bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergence, Not Supervenience
Authors: Humphreys Paul
Published: May 2019

It is argued that supervenience is an inadequate device for representing relations between different levels of phenomena and that emergence is a better vehicle for interlevel relations. Various interpretations of supervenience relations are examined and they are found to be excessively thin compared to explainable emergence relations. A question is raised about the differences between `vertical’ and `horizontal’ determination relations. Some possible examples of emergence are given and six criteria are provided that emergent phenomena seem to satisfy. Using examples drawn from macroscopic physics, it is suggested that such emergent features may well be quite common in the physical realm.
Emergence
Authors: Humphreys Paul
Published: May 2019

Retrospective reflections are provided on the papers “How Properties Emerge,” “Emergence, Not Supervenience,” “Synchronic and Diachronic Emergence,” and “Computational and Conceptual Emergence” by Paul Humphreys. Remarks are made on the respective merits of diachronic and synchronic approaches to emergence and it is noted that fusion emergence is a special case of the author’s more recent transformational emergence. An argument is given that holism should be imposed as a requirement for emergence only on synchronic accounts, and a reevaluation of the six conditions for emergence given in the author’s “Emergence, Not Supervenience” paper is provided. Elaborations of why features are conceptually emergent or inferentially emergent are given and brief remarks on theoretical approaches to emergence are provided. A clarification of the author’s position that introducing levels of properties is in many cases a methodological convenience rather than a recognition of ontological reality is given.
Some Considerations on Conditional Chances
Authors: Humphreys Paul
Published: May 2019

Four interpretations of single-case conditional propensities are described, and it is shown that for each of these interpretations a version of what has been called "Humphreys' Paradox" reappears. This paradox is shown to be a formal paradox rather than simply an argument containing a surprising conclusion. Proposed solutions by Donald Gillies, Peter Milne, Christopher McCurdy, and David Miller are considered and are evaluated in the light of those interpretations. Each is shown to have not dissolved the paradox. A general conclusion that the standard theory of probability is not the correct theory for conditional propensities is drawn. Along the way, the role of causation and the temporal development of propensities are examined.
The New Frontier
Authors: Fernandez Marilyn
Published: May 2019

Does the burgeoning Indian Information Technology (IT) sector represent a deviation from the historical arc of caste inequality or has it become yet another site of discrimination? Those who claim that the sector is caste-free believe that IT is an equal opportunity employer, and that the small Dalit footprint is due to the want of merit. But they fail to consider how caste inequality sneaks in by being layered on socially constructed ‘pure merit’, which favours upper castes and other privileged segments, but handicaps Dalits and other disadvantaged groups. In this book, Fernandez describes how the practice of pure and holistic merit are deeply embedded in the social, cultural, and economic privileges of the dominant castes and classes, and how caste filtering has led to the reproduction of caste hierarchies and consequently the small Dalit footprint in Indian IT.
Merit vs. Caste ‘Blood Sport’ in the IT Work Arena
Authors: Fernandez Marilyn
Published: May 2019

When rank-and-file IT professionals and their industry and knowledge leaders were invited to reflect on their views and experiences with caste in the merit construction process, the conversations became passionately vocal, sometimes even strident and combative, taking on tones of a metaphorical ‘blood sport’ pitting the Merit Camp against the Caste Camp. There was consensus on the small Dalit footprint and founder effect in Indian IT, but the explanations for the same were drastically different. To the Merit camp, the business and functional imperatives of a transnational IT sector required that they use EEO policies and not the caste-reservation quotas while the Caste camp countered that business imperatives have turned discriminatory and reinforced casteism in Indian IT. There is a stalemate in the Merit-Caste debate.
Merit and Gender Diversity
Authors: Fernandez Marilyn
Published: May 2019

Despite gendered leakage in the engineering and general education pipelines, there is much progress in gender diversity or numerical parity in Indian IT. Gender parity in Indian IT has been achieved through gender neutral merit, even if privileged, and opportunities; Indian IT women professionals were as meritorious as men, equal to men on the streamlined pure merit metrics. But, significant hurdles exist in transforming the IT workspace into a gender inclusive one that makes room for family-work conflicts, systemic gendered glass ceiling and personal obstacles. The intersectionality of caste, family, and gender in dominant caste women’s access to IT networks through their strong family ties, has rendered gender inequality and equality more readily accessible and amenable for discussion, analyses, and redress than caste (in)equalities. The assessment of gender diversity progress in Indian IT offered a contrast point to the resistance to caste diversity.
Negotiating Cultures
Authors: Guerrieri Pilar Maria
Published: May 2019

This book focuses on the city of Delhi, one of the largest mega-cities in the world, and examines—from a historical perspective—the processes of hybridization between cultures within its local architecture and urban planning from 1912, when the British Town Planning Committee for New Delhi was formed, to 1962, when the first Master plan was implemented. The research originates directly from primary documents and examines how and to what extent the city plans, the neighbourhoods, the types of residential, public buildings and the architectural styles have changed over time. The analysis of architectural elements, the city and its intricacies, is in itself useful to understand how foreign models were adopted, how much resistance was encountered, and how much adaptation there was to local conditions. The book establishes and demonstrates that Delhi has played an active role in the complex process of hybridization in both the pre- and post-Independence periods, developing its own character as opposed to merely accepting what was brought from abroad. Both periods have been characterized by a resilient and continuing compromise between indigenous and foreign elements and thus the post-1947 period cannot be construed as more ‘indigenous’ than that which preceded it. Delhi can be considered to be a comprehensive model or case study of the intermingling and conflict of cultures; its initial transition period, when the actual mega-city was born, gives an important starting point to critically investigate the current phenomenon of globalization.
Community Spaces and Public Buildings
Authors: Guerrieri Pilar Maria
Published: May 2019

With the arrival of the British (1803) in the capital there is a noticeable change in public buildings. Churches and missionary schools joined mosques and temples of various faiths; the market takes the place of the market-road and the bazar or there is a progressive transition towards buildings of power. After 1947, instead, the most significant aspect is the focus on buildings for the collective. The trend, however, was to add rather than to re-build or demolish, the city absorbed pre-existing buildings, making them become part of the present, shows the inclusive attitude the capital had established with regard to time and cultures. Nonetheless, more than in other urban elements, many buildings, both from the colonial and the post-colonial period, pose the question of how to be ‘Indian’.
Introduction
Authors: Jacob Happymon
Published: May 2019

This chapter explains the rationale of the book and discusses the book’s key puzzles and arguments. The book makes four key arguments. One, ceasefire violations (CFVs) are generally not planned, directed, or cleared by higher military commands or political establishments, but are instead driven by the dynamics on the frontlines. Two, the 2003 ceasefire agreement tends to hold when a dialogue process is under way between India and Pakistan on key disputes, autonomous military factors having little or no influence under such a positive environment. During times of bilateral tension, the agreement tends to break down and CFVs are routine. During such phases, local factors tend to have a dramatic influence on CFVs. Three, CFVs contribute to India–Pakistan escalation dynamics in a significant manner. Conventional wisdom suggests that terror attacks are the primary cause of India–Pakistan escalation. However, evidence shows that political, diplomatic, and military tensions between the two adversaries have occurred even when there have been no terror attacks. Finally, ad hocism in managing the border has historically been a key factor behind border tensions between India and Pakistan. Unsettled borders, among other factors, have played a major role in escalating tensions between the two sides.
Lull before the Storm
Authors: Jacob Happymon
Published: May 2019

This chapter offers a historical and statistical analysis of ceasefire violations (CFVs) in Jammu and Kashmir (J&K) since the ceasefire was agreed upon in 2003. The chapter is divided into two broad sections. Section one focuses on the occurrence of CFVs prior to 2003 when the current ceasefire agreement (CFA) was signed and explains the immediate background to the CFA of 2003. Section two analyses the various datasets on CFVs, including the one this book has put together, and draws conclusions regarding the locations, causes of and various factors relating to CFVs. This section also discusses how CFVs are counted, how they are spread horizontally and vertically and the existing explanations for the occurrence of CFVs.
Recasting Public Administration in India
Authors: Mathur Kuldeep
Published: May 2019

Ever since a democratic system of government was adopted and a strategy of planned economic development was launched in India, the planners were quite conscious of the need for an administrative system different from the colonial one to implement the planned objective of development. Kuldeep Mathur, in this volume, examines these administrative reforms and provides a magisterial account of the changes in the institutional process of public administration. The introduction of neoliberal policies revived the concerns about reform and change, thereby giving rise to a new vocabulary in the discourse of public administration. The conventional world of public administration was now expected to adopt management practices of the private sector and interact with it to achieve public policy goals. New institutions are now being layered on traditional ones, and India is becoming a recipient of managerial ideas whose efficacy has yet to be tested on Indian soil. In light of the aforementioned changes, this volume argues that hybrid architecture for delivering public goods and services has been the most significant transformation to be institutionalized in the current era and critiques the neoliberal transformation from within a mainstream public administration perspective.
Nature of Indian Administration
Authors: Mathur Kuldeep
Published: May 2019

This chapter emphasizes the position of district collector and the role of civil service as a significant legacy of colonial administration. The developmentist administration added more functions and responsibilities to them; thus, embellishing their power and importance in the system. This rising power was challenged by other functional services with demands of service parity and appointments to positions of their specialization. Rivalry and conflicts arose but no change took place in spite of indictments from many reform committees.
The Formal Reform Effort
Authors: Mathur Kuldeep
Published: May 2019

The chapter points out that concern for inappropriateness of a colonial-style administration and need for reform had been a continuous refrain since Independence. A number of formal committees and commissions had been appointed and their recommendations discussed. A widely noticed report was that of an international expert Paul Appleby in 1953, which set the pace for this activity. Five-Year Plans and pay commissions joined in by adding suggestions. However, little impact was made and the administration continued with an essentially colonial legacy.
Partnership in Policy Process
Authors: Mathur Kuldeep
Published: May 2019

This chapter narrates the relationship of government with businesses during the Plan era when policies were determined by government for businesses to follow, mainly regulating economic production. However, often businesses tweaked regulations when they affected their work negatively. In the neoliberal era, government–business consultations were institutionalized and formal participative committees to initiate specific polices were also instituted. Issues of the influence of business on public policies and its social consequences are also raised in this chapter.
The Commercial Network of Gujarat in the Light of the Jewish Documentary Geniza (Eleventh–Twelfth Centuries)
Authors: Chakravarti Ranabir
Published: May 2019

This chapter explores the significance of the Gujarati ports by situating these in the broader background of the maritime commerce in the Indian Ocean (particularly the western sector) during 900–1500 CE phase in the light of epigraphic and textual sources and the letters of Jewish traders. In the background of the western sea-board of the subcontinent, the primacy of Stambhatirtha/Khambayat as a port (velakula) is explained by highlighting its impressive hinterland and foreland. How feeder ports like Somanatha (Sumnat), Ghogha, Sanjan and Diu contributed to the pre-eminence of Cambay is discussed. To what extent the agrarian prosperity in Gujarat was conducive to the maritime trade in this region is a point of enquiry. The chapter argues that the Gujarati ports became the focal point not only for the exchange of commodities, but also for cultural transactions.
New directions since Meyendorff
Authors: Russell Norman
Published: May 2019

This chapter examines the new directions taken since Meyendorff’s work in four fields: the edition of texts, historical research, philosophical investigation, and theological analysis. Ettore Perrella has made Palamas’ texts more widely available. Antonio Rigo and Ioannis Polemis have made fundamental contributions to our historical understanding. Much work has been done by scholars such as Demetracopoulos, Erismann, and Tollefsen on the philosophical structures of Palamas’ thinking. Our understanding of his theological perspective has been deepened by the work of, among others, Radović, Lison, and Yangazoglou. It is argued that a more nuanced Palamas has emerged from these studies, which has enabled us to understand better the context in which Palamas conducted his debates and the nature of the challenges facing him.
How is a participatory understanding of the divine mystery to be attained?
Authors: Russell Norman
Published: May 2019

The next question concerns the nature of human participation in God. Participation implies duality, not identity, but the two terms are not commensurate, the one being finite, the other transcendent. Palamas’ solution to the problem of participation was his development of the essence–energies distinction based on Basil of Caesarea’s distinction between the divine essence and its attributes. Testimony to this distinction was sought in the gospel accounts of the transfiguration of Christ, which thus became the subject of detailed exegesis. This chapter discusses the distinctions Palamas sought to make, including one he hotly denied between a higher and a lower divinity, and concludes that the distinctions are not ontological but are intended to highlight the centrality of the experience of God.
A Positive View of Freedom?
Authors: Leiter Brian
Published: May 2019

This chapter reviews the textual evidence that Nietzsche retains a positive conception of “freedom.” Interpretive proposals due to Gemes and Poellner are shown not to be borne out by the texts. The chapter concludes that Nietzsche offers a “persuasive definition” of freedom, attaching the term’s positive valence to a sense of freedom unfamiliar in the modern Humean or Kantian traditions, but having echoes in Spinoza: “freedom” as acting from one’s inner nature rather than from external influences, something one can only do if fated to do so. The Spinoza-type view is shown not to be a kind of Control view of free will, so not one that vindicates moral responsibility.
All About Internalism
Authors: Weatherson Brian
Published: May 2019

This chapter goes into more detail about the varieties of, and motivations for, internalism in ethics. It argues that internalist theories have to, and typically do, deploy two distinct normative concepts, and discusses what those concepts might be. It then looks at three motivations for normative internalism: that only internalist norms can be guiding, that externalists endorse a bad kind of recklessness, and that only internalists treat factual and moral uncertainty symmetrically. It is argued that the last of these motivations is the strongest, and if this motivation is undercut, internalism will be undermotivated.
Against Symmetry
Authors: Weatherson Brian
Published: May 2019

This chapter argues that there are a host of intuitive asymmetries between moral uncertainty and factual uncertainty, and these are enough to undermine the symmetry-based motivation for internalism. Our reactive attitudes to our own past failings are different if the failings were caused by factual rather than moral ignorance. Factual ignorance can motivate taking a safe but known to be suboptimal outcome; moral ignorance cannot. And unlike factual ignorance, moral ignorance can only lead to bad action if it is paired with a motivation we should not have: namely a motivation to do what is right whatever that is. Various attempts to argue that this is a good motivation are considered and mostly rejected; the attempts that are plausible do not support popular forms of normative internalism.
Meat and Evil
Authors: Halteman Matthew C.
Published: May 2019

In a world where meat is often a token of comfort, health, hospitality, and abundance, one can be forgiven for raising an eyebrow at the conjunction “meat and evil.” From another perspective, the problem is obvious: meat—the flesh of slaughtered animals taken for food—is the remnant of a feeling creature who was recently alive and whose death was premature, violent, and often gratuitous. The truth is that meat has a checkered history in the west. From its origin-story in Abrahamic religion to its industrial production today, meat is well-marbled with evil and its minions: sin, violence, injustice, destruction, suffering, and death. My aim is to consider meat’s fitness for a place in the Western history of evil by reflecting on its outsized roles at the bookends of this narrative: meat’s primeval history in Genesis, and its contribution today to ethical and environmental problems of arguably apocalyptic proportions.
Calvinism and the Demonic in the Divine
Authors: Pereboom Derk
Published: May 2019

Many of John Calvin’s followers took him to be advocating a supralapsarian view of salvation history according to which God has decided, from all eternity, what will happen, who will be elected, and who will be damned. This raises obvious questions about divine goodness—or, put another way, this brand of Calvinism raises questions about the extent to which there is a streak of the diabolical even in the heart of the divine. Such a view of the divine tends to provoke a strong reaction, which we see in Horace Mann’s turn to a view of the divine that foregrounds kindness and ethical integrity.
Is Don Giovanni Evil?
Authors: Sisman Elaine
Published: May 2019

Although Mozart’s librettist for Don Giovanni, Lorenzo Da Ponte, explicitly invoked Dante’s Inferno as a source of his inspiration, both text and music tell a much more ambivalent story. The parts of the action familiar to its first audiences (the night-time escape and duel, the country maid, the statue of the dead Commander coming to dinner) were complicated by Don Giovanni’s persuasive, even heroic music and the hyper-dramatic self-justifications by his would-be conquests. Chronicling the Don’s last day, the opera focuses on his behaviors both nonchalant and impassioned as well as the inability of patriarchal norms and punishments to contain him. The opening scene, the episodic introduction of the women, and the serenade in Act II are seen here as telling examples of Mozart and Da Ponte’s desire—as in their other two collaborations, Le nozze di Figaro and Così fan tutte—to accommodate a serious moral tale to the poignant delights of comic opera. They reveal a vision of the Don beyond good and evil.
Evil in Classical German Philosophy
Authors: Wood Allen
Published: May 2019

This chapter compares the accounts of evil will and evil moral psychology in Kant, Fichte, and Kierkegaard. For Kant, evil is the result of a free but ultimately incomprehensible choice on the part of rational agents to prefer self-advantage over the moral law when encountering others in society. For Fichte, evil may involve improperly giving in to natural drives, but it can also involve the giving oneself over to the pure drive to self-sufficiency. Both forms of evil manifest a self-deceptive obscurity and willful complacency that Fichte calls despair. Kierkegaard appropriates this notion of despair and incorporates it into his own more traditional (and less rationalist) picture of sin and redemption.
Leopardi
Authors: Toffoli Silvia De
Published: May 2019

Giacomo Leopardi, a major Italian poet of the nineteenth century, was also an expert in evil to whom Schopenhauer referred as a “spiritual brother.” Leopardi wrote: “Everything is evil. That is to say, everything that is, is evil; that each thing exists is an evil; each thing exists only for an evil end; existence is an evil.” These and other thoughts are collected in the Zibaldone, a massive collage of heterogeneous writings published posthumously. Leopardi’s pessimism assumes a polished form in his literary writings, such as Dialogue between Nature and an Islander (1824)—an invective against nature and the suffering of creatures within it. In his last lyric, Broom, or the flower of the desert (1836), Leopardi points to the redeeming power of poetry and to human solidarity as placing at least temporary limits on the scope of evil.
Evil, Natural Science, and Animal Suffering
Authors: Martin Eric , Watkins Eric
Published: May 2019

This chapter investigates how historical developments within the natural sciences—specifically, the emergence of mathematical physics in the seventeenth and eighteenth centuries and of evolutionary biology in the nineteenth and twentieth centuries—shaped European thought about evil. The chapter also considers how the problem of evil takes on different forms and elicits different responses as a result. The first section describes how laws of nature became fundamental to science in the early modern period and then shows how that development influenced conceptions of both moral and natural evil. The second section turns to evolutionary biology and describes the evolutionary problem of evil in its terms. The third section considers Charles Darwin’s position on the problem before examining broadly Darwinian theodicies in the fourth section.
Cinematic Evil
Authors: Uidhir Christy Mag
Published: May 2019

Prior to the enforcement of the Motion Picture Production Code in 1934, Hollywood films were infamous for featuring violence, sexuality, profanity, drug use, and all manner of moral turpitude. Despite this, it wasn’t until the middle of the century that what might be called “pure” or “intrinsic” evil became a prominent theme in American film. In this chapter, I investigate the varieties of evil on display in American cinema and conclude that perhaps the relatively late appearance of “pure” evil depicted cinematically may have had to do with the very sorts of very real evils occurring in the very actual world in the middle of the twentieth century.
Medicaid Expansion during the Trump Presidency: The Role of Executive Waivers, State Ballot Measures, and Attorney General Lawsuits in Shaping Intergovernmental Relations
Authors: Richardson Lilliard E
Published: May 2019

This article assesses developments in the first two years of the Trump presidency regarding implementation of the Affordable Care Act (ACA), with a focus on Medicaid policy. Trump administration officials relied on executive actions to chip away at various elements of the ACA and encouraged and granted state requests for waivers allowing work-requirements and other personal-responsibility rules for Medicaid beneficiaries. Governors and state attorneys general were actively involved in lawsuits that led to several federal court rulings blocking implementation of Medicaid work requirements as well as a ruling that re-opened the legitimacy of the entire ACA. Citizens and interest groups had a major impact at the ballot box by approving several ballot measures that expanded Medicaid in states where expansion was opposed by elected officials. These developments demonstrate how policy adjustments and disputes are worked out in the U.S. federal system in a polarized era, with Congress essentially a bystander and other institutions and actors coming to the fore and resulting in variable speed federalism characterized by different partisan trajectories of state implementation of national policies.
Broad range shuttle vector construction and promoter evaluation for the use of Lactobacillus plantarum WCFS1 as a microbial engineering platform
Authors: Spangler Joseph R , Caruana Julie C , Phillips Daniel A , Walper Scott A
Published: May 2019

As the field of synthetic biology grows, efforts to deploy complex genetic circuits in nonlaboratory strains of bacteria will continue to be a focus of research laboratories. Members of the Lactobacillus genus are good targets for synthetic biology research as several species are already used in many foods and as probiotics. Additionally, Lactobacilli offer a relatively safe vehicle for microbiological treatment of various health issues considering these commensals are often minor constituents of the gut microbial community and maintain allochthonous behavior. In order to generate a foundation for engineering, we developed a shuttle vector for subcloning in Escherichia coli and used it to characterize the transcriptional and translational activities of a number of promoters native to Lactobacillus plantarum WCFS1. Additionally, we demonstrated the use of this vector system in multiple Lactobacillus species, and provided examples of non-native promoter recognition by both L. plantarum and E. coli strains that might allow a shortcut assessment of circuit outputs. A variety of promoter activities were observed covering a range of protein expression levels peaking at various times throughout growth, and subsequent directed mutations were demonstrated and suggested to further increase the degree of output tuning. We believe these data show the potential for L. plantarum WCFS1 to be used as a nontraditional synthetic biology chassis and provide evidence that our system can be transitioned to other probiotic Lactobacillus species as well.
Epidemiological profile and outcomes of snakebite injuries treated in emergency departments in South Korea, 2011–2016: a descriptive study
Authors: Senek Mohd Zaki Fadzil , Kong So Yeon , Shin Sang Do , Sun Kyong Min , Kim Jungeun , Ro Young Sun
Published: May 2019

Background

Snakebite is a global public health crisis, but there are no nationwide data on snakebite in South Korea. The aim of this study was to describe the epidemiological profile and outcomes of snakebite cases in South Korea seasonally.

Methods

The selected subjects were patients of all ages with a chief complaint of snakebite who presented to participating emergency departments (EDs) between 1 January 2011 and 31 December 2016.

Results

A total of 1335 patients were eligible for the study. There were an average of 223 snakebite cases reported each year. Most snakebites occurred during the summer months (55.9%) in patients aged 40–59 y (36.3%) and males (61.5%). Snakebites occurred most frequently on Mondays (22.9%) between 12:00 and 17:59 h (42.0%) outdoors (57.9%) and in farm areas (20.7%). Over 82% of the bites were by venomous snakes across all seasons, and 66% of the patients visited EDs without using emergency medical services. Based on the excess mortality ratio-adjusted injury severity score, 88, 9.2 and 2.8% had mild, moderate and severe injuries, respectively. There were 10 fatalities during the study period.

Conclusion

This study provides essential information to understand and assess the burden and distribution of snakebites in South Korea and provides valuable information for developing appropriate prevention and control interventions to address it.
Using health coaching to improve patients' BP management
Authors: Higgins Karen , Scott Micah A.
Published: May 2019

Nurses have unique opportunities to influence patient outcomes and reduce healthcare expenditures. Health coaching is one patient-centered strategy nurses can use to improve the limited health literacy often associated with hypertension. This article describes the use of health coaching to help patients understand their medications and give them the knowledge, skills, and confidence to self-manage their hypertension.
Increasing cultural competence with LGBTQ patients
Authors: Margolies Liz , Brown Carlton G.
Published: May 2019

Many nurses practicing today lack basic education about LGBTQ (lesbian, gay, bisexual, transgender, queer) patient care. How can they better prepare to care for this population? This article provides insight on LGBTQ people, their health risks and disparities, and how nurses can work with LGBTQ patients to improve outcomes.
Carcinoma Cuniculatum of the Lower Leg: A Case Report and Proposed Diagnostic Criteria
Authors: Kunc Michał , Biernat Wojciech
Published: May 2019

Carcinoma cuniculatum is an infrequent variant of squamous cell carcinoma described for the first time by Ian Aird in 1954. Since then, multiple reports of cutaneous carcinoma cuniculatum have been published at various sites, including palms, soles, buttocks, and lower legs, but most of them did not match to original description. In the current study, we report a unique case of a 69-year-old woman with carcinoma cuniculatum arising in the calf. Moreover, we update the histopathological criteria of cutaneous carcinoma cuniculatum by combining the literature descriptions and the experiences from the current case.
Effects of ospemifene on genitourinary health assessed by prospective vulvar-vestibular photography and vaginal/vulvar health indices
Authors: Goldstein Irwin , Simon James A. , Kaunitz Andrew M. , Altomare Corrado , Yoshida Yuki , Zhu Julie , Schaffer Sam , Soulban Graziella
Published: May 2019

Objective:

To prospectively evaluate the effects of ospemifene on the vulva and vagina in postmenopausal women using vulvar-vestibular photography and direct visual assessments.

Methods:

Postmenopausal women (aged 40-80 years) with moderate to severe vaginal dryness as their most bothersome symptom (MBS) were randomized to daily ospemifene 60 mg or placebo in this 12-week, multicenter, double-blind, phase 3 study. Vulvar-vestibular photographic images were captured at baseline and week 12 and were independently assessed with the Vulvar Imaging Assessment Scale (VIAS). Changes from baseline in Vaginal and Vulvar Health Indices (VHI and VuHI) with ospemifene versus placebo were analyzed at weeks 4, 8, and 12. Correlations between VIAS, VHI, and VuHI, with vaginal dryness severity and the Female Sexual Function Index (FSFI) scores were also assessed.

Results:

In all, 631 eligible participants were randomized (ospemifene 316, placebo 315) and included in the intention-to-treat population. Compared with placebo, ospemifene significantly improved total scores for VIAS (P = 0.0154), VHI (P < 0.0001), and VuHI (P < 0.0001) from baseline to week 12; significant VHI (P < 0.0001) and VuHI (P = 0.002) improvements were observed at week 4. Most VHI and VuHI individual items were significantly better with ospemifene versus placebo at week 12 (P < 0.05). Most correlations between the vulvovaginal assessment total scores versus vaginal dryness severity and FSFI scores were significant (P < 0.05).

Conclusion:

Improvements observed in vulvovaginal health with ospemifene assessed by prospective vulvar-vestibular photography and other direct visual assessments support its efficacy in addition to the treatment of moderate to severe vaginal dryness due to menopause and the use of photographic and direct visual evaluations in future clinical trials.

Video Summary

Supplemental Digital Content 1, http://links.lww.com/MENO/A415
Determination of Uranium Series Activity Before Secular Equilibrium Is Established
Authors: Wilson Charles A. , Matthews Kenneth L. , Hamideh Amin M. , Wang Wei-Hsung
Published: May 2019

Timely achievement of uranium series’ secular equilibrium is not always feasible. Our objective is to mathematically justify methods for early uranium series gamma spectroscopy measurements that can accurately predict naturally occurring radioactive material equilibrium activities long before equilibrium is established. It was believed that, regardless of prior 222Rn escape, after sealing a sample for a few hours the activities of 222Rn, 226Ra, and 238U could theoretically be determined with a single measurement of both 214Pb and 214Bi. However, when accounting for error, this theory did not work as expected (CV = 14.0 in 226Ra simulation). A similar approach published by Li et al. in 2015 proved to be much more reliable with the error considered, using 214Pb activities measured at two different times gave significantly improved results when tested the same way (CV = 0.29 in 226Ra simulation). Because both 214Pb and 214Bi activities are typically available when using gamma spectrometry, we combine these approaches and further increased the accuracy of the calculated activities (CV = 0.21 in 226Ra simulation).
Radionuclide Concentrations in Different Water Sources From Nigeria
Authors: Owoade Latifat , Alakiu Helen , Akinde Kazeem , Nwankwo Chioma Uchenna
Published: May 2019

Gamma spectrometric analysis was done on all the different sources of water samples in the rural communities of Egbeda Local Government Area of Oyo State in Nigeria. Water samples were collected from 6 boreholes, 11 streams, 5 taps, and 41 hand-dug wells. The water samples were analyzed using a high-purity germanium detector at the National Institute of Radiation Protection and Research, Ibadan, Nigeria. Radionuclides found in the water samples include 40K, 232Th, and 238U. The average amount of 40K found in the borehole, stream, tap, and well water is 3.22, 2.23, 2.11, and 1.77 Bq L−1, respectively. The average amount of 232Th found in the borehole, stream, tap, and well water is 0.57, 0.46, 0.47, and 0.55 Bq L−1, respectively. The average amount of 238U found in the borehole, stream, tap, and well water is 0.54, 0.27, 0.29, and 0.61 Bq L−1, respectively. The annual effective doses calculated from radionuclides in the water are 0.11, 0.09, 0.09, and 0.11 mSv for borehole, stream, tap, and well, respectively.
Drug-eluting bead transarterial chemoembolization (TACE) vs conventional TACE in treating hepatocellular carcinoma patients with multiple conventional TACE treatments history
Authors: Li Hui , Wu Fucang , Duan Min , Zhang Guodong
Published: May 2019

This study aimed to compare the efficacy and safety of drug-eluting bead transarterial chemoembolization (DEB-TACE) vs conventional TACE (cTACE) in hepatocellular carcinoma (HCC) patients with multiple cTACE treatments history.

Eighty-one HCC patients with multiple cTACE treatments history who underwent DEB-TACE (N = 42) and cTACE treatment (N = 39) were included in this retrospective cohort study and allocated to DEB-TACE and cTACE groups accordingly. Multiple cTACE treatments history was defined as history of three or more cycles cTACE treatments. Then treatment responses were assessed according to the criteria of modified Response Evaluation Criteria in Solid Tumors (mRECIST), and progression free survival (PFS), as well as overall survival (OS), was calculated. In addition, adverse events and liver function related indexes were recorded.

Complete response (P = .167) was of no difference while objective response rate (ORR) (P = .003) was increased in DEB-TACE group compared with cTACE group. Patients in DEB-TACE group presented with more favorable PFS (P = .028) and OS (P = .037) compared with cTACE group. Further analysis revealed that DEB-TACE (vs cTACE) was an independent predictive factor for better ORR (P = .001), PFS (P = .006) and OS (P = .001). The albumin (ALB) level at first month after treatment was elevated (P = .015) while the other liver function indexes levels did not vary (all P > .05) in DEB-TACE group compared with cTACE group. The incidences of pain (P = .327), fever (P = .171) and nausea/vomiting (P = .400) during hospitalization were similar between the 2 groups.

DEB-TACE is more efficient and equally tolerant compared with cTACE in HCC patients with multiple cTACE treatments history.
The association between epididymo-orchitis and prostate cancer
Authors: Liu Jui-Ming , Yi Chin-Chang , Lin Chien-Yu , Chang Hung , Hsu Ren-Jun , Chuang Heng-Chang , Hsu Wen-Lin
Published: May 2019

To determine whether epididymo-orchitis, a common infectious disease among men, is associated with subsequent prostate cancer (PCa) via a nationwide cohort study.

This nationwide population-based study of patients treated from 2001 to 2013 included a total of 4991 patients with epididymo-orchitis as the study group and 19,922 matched patients without epididymo-orchitis as a control group. We tracked the patients in both groups for a 5-year period to identify any new cases of PCa. Cox proportional hazards regressions were performed to calculate the hazard ratio (HR) of PCa during this 5-year follow-up period.

Of the 24,913 patients in the study, 235 (0.9%) were newly diagnosed with PCa during the 5-year follow-up period; 77 (1.5%) of those were from the epididymo-orchitis group and 158 (0.8%) were from the control group. Compared to the patients without epididymo-orchitis, the adjusted HR for PCa for the patients with epididymo-orchitis was 1.56 (95% confidence interval [CI]: 1.18–2.06) during the 5-year follow-up period. Ages of more than 70 years, higher incomes, hypertension, and hyperlipidemia were more strongly associated with

PCa in the study group than in the control group.

The results were associated with a 56% increased risk for PCa among patients with epididymo-orchitis. Epididymo-orchitis may play an etiological role in the development of PCa in Asian populations. Further studies are warranted, however, to investigate the relationship between epididymo-orchitis and PCa.
Propofol-based palliative sedation in terminally ill children with solid tumors
Authors: Miele Evelina , Mastronuzzi Angela , Cefalo M. Giuseppina , Del Bufalo Francesca , De Pasquale M. Debora , Serra Annalisa , Spinelli Gian Paolo , De Sio Luigi
Published: May 2019

Rationale:

The palliative sedation therapy is defined as the intentional reduction of the alert state, using pharmacological tools. Propofol is a short-acting general anesthetic agent, widely used for induction and maintenance of general anesthesia and rarely employed in palliative care.

Patient concerns and Diagnoses:

This case series describes 5 pediatric oncology inpatients affected by relapsed/refractory solid tumors received palliative sedation using propofol alone or in combination with opioids and benzodiazepines.

Interventions and Outcomes:

Five terminally ill children affected by solid tumors received propofol-based palliative sedation. All patients were previously treated with opioids and some of them reduced the consumption of these drugs after propofol starting. In all cases the progressive increase of the level of sedation until the death has been the only effective measure of control of refractory symptoms related todisease progression and psychological suffering.

Lessons:

We evaluated the quality of propofol-based palliative sedation in a series of pediatric oncology patients with solid tumors at the end of their life. We concluded that propofol represents an effective and tolerable adjuvant drug for the management of intractable suffering and a practicable strategy for palliative sedation in pediatric oncology patients at the end of their life.
Prediction of mortality and organ failure based on coagulation and fibrinolysis markers in patients with acute pancreatitis
Authors: Liu Chaonan , Zhou Xinfeng , Ling Liqin , Chen Si , Zhou Jing
Published: May 2019

This study explored the predictive value of coagulation and fibrinolysis markers with acute pancreatitis (AP)-related mortality and organ failure.

We retrospectively reviewed and analyzed coagulation and fibrinolysis markers and clinical outcomes of the patients with AP.

A total of 273 patients with AP were enrolled, 7 patients died and 28 patients suffered from organ failure. Uni- and multivariate logistic regression identified the differences of all of the coagulation and fibrinolysis markers as risk factors for AP-related mortality. The differences of APTT value, TT value, D-dimmer level, FDP level, and AT III level were risk factors for organ failure. Furthermore, the OR of the differences of platelet, PT, APTT, TT, fibrinogen, D-dimmer, FDP, and AT III was substantially improved by grouping with intervals of 10 × 109/L, 2 seconds, 5 seconds, 3 seconds, 0.5 g/L, 3 mg/L FEU, 5 mg/L and 10%, respectively. The risk of mortality can increase up to 1.62, 5.17, and 5.60 fold for every 10 × 109/L, 2 seconds and 5 seconds of increase in platelet, PT and APTT, respectively. There is approximate 2-fold increase in risk of organ failure for every 2 seconds of TT increase. In receiver operating characteristic analysis, there is no difference in the predictive power of bedside index for severity in acute pancreatitis (BISAP) with them in mortality or organ failure.

In patients with AP, the dynamic changes of coagulation and fibrinolysis markers are good predictors for AP-related mortality and organ failure, especially platelet, PT and APTT in mortality and TT in organ failure.
MicroRNA expression profiling of lung adenocarcinoma in Xuanwei, China
Authors: Hu Zaoxiu , Wang Xiaoxiong , Yang Yanlong , Zhao Yonghe , Shen Zhenghai , Huang Yunchao
Published: May 2019

MicroRNAs (miRNAs) have been proved to be related to the development and progression of lung cancer. However, the expression signatures of miRNAs in lung adenocarcinoma in Xuanwei are not yet clear. The current study aimed to identify the potential miRNA profiles in lung adenocarcinoma in Xuanwei by microarray.

The miRNA profiles in 24 lung adenocarcinoma and paired non-tumor tissues in Xuanwei were ascertained by using the Exiqon miRCURY LNA microRNA Array (v.18.0). The results of the microarrays were further verified by quantitative real-time polymerase chain reaction (qRT-PCR) detection. Bioinformatics analysis was used to carry out the functional annotations of differentially expressed miRNAs.

One hundred fifty five differentially expressed (≥2-fold change) miRNAs were identified (65 upregulated and 90 downregulated). QRT-PCR was used to validate the top 4 most upregulated and downregulated miRNAs, and the results were generally consisted with microarray. Furthermore, the differentially expressed miRNAs were significantly enriched in numerous common pathways that were bound up with cancer. The pathways included focal adhesion and signaling pathways, such as cyclic guanosine monophosphate -protein kinase G (cGMP-PKG) signaling pathways, mitogen-activated protein kinase (MAPK) signaling pathway, and Hippo signaling pathway, etc.

Our study identified the potential miRNA profiles in lung adenocarcinoma in Xuanwei by microarray. These miRNAs might be used as biomarkers for diagnosis and/or prognosis for lung cancer in Xuanwei and therefore warrant further investigation. Further study is needed to reveal the potential role of these miRNAs in the carcinogenesis of XuanWei Lung Cancer (XWLC).
Effect of RNA splicing machinery gene mutations on prognosis of patients with MDS
Authors: Wang Xiaoxue , Song Xiaomeng , Yan Xiaojing
Published: May 2019

Background:

Gene mutations with important prognostic role have been identified in patients with myelodysplastic syndrome (MDS). We performed a meta-analysis to investigate the effects of RNA splicing machinery gene mutations on prognosis of MDS patients.

Methods:

We searched English database including PubMed, Embase, Cochrane Library for literatures published within recent 10 years on the effect of RNA splicing machinery genes in MDS. Revman version 5.2 software was used for all the statistical processing. We calculated risk ratio and 95% confidence interval (CI) of continuous variables, and find hazard ratio (HR) and 95% CI of time-to-event data.

Results:

We included 19 studies enrolling 4320 patients. There is a significant superior overall survival (OS) in splicing factor 3b, subunit 1 (SF3B1)-mutation group compared to unmutated group (HR = 0.58, 95% CI: 0.5–0.67, P < .00001); OS decreased significantly in serine/arginine-rich splicing factor 2/ U2 auxiliary factor protein 1 (SRSF2/U2AF1) mutation group compared to unmutated group, (HR = 1.62, 95% CI: 1.34–1.97, P < .00001 and HR = 1.61, 95% CI: 1.35–1.9, P < .00001, respectively). In terms of leukemia-free survival (LFS), the group with SF3B1 mutation had better outcome than unmutated group, HR = 0.63 (95% CI: 0.53–0.75, P < .00001). Other RNA splicing gene mutation group showed significant poor LFS than unmutated groups, (HR = 1.89, 95% CI: 1.6–2.23, P < .00001; HR = 2.77, 95% CI: 2.24–3.44, P < .00001; HR = 1.48, 95% CI: 1.08–2.03, P < .00001; for SRSF2, U2AF1, and zinc finger CCCH-type, RNA binding motif and serine/arginine rich 2 [ZRSR2], respectively). As for subgroup of low- or intermediate-1-IPSS risk MDS, SRSF2, and U2AF1 mutations were related to poor OS. (HR = 1.83, 95% CI: 1.43–2.35, P < .00001; HR = 2.11, 95% CI: 1.59–2.79, P < .00001 for SRSF2 and U2AF1, respectively). SRSF2 and U2AF1 mutations were strongly associated with male patients. SF3B1 mutation was strongly associated with disease staging.

Conclusion:

This meta-analysis indicates a positive effect of SF3B1 and an adverse prognostic effect of SRSF2, U2AF1, and ZRSR2 mutations in patients with MDS. Mutations of RNA splicing genes have important effects on the prognosis of MDS.