195 SLED sessions. The mean s-P before the start of the first SLED session (baseline s-P) was 5.6 ± 2.1 mg/dL (range 1.5–12.3). Serum phosphate levels at the end of each SLED decreased with increasing age, SLED duration and number of SLED sessions (P < .05 for all). The frequency of hypophosphatemia increased after the first through the third SLED session (P = .012). Intravenous phosphate supplementation was scheduled after 12/45 (26.7%) SLED sessions complicated by hypophosphataemia. The overall ICU mortality was 23.1% (15/65). In Cox regression models, after adjusting for potential confounders and for current s-P, intravenous phosphate supplementation was associated with a decrease in ICU mortality [adjusted hazard ratio: 0.24 (95% confidence interval: 0.06 to 0.89; P = 0.033)].

Conclusions

Hypophosphatemia is a frequent complication in critically ill patients undergoing SLED with standard dialysis solutions, that worsens with increasing SLED treatment intensity. In patients undergoing daily SLED, phosphate supplementation is strongly associated with reduced ICU mortality.
Personal Identity and Meaning in Life
Authors: Schechtman Marya
Published: April 2022

This essay explores the connection between personal identity and meaning in life. It begins with a popular understanding of identity as defined by a core set of commitments and values and shows how this can be connected to an understanding of meaning as involving purposeful activity and direction. Next it considers an objection to this picture from the work of Galen Strawson. This serves as a springboard to the development of a more expansive picture of personal identity, intermediate between the strong unity found in ‘core-self’ views and the weak unity described by Strawson. It concludes with a discussion of how this intermediate view adds nuance to the dispute between Strawson and core-self views, as well as implying a different, more controversial, understanding of meaning.
Hard Determinism and Meaning in Life
Authors: Pereboom Derk
Published: April 2022

This chapter begins by defending a sceptical view about free will, of which hard determinism is the main representative, by providing a schematic version of the author’s arguments against the leading positions that affirm free will. Compatibilism is challenged by the four-case manipulation argument, event-causal libertarianism by the disappearing agent argument, and agent-causal libertarianism by the argument from irreconcilability with the laws of nature. A significant objection to free will scepticism is that it cannot preserve the sense of meaning in life. Objections that focus on the sense of achievement and the possibility of meaningful personal relationships are addressed. Lastly, the rationality of hope for humanity, supposing the absence of free will, both on theistic and non-theistic grounds, is defended.
Meaning in Life and the Nature of Time
Authors: Markosian Ned
Published: April 2022

Many of the leading accounts of what makes a life meaningful are goal-based theories, according to which it is the pursuit of some specific goal (such as love for things that are worthy of love) that gives meaning to our lives. In this chapter, the author considers how these goal-based theories of meaning in life interact with the two main theories of the nature of time that have been defended in the recent metaphysics literature, namely, The Dynamic Theory of Time and The Static Theory of Time. He argues that The Dynamic Theory fits well with goal-based theories of meaning in life, but The Static Theory does not. The chapter closes with some thoughts about what a Static Theorist should make of this conclusion.
Mysticism, Ritual, and the Meaning of Life
Authors: Bennett-Hunter Guy
Published: April 2022

Contemporary philosophical debates about life and meaning often include discussions of religion (especially the relative merits of atheism and theism), but they tend to ignore mysticism, which offers a distinctive perspective on the division between naturalist and supernaturalist theories of life’s meaning. This chapter examines the relationships between mysticism, ritual practices, and life’s meaning through the philosophical lens of existential phenomenology—a perspective that also cuts across subjectivism and objectivism. It endorses the view that the meaning of life can only be explained in terms of the concept of ineffability and defines mysticism as the experience of ineffability, which is inassimilable to the binary categories of naturalism and supernaturalism, theism and atheism. It argues that it is pre-eminently through such mystical experience that life’s meaning is apprehended. Given the transience and passivity of mystical experience, it explores the role of ritual in cultivating an otherwise elusive sense of life’s meaning.
Love and Meaning in Life
Authors: Goldman Alan H.
Published: April 2022

As discussed in this chapter, those who are in love find their lives more meaningful than they were before. The right analyses of love and meaning in life show why this is so. Love is an emotion. Emotions include behavioural dispositions, which in the case of love include long-term commitment to share one’s life story. Lives have meaning when events within them fit into intelligible narratives. The deepest meanings derive from the most extended narratives, linking many events over time into significant patterns, especially when these narratives are shared with others. One’s love interests, whether romantic or not (things and pursuits one loves), are the primary sources of an individual’s most extended personal narratives. Whether these stories proceed smoothly, overcome obstacles, or end happily or sadly, the link between the long-term commitment of love and the narrative account of meaning in life shows why love is the most important source of such meaning.
Gratitude and Meaning in Life
Authors: Manela Tony
Published: April 2022

This chapter distinguishes two attitudes often referred to as ‘gratitude’—prepositional gratitude and appreciation—and it explores the ways that each of these attitudes influences meaning in life. It argues that prepositional gratitude, the fitting response to benevolence, enhances meaning in life by bolstering one’s sense of self-worth, motivating altruistic behaviour, fostering deep social relationships, and integrating individuals into communities. But it can also leave individuals burdened with commitments, in the form of debts of gratitude; and if one owes gratitude but fails to respond appropriately or fails to balance gratitude against other virtues, one risks the sort of immoral behaviour that could undermine meaningfulness in a life. Appreciation, like prepositional gratitude, can bring meaning to life in several ways. It can motivate meaningful projects, for instance, and connect individuals to value. But appreciating the wrong things, or appreciating the right things too little or too much, can undermine meaning in life as well.
Meaning and Anti-Meaning in Life
Authors: Nyholm Sven , Campbell Stephen M.
Published: April 2022

While it is widely thought that activities and lives can be meaningful or meaningless, this chapter explores the possibility that they could also be ‘anti-meaningful’. Anti-meaning is the opposite of meaning. This chapter has two main objectives: first, it discusses what anti-meaning is (or could be taken to be); second, it discusses whether there are good reasons to add this unfamiliar notion to our set of concepts for thinking about meaning in life. The authors review the limited literature on this topic, distinguish two formal interpretations of the idea of anti-meaning, and propose different substantive theories of anti-meaning that correspond to leading theories of meaning. They then defend the notion of anti-meaning against scepticism about the usefulness of this concept.
Education and Meaning in Life
Authors: de Ruyter Doret , Schinkel Anders
Published: April 2022

This chapter explores the relation between education and meaning in life. People experience meaning in life when they (a) can make sense of their life and the(ir) world, (b) have purpose in life, and (c) experience significance and that they matter. The chapter describes how family life and parental upbringing, as well as students’ participation in schools and teachers’ education, can make positive and unique contributions to children’s (future) meaning in life. It concludes that parents and teachers should open the complex world to help children find their way, present a meaning framework that provides a standpoint from which to evaluate what is significant while also giving sufficient freedom to engage with other views on the good life, and develop relationships with children that foster their feelings that they matter while at the same time instilling a desire and sense of responsibility to matter to others.
Virtual Reality and the Meaning of Life
Authors: Danaher John
Published: April 2022

It is commonly assumed that a virtual life would be less meaningful (perhaps even meaningless). As virtual reality technologies develop and become more integrated into everyday lives, this poses a challenge for those who care about meaning in life. In this chapter, it is argued that the common assumption about meaninglessness and virtuality is mistaken. After clarifying the distinction between two different visions of virtual reality, four arguments are presented for thinking that meaning is possible in virtual reality. Following this, four objections are discussed and rebutted. The chapter concludes that we can be cautiously optimistic about the possibility of meaning in virtual worlds.
The Meaning of Life and Transcendence
Authors: Cottingham John
Published: April 2022

Atheism and naturalism have become the default positions in academic philosophy, and this is reflected in much of the contemporary work on meaning in life, which assumes what might be called a broadly ‘immanentist’ perspective: the sources of meaning must be sought entirely within the sphere of our purely human pursuits and activities. This chapter, by contrast, lays stress on the yearning for transcendence that seems an ineradicable part of our nature. It is argued that no human life can be fully meaningful if it denies or suppresses that yearning, and that this in turn points to the need for humans to find a vehicle whereby they can enact their longing for an ultimate source of meaning and value that might bring fulfilment and completion to their lives.
Pauline Epistles
Authors: Balabanski Vicky S.
Published: April 2022

This chapter examines the Pauline eschatological vision of cosmic liberation and renewal ecologically as reconciling all things, not just the rift between God and humanity. Beginning with Rom 8:18–23, which portrays creation as a living subject, it examines key interpretive questions, including the passage’s intertextual connection with Gen 3:17–19 and other intertexts. It argues that humanity’s loss of God’s glory (Rom 1:18–23) contrasts with the creation’s ongoing ability to communicate God’s glory, articulated in Psalm19 (cf. Rom 10:18). Creation actively “groans” and “labors” together with humans toward a shared future of freedom and glory. Creation’s subjection to futility and its slavery to perishability (Rom 8:20–21) are analyzed as a twofold problem. The centrality of Christ’s work in creating and reconciling all things is examined in Col 1:15–20, where the cross has cosmic implications for reconciliation and peace-making. Pauline soteriology is examined through an ecological lens, and Pauline ecological ethics are discussed.
Stewardship
Authors: Liederbach Mark D.
Published: April 2022

While the concept of biblical stewardship has been heavily critiqued in recent decades, this chapter argues that a contextual development of Gen 1:27–28 demonstrates that using the biblically normative concept of stewardship is both warranted and an appropriate model for guiding the interaction of God’s image bearers with God’s world. The chapter begins with a discussion of the general concept of stewardship as it is found in the biblical narrative. It then identifies five categories of critiques offered against the use of a stewardship model to guide human interaction with the environment. Following this it explores key elements in the Genesis 1 and 2 creation narratives to show how the grounding of the concept of stewardship in a robust biblical theology enables it to provide a positive model for human interaction with “our Fathers world” (Psalm 24).
City as Sustainable Environment
Authors: Mills Mary E.
Published: April 2022

This chapter offers a basic definition of sustainability as used in environmental ethics before exploring defining the biblical category of city as “walled enclave.” It examines images of security and insecurity in biblical treatments of cities and then sets out the duality of historical references to city space alongside symbolic literary landscapes. The chapter then moves to urban–rural divides and to theology of built environments, leading into comparative use of the concept of apocalypse in contemporary ecological discourse and in major biblical books. Interdisciplinary engagements between biblical and cultural scholarship follows, leading into the theme of attunement and hope.
Leviticus
Authors: Rooke Deborah
Published: April 2022

The environmental concerns in Leviticus can be divided into two groups: those relating to animals, and those relating to agriculture. The animal-related topics are the system of sacrifices, the list of clean and unclean animals, the ban on nonsacrificial slaughter of domestic animals, and the ban on consuming animal suet and blood. The agricultural topics are instructions about harvesting, regulations for sabbatical years (when land is not cultivated) and Jubilee years (when land is returned to its original owner), and divine punishment via environmental chaos and exile for neglecting the regulations. Taken together, these provisions serve to limit humans’ use of the land and animals, encourage trust in God as the ultimate provider, and promote morally appropriate use of natural resources in a way that maintains a balance between all forms of life and their environment. This is part of what Leviticus views as “being holy.”
Climate Skepticism, Politics, and the Bible
Authors: Lowe Benjamin S. , Lamb Rachel L. , Toly Noah J.
Published: April 2022

This chapter examines the use of Christian scripture by some who doubt the reality, anthropogenesis, or seriousness of climate change. It offers an overview of public opinion surveys and social scientific research on the relationship between religion and climate attitudes in the United States, with a focus on evangelical Christianity as the largest and generally most skeptical religious group. Surveying uses of the Bible by evangelical climate skeptics, the chapter demonstrates various ways in which skeptics—including pastors, policymakers, scholars, and others—draw from scripture to cast doubt on climate science and to advocate against climate action. It outlines the logic behind those uses, explores the limits and contradictions of such logic, and highlights political affinities that may motivate skeptics to interpret and deploy scripture in these ways.
The Bible and Animal Theology
Authors: Clough David L.
Published: April 2022

Attention to the place of animals in the Bible has been significant in provoking new Christian theological understandings of the place of animals. Theologians bringing the question of the animal to biblical texts have found a wide range of resources for discussing Christian belief about animals, with significant implications for Christian ethics. This chapter provides a survey of key themes and texts at the interface between the Bible and animal theology, including biblical understandings of animal life, the relationship between human and nonhuman animals, the place of animals in visions of redemption, and biblical accounts of human responsibilities for other animals.
Key Ingredients for a World Religion
Authors: Van Slyke James , Slone D. Jason
Published: April 2022

Imagine you want to start a religion, and you want it to spread widely throughout the world and last for many generations. What would your religion need to be like to have a good chance of success? Is there a recipe of some kind that you could follow? This chapter argues based on insights from cognitive and evolutionary science that contemporary world religions tend to follow the same basic recipe. As with all successful recipes—those that get shared among friends and family, and passed down through generations—the reason some religions have become world religions is that they fit the expectations, biases, and preferences of the human mind, formed through our shared evolutionary heritage. The first ingredient consists of the cognitive foundations of gods and rituals, which refers to the cognitive tendencies that influence the formation and spread of god concepts and rituals. The second ingredient is supernatural monitoring and intuitive morality, which refers to the use of religion as a form of social monitoring and the ways in which religious morality reflects aspects of evolved moral intuitions. The third and final ingredient is mating strategies, in that religion enhances aspects of long-term mating strategies at both the individual and cultural levels.
A Social Justice Perspective on Intellectual Property Protection for Folk Music
Authors: Jamar Steven D. , Mtima Lateef
Published: April 2022

In this chapter we explore IP protectability of what may be broadly termed “folk music,” though that is a term fraught with ambiguity, from an intellectual property social justice (IP-SJ) framework. Our IP-SJ approach helps illuminate how IP law and administration affect opportunities for access, inclusion, and empowerment through IP endeavor, particularly for traditionally marginalized communities. IP social justice balances claims for protection with other interests and values of society relating to the broad dissemination of ideas and expressive works for the benefit of all including trans-cultural transmission of music. Traditional folk music and, more generally, traditional knowledge and expression (TKE) are not generally protectable by intellectual property (IP) law as it is currently structured. We advocate rethinking and reworking IP protection for musical works, including in particular folk music broadly understood, to provide economic and other benefits to originators and performers of music on terms that balance all interests.
How Not to Avoid the Repugnant Conclusion
Authors: Chang Ruth
Published: April 2022

This chapter examines four seemingly promising ways to defuse continua or “spectra” arguments that exploit normative predicates like “better than,” “worse than,” “more choiceworthy,” “preferable to,” “best,” and the like in order to generate puzzles or paradoxes of normativity. The most famous of these arguments is Parfit’s continua argument in population ethics which leads to the Repugnant Conclusion, the claim that a world with a vast number of people with lives barely worth living is better than a world with a large number of people enjoying excellent lives. I argue that we cannot defuse such arguments by appeal to incommensurability, incomparability, indeterminacy, or, indeed, Parfit’s own suggested solution, lexical imprecision. If we are to find a solution to continua arguments, we must look elsewhere.
Loosening the Betterness Ordering of Lives: A Response to Rabinowicz
Authors: Broome John
Published: April 2022

The betterness ordering of lives is obviously not tight: it is not true of every pair of lives that one is determinately better than the other or else they are determinately equally good. The goodness of a life is a nebulous property. But this obvious fact is rarely recognized in population axiology. This chapter recognizes it. It provides a way of formalizing a loose betterness ordering of goodness for lives and fits it into utilitarian theory that has a neutral range for existence. It asks what difference the looseness of the ordering makes to population axiology and arrives at the answer: not much.
The Person-Based Intuition and the Better Chance Puzzle
Authors: Roberts M. A.
Published: April 2022

This chapter explores the tensions that arise among three claims regarding the value of existence that seem, on close inspection, highly plausible. The first is (a) that the additional worth-having existence (other things being equal) is not a moral plus; the additional worth-having existence doesn’t (other things being equal) make an outcome, or possible world or possible future morally better. It’s true that (a) seems rooted in what is called the person-affecting intuition, and that intuition has been roundly criticized on grounds of inconsistency and, independently, the Non-Identity Problem. Both objections, however, can be avoided if accept a second claim: (b) that the additional worth-having existence can make a future, not just not morally better, but also morally worse. The third claim is simply (c) that a person’s having a better chance of coming into existence can itself be a moral plus. It can, for example, easily convert a choice that would otherwise be morally wrong into a choice that is morally permissible. But now we are in a bind. For how can (c) a better chance of existence make things morally better when (a) the fact of the worth-having existence doesn’t make things better? Moreover, how can (c) a better chance of existence make things morally better when (b) the fact of the worth-having existence can make things morally worse? The aim of this chapter is to reconcile (c) against both (a) and (b).
Population Overshoot
Authors: Dasgupta Aisha , Dasgupta Partha
Published: April 2022

Externalities are the unaccounted-for consequences for others of actions taken by one or more persons. They are symptoms of institutional failure, which is why they cannot be eliminated without collective action. When externalities are adverse, the moral directives flowing from them can clash with the exercise of personal rights. In this paper we identify a class of environmental externalities in the contemporary world that accompany procreation. We also identify externalities that are allied to socially embedded preferences for family size. Those preferences can give rise to a heightened demand for children, which exacerbates the adverse environmental externalities present people impose on future generations. Crude but suggestive estimates of the demand humanity currently makes on the biosphere are used to show that adverse environmental externalities accompanying new births are significant. We use data on global economic demography to provide rough estimates of the size of the human population the Earth system can support at a good standard of living. Our analysis, which is designed only to raise questions that have been much neglected in economic demography, allows us to study the sensitivity of sustainable global population to the standard of living.