bluuebunny/crossref_metadata_2025 huggingface dataset:
The Islamic State
Authors: Hamming Tore
Published: May 2023

The chapter looks at the internal conflict dynamics within the Islamic State. It describes the development of an internal ideological schism between the so-called Binaliyya and the Hazimiyya wings of the group. Diverging in their views on the criteria for excommunication (takfir), the two wings engaged in a violent conflict for control over the Islamic State's most powerful institutions including the Delegated Committee. While manifesting itself most prominently in Syria and Iraq, this internal schism would also affect internal dynamics within several of the caliphate's affiliates with severe effects for the global group's cohesion at a critical time in its evolution.
Renewed Cohesion or Continued Polarisation?
Authors: Hamming Tore
Published: May 2023

Following the previous two chapters' examination of the internal conflict dynamics within the Islamic State and al-Qaida, this chapter investigates the immediate aftermath. It reveals how the ideological cleavage between al-Qaida and Hayat Tahrir al-Sham continued to escalate and even led to a break between previously unified ideologues, who started to debate the role of the Jihadi movement in the contemporary political context and essentially question its future. The analysis also highlights how the Jihadi movement had become more fragmented than ever, no longer exclusively defined by the competitive relation between al-Qaida and the Islamic State but facing the challenge of accommodating a third way of viewing the Jihadi project.
Epilogue
Authors: Hamming Tore
Published: May 2023

After years of inter- and intra-group conflict and infighting, the pressing question is when, or whether, inter-Jihadi conflict is coming to a halt. The epilogue moves on from the 2014–2019 period to show how Jihadi fratricide continued to escalate and move to new locations in a replay of events that confirm a specific conflict cycle. Taking stock of the development, it lists six negative effects of conflict that are likely to function as drivers for continued conflict cycles.
Jesus the Philosopher
Authors: Dusenbury David Lloyd
Published: May 2023

The poet William Blake once claimed: "There is not one Moral Virtue that Jesus Inculcated but Plato and Cicero did Inculcate before him." This chapter tries to show that Blake's comparison of Jesus with "pagan" philosophers is less eccentric than it might strike us today. For most of their history, the gospels have been read in connection to Graeco-Roman philosophy. And, indeed, they may have been written with an eye to certain philosophical traditions. Nor does this diminish the Jewish provenance of the gospels: Graeco–Roman philosophy belongs to the reception horizon, not only of the gospels, but of most first-century Jewish literature. This chapter tries, therefore, to present Jesus as a figure whose life and sayings connect him--at once--to the legacies of Hebrew prophecy, and "pagan" philosophy.
Jesus among the Lawbreakers
Authors: Dusenbury David Lloyd
Published: May 2023

There is an iconic scene in John 8, in which Jesus is asked whether a woman who has been unfaithful to her husband should be put to death. The present chapter offers a new reading of this tense--and ultimately, redemptive--scene, beginning with the question of its literary origins. Although this scene is found in John, it seems to have originated outside the gospel. Textual critics have nevertheless concluded that it is a piece of very early Christian tradition which entered the gospel collection in its current position--namely, in John 8. This scene can therefore be treated in the context of John's gospel. And as chapter 10 has shown, this is not the only text in which Jesus boldly refuses to act as a political judge.
The Way
Authors: Fraser Chris
Published: May 2023

This chapter examines different views concerning the nature of and grounds for dào (the Way), the central architectonic concept in late Warring States thought. The discussion considers views on which dào is fixed by nature, as well as the claim that people’s nature provides a built-in dào to follow. It examines texts that present dào as primarily a natural or cosmogenic process, in which wise human agents subsume themselves. It then explores a ‘craft’ conception of dào, on which human dào is a construct justified by how effectively it engages with natural conditions. This view overlaps but contrasts with Xúnzǐ’s cultural constructivism, on which human dào is an authoritative system of cultural and political norms and institutions developed by epochal cultural leaders. Finally, the chapter looks at the pragmatic pluralism found in parts of the Zhuāngzǐ.
Introduction
Authors: Wickham Chris
Published: May 2023

This chapter sets out the main underpinnings of the arguments of the book as a whole. It presents the regions chosen for study, and explains the methodology of how written sources and archaeology are used. It argues that the main indicator for economic activity, complexity, and prosperity of different regions has to be the production and exchange of bulk goods, such as (in this period) wine, olive oil, cloth and its raw materials, or iron, and not luxury goods. It also stresses that regional economic complexity is far more important than interregional trade, as indeed is still the case even today. It argues that it is wholly wrong to discuss any Mediterranean region in the central middle ages in terms of its supposed economic failure.
Kant’s Practical Proof of the Fact of Freedom
Authors: Kitcher Patricia
Published: May 2023

Kant examined the necessary conditions for the possibility of phenomena, e.g. cognition or morality. Still, his approaches to freedom differed in the Critique of Pure Reason and the Critique of Practical Reason. In the former, Kant argues that the freedom required for morality is not impossible; in the latter, he argues that freedom and morality are actually possible, because their enabling conditions are actual. The crucial capacity is being determinable by the moral law. Since the only human access to theoretical or practical reasoning is through reasoning, the proof of practical freedom must be practical. Just before the “fact of reason” passage, Kant invites readers to consider adopting a maxim of false testimony; his expectation is that when they do, they are conscious of the moral law as producing a determinate willing, an intention to not to lie. As determinable by the moral law, they are free.
Imagining Freedom
Authors: Matherne Samantha
Published: May 2023

The main focus of this chapter is on the role that the imagination plays in Kant’s theory of the sublime. Although commentators tend to describe the imagination’s contribution in wholly negative terms, I defend a positive interpretation of what the imagination does in relation to the sublime. More specifically, I argue that the imagination is expanded and empowered in judgments of the sublime insofar as it treats objects in nature as a symbolic exhibition of what in us is properly sublime, viz., our vocation as free and moral agents. I show that insofar as Kant connects this vocation to our freedom, the imagination contributes to Kant’s overall efforts in the third Critique to explain how the “great chasm” between nature and freedom can be overcome, helping us regard nature as a symbol of our freedom and sublimity within.
MANUS MANUTII
Authors: de Candal Geri Della Rocca
Published: May 2023

Aldus Manutius (c. 1450–1515), arguably the best-known Renaissance printer, was eager to offer the highest editorial and typographical standards in his editions. Not even Aldus, however, was immune to typographical errors and occasional disasters. This chapter provides a checklist of all known in-house corrections found in the first five years of his printed production (1495–1500), examining various approaches to deal with errors, and addressing the question of how typographical flaws help us understand early printing practices. The sheer number of misprints, alterations, and interventions observed in this handful of editions should serve as a reminder that Renaissance print shops were far from the idealised, almost clockwork descriptions that one still occasionally finds in modern secondary literature, and Manutius’s was no exception: printing was, simply put, a highly complex and messy business.
Sepúlveda on the Spanish Invasion of the Americas
Authors: Glanville Luke , Lupher David , Feile Tomes Maya
Published: May 2023

This volume presents translations of four key texts from the dispute between Juan Ginés de Sepúlveda and Bartolomé de las Casas regarding the justice of Spain’s invasion of the Americas, culminating in their famous debate in Valladolid in 1550–51. Sepúlveda’s Democrates secundus (composed around 1544), an impassioned defence of the invasion, amplified the controversy within Spain about the justice of its activities in the Americas. When Las Casas schemed to block publication of Sepúlveda’s manuscript, Sepúlveda wrote an Apologia (1550) in its defence. Tensions were so heightened that Emperor Charles V called a temporary halt to undertakings in the Americas and convoked a meeting of theologians and jurists in Valladolid to address the matter. Here, Sepúlveda and Las Casas debated bitterly. Las Casas subsequently printed a composite record of the Valladolid deliberations (Aquí se contiene una disputa o controversia, 1552). Sepúlveda retaliated by penning a furious response (Proposiciones temerarias y de mala doctrina, around 1553–54) and strove to have Las Casas’s text banned by the Inquisition. Complete English translations of these texts are here published for the first time. The debate between Sepúlveda and Las Casas was a pivotal moment in the history of international legal thought. They argued over fundamental matters of empire and colonial rule; natural law and cultural difference; the jurisdiction of the Church, responsibilities of Christian rulers, and rights of infidel peoples; the just reasons for war and grounds for resistance; and the right to punish idolatry, protect innocents from tyranny, and subjugate unbelievers for the purpose of spreading the Christian faith.
Jane Addams
Authors: Grady Kate , Heathcote Gina
Published: May 2023

Jane Addams, born 6 September 1860—died 21 May 1935, was an important early feminist theorist of international law, linking domestic and international activism, identifying labour rights, citizenship, arms control, and gender equality as components of peace. Addams was also the recipient of the Nobel Peace Prize in 1931. As a founding member of the Women’s International League for Peace and Freedom (WILPF), she is recognized as holding a crucial role in the development of transnational feminist movements and anti-militarism that continue to this day. Addams published extensively, of particular note to international law are: Newer Ideals of Peace (1907), The Revolt against War (1915), and Peace and Bread in the Time of War (1922).
Avabai Wadia
Authors: Nesiah Vasuki
Published: May 2023

Avabai Wadia was a lawyer and activist whose work built and travelled paths between law and public health, feminist, and anti-colonial struggles. A co-founder of International Planned Parenthood Federation (IPPF), she was an earlier pioneer in the field of reproductive health but equally in a feminist, anti-imperial, internationalism. She was born in 1913 in Colombo, Sri Lanka (then colonial Ceylon) into a peripatetic Zoroastrian family but she also created her own home, politically and otherwise, in women’s movements across the world and the paths they forged towards each other, and away from the world they had inherited. They sought to develop nothing less than a new international order, from the most intimate arenas of women’s lives to the most public and global arenas of international law and policy that determined possibilities for their future.
Alva Myrdal
Authors: Orford Anne
Published: May 2023

Alva Myrdal was a feminist public intellectual, social policy researcher, ambassador, socialist internationalist, and eventual Nobel Peace Prize Laureate. She is remembered both as one of the major architects of the Swedish welfare state and as a significant figure in international disarmament. For much of her life she was engaged in debates about social policy, initially within Sweden and then on the international stage, first as principal director at the UN Department of Social Affairs in New York from 1949, then director of the Department of Social Sciences at UNESCO from 1951, and finally as Swedish Ambassador to India from 1955 to 1961, before becoming the head of Sweden’s delegation to the UN Committee on Disarmament from 1962 to 1973. Alva Myrdal’s life and work offers a window into social democratic internationalism at the period when it was at its most idealistic and influential. As this chapter shows, the struggle over how to interpret her legacy is closely tied up with the rise and fall of social democratic internationalism in Sweden and beyond.
Suzanne Bastid
Authors: Tallgren Immi , Buchet Antoine
Published: May 2023

Suzanne Bastid was the first woman in many professional roles and institutional positions: as a professor of international law in France, an international judge and later president of the United Nations Administrative Tribunal, as a legal counsel at the International Court of Justice and later an ad hoc judge in the same court, and as a member and later president of the Institut de droit international. She was also the founder and editor-in-chief of L’Annuaire français de droit international, a leader of diverse academic and professional associations, such as Société française pour le droit international, a member and subsequently the president of the French Académie des sciences morales et politiques, and the author of not a small number of academic publications. The portrait traces Suzanne Bastid’s ascension into a prominent and respected figure in international law in France and internationally in an analysis that focuses on the representations (visual and textual) of her exceptionality. How did Suzanne Bastid manage to overcome the gendered legal, social, cultural, and political obstacles? In the representations of Bastid today, the sex and gender marking on her career makes it figure as a site of struggle for representation. She has become an emblem of progress for women in the legal professions, but was she a ‘feminist’, and in the eyes of whom? What difference does it make?
Marjorie M Whiteman
Authors: Shinohara Hatsue
Published: May 2023

Marjorie M Whiteman (1898–1996) served at the United States Department of State from 1929 to 1970. During her tenure, she served ten Secretaries of State. Her original specialization was ‘damage in international law’, yet her participation in the League of Nations Codification Conference of 1930 broadened her expertise in international legislation. In 1946, First Lady Eleanor Roosevelt asked Whiteman to assist in the drafting of the UN Declaration of Human Rights. Her major accomplishment lay in the first United Nations Conference on the Laws of the Sea in 1958. At the 1958 Conference, her role was paramount in negotiating and reaching an agreement on the Convention on the Continental Shelf. In addition to the practical contribution to the development of international legislation, Whiteman edited fifteen volumes of Digest of International Law, acclaimed as a monumental work indispensable for international lawyers. In 1985 the American Society of International Law awarded her the Manley O Hudson medal, the first American woman that received such an honor.
The Grounds of Political Legitimacy
Authors: Peter Fabienne
Published: May 2023

Political decisions have the potential to greatly impact our lives. Think of decisions in relation to abortion or climate change, for example. This makes political legitimacy an important normative concern. But what makes political decisions legitimate? Are they legitimate in virtue of having support from the citizens? This is what democratic conceptions of political legitimacy maintain. And they are right to highlight that legitimate political decision-making must respect disagreements among the citizens. But what if democratic decisions fail to track what there is most reason to do? For example, what if a democratically elected government fails to take measures necessary to protect its population from threats related to climate change? In this book, I defend a hybrid conception of political legitimacy. I argue that political legitimacy doesn’t just depend on respect for the political will. It also depends on responding to evidence for what there is most reason to do.
Translation and Mystification: Wilkins
Authors: Figueira Dorothy M.
Published: May 2023

This chapter looks at the Gītā’s discovery in the West in its first English translation by Charles Wilkins (1785) and the commentary and analysis of this translation by his colonial sponsor, Warren Hastings. This early stage of conceptualization and contextualization is sketchy. However, Wilkins and Hastings present a cogent expression of the Indian Other to be studied in order to improve Europe’s cultural present and delimit British national identity. They valorize the act of translation itself and show the usefulness of translating from Sanskrit for Britain to better rule its subjects. Translation becomes part and parcel of empire building. Wilkins was very concerned with the issue of fidelity and recognized the challenge posed by the Gītā’s foreignness (mystery). He also raised the issue of the criteria needed to translate from Sanskrit into another language, particularly a Western idiom. This chapter shows the limitations of much postcolonial theory in not acknowledging the aesthetic and religious concerns raised in even this initial colonialist literary encounter. The exoticism of the Gītā, a concern raised by its initial translator, will continue to haunt subsequent readers and translators and necessitate the formulation of strategies for dealing with this text effectively.
Disability Through the Lens of Justice
Authors: Begon Jessica
Published: May 2023

When thinking about disability in the context of justice, our focus should not be on the ways in which people’s bodies and minds function differently. Instead, we should shift our focus to the limitations that this leads to—for particular people, in particular contexts. And, at least from the perspective of justice, only a subset of these limitations matter. Specifically, those that prevent individuals from having control in certain domains of their life, by restricting the availability of acceptable options or the ability to choose between them. Our theory of justice should be concerned with the lives individuals can lead, and not with whether their bodies and minds function typically. What matters is that people can be mobile, form relationships, engage in leisure, and so on—not how they achieve these things. The problem that disability raises is not the mere fact of difference, but the ways in which that difference is accommodated (or not) and the limitations it may cause. Indeed, on my definition of disability, to be disabled just is to be unable to exercise the control over our life that everyone should be able to. Our focus, then, should not be on whether someone has received a particular diagnosis, or on the most visible deviations from what we take to be the species norm, but on whether people have access to central capabilities. Achieving justice does not require ‘normalisation’, or the elimination of difference, but enabling all individuals to control their lives as they choose.
Disability and Distribution
Authors: Begon Jessica
Published: May 2023

Reflection on disability can contribute to an argument in favour of adopting a capability approach to distributive justice. Here I delineate the core features of such an approach. Indeed, insofar as disability has been considered in the context of distributive justice it is usually by proponents of the capability approach. However, capabilities are commonly understood as components of well-being, meaning that individuals are entitled to those capabilities that will make them better-off. If incorporated into my justice-based account of disability this would entail that individuals are disabled whenever their impairments contribute to an opportunity loss that reduces well-being. This is implausible both as an account of justice and of disability, since it will justify extensive intervention, pushing us towards normalising—even perfecting—human functioning capability. Thus, I argue entitlements must be distinguished from well-being, where the former is narrower than the latter.
Communication and Transformation of Music Theory
Authors: Blum Stephen
Published: May 2023

As musicians reflected on how to communicate musical knowledge, they developed models of social relationships intended to meet the needs of those involved, and this remains a major concern. The models may be explicit to some extent or wholly implicit. Numerous ethnomusicologists have gained invaluable experience as disciples or apprentices of master musicians whose teaching takes advantage of complementarities among speech, writing, gesture, movement patterns, and performance of illustrations. All of these media are conducive to theorizing as well as to pedagogy. Through their relationships with other musicians, researchers and educators, ethnomusicologists become aware of weaknesses in theories and pedagogies and may seek to develop alternatives. One serious weakness is insufficient attention to aural learning and techniques of the body.
Concepts, Models, and Metaphors
Authors: Blum Stephen
Published: May 2023

Ethnomusicological studies of music theory are necessarily concerned with relationships of names and terms to concepts. It is important not to lose sight of significant differences when assessing commonalities in usages of words from diverse languages whose meanings overlap to some extent. Lexicographic studies of pertinent terminology in all major language groups are crucial if musicology is ever to become an international rather than a Eurocentric discipline. European and North American projects of colonialism and imperialism fostered an internationalization of music-theoretical terms (e.g., mode, composition, improvisation) as they were applied to activities and resources to which they were not always well suited. Models of relationships among terms are potentially helpful in translating terms of one musical practice into those of another and in identifying variables among the interrelated terms used in a given musical practice (often in two or more languages). Empirical research has allowed ethnomusicologists to correct erroneous representations of realities to which prominent terms refer.
An Infidel among Believers
Authors: Molteno Marion
Published: May 2023

Russell describes how and why he became an atheist at 15, his attitudes now best described as ‘humanist’. He has spent most of his life in the company of religious believers, and particularly—as a scholar of Urdu—Muslims. He makes clear his respect for sincere and thoughtful believers like Raza Ansari of Firangi Mahal and how much he has gained from being involved with people of different cultures. He looks for common ground with whoever he meets, and attaches more importance to this than to differences. Mutual respect goes together with frankness but he feels it is important not to shy away from challenging harmful practices. He examines the stances taken up by various groups of Muslims against Rushdie after Khomeini’s fatwa condemning him to death for writing Satanic Verses; and argues that Muslims should be as active in exposing abuses within Muslim communities.
Irrigation Water Source Matters: Saline Groundwater Irrigation Lowers Date Palm Root-Associated Fungal Richness and Alters Their Community Structural Patterns
Authors: Chandran Subha , Sanka Loganathachetti Dinesh , Masmoudi Khaled , Iratni Rabah , Mundra Sunil
Published: May 2023

Saline groundwater irrigation is commonly used in arid regions of the Middle East and North Africa for date palm ( Phoenix dactylifera) cultivation, yet little is known about its impact on communities of root-associated fungi (RAF). We investigated the impact of irrigation water sources (freshwater versus saline groundwater) on date palm RAF diversity, communities, and their assembly processes. RAF richness was lower in roots under saline groundwater irrigation and was significantly related to soil and water electrical conductivity (EC), and only 25.3% of the total operational taxonomic units (OTUs) were strictly found in roots under saline groundwater irrigation. Overall, the RAF communities were distinct among irrigation water sources, wherein water pH and EC were the major structuring factors. The relative importance of drift assembly was higher for RAF distribution under saline groundwater irrigation. Saprotrophic and pathotrophic communities were also distinct between irrigation water sources and shaped by irrigation water pH. In addition, we found higher abundance of saprotrophic OTUs Acrocalymma vagum, Coprinopsis sp., and Myrothecium sp. in roots under saline groundwater irrigation. In summary, we show that saline groundwater irrigation lowers RAF richness and alters overall and guild level RAF communities (saprotroph and pathotroph), which assemble mainly through drift process, wherein overall communities are shaped by irrigation water pH and EC, while saprotrophic and pathotrophic communities are structured by water pH. The high abundance of specific saprotrophs under saline groundwater irrigation indicates their potential role in nutrient cycling and plant growth promotion in arid agroecosystems.
Acute Vulvar Aphthous (Lipschütz) Ulcer After COVID-19 Vaccine: Two Cases [ID: 1337743]
Authors: Fassett Karena , Combs Shanna
Published: May 2023

INTRODUCTION:

Vulvar aphthous ulcers are uncommon, non-sexually transmitted genital lesions that typically arise in adolescents and young women after viral infection. The pathogenesis of this condition is poorly understood but is thought to arise from an immune-mediated process. More recently, there have been several reports of vulvar aphthosis after COVID-19 infection, and to date, we have identified five case reports describing the development of this condition within days of receiving one of the existing U.S. Food and Drug Administration-approved mRNA COVID-19 vaccines.

METHODS:

We present the cases of two adolescents, aged 13 and 16 years, who both developed acute genital aphthous ulcers within days of their second Pfizer-BioNTech COVID-19 vaccinations with no other apparent triggers.

CONCLUSION:

These two cases represent a growing number of patients who have developed acute genital ulceration (AGU) in close temporal proximity to COVID-19 vaccination, which represents a potential novel etiology for this uncommon condition. If vaccination is indeed a trigger for AGU, this may support an immune-mediated pathogenesis, although future studies are needed to explore this further. The continued publication of high-quality case reports describing AGU will allow us to gather enough data to make statistical inferences and to raise awareness for this condition, which is underrecognized and often misdiagnosed by providers.
Does Weaning of Buprenorphine in Pregnancy (in Outpatient Setting) Improve Neonatal and Maternal Outcome? [ID: 1369357]
Authors: Shah Darshan , Chroust Alyson , Olsen Martin
Published: May 2023

INTRODUCTION:

Treatment of opioid use disorder (OUD) in pregnancy is challenging. There are reports of successful weaning in OUD in pregnancy, even though professional bodies maintain the recommendation of nonweaning during pregnancy.

METHODS:

It was a prospective, nonintervention study after the local IRB's approval. We have a university group of obstetrician providers who will wean buprenorphine during pregnancy after contracting with pregnant women while providing counseling and social services. Many women choose to wean, while many continue not to wean and get their obstetric care at university but their substance use disorder care at other medical-assisted treatment centers. Women in the weaning group consented at the prenatal clinic, while the nonweaning group consented to the study at the hospital when they presented for the delivery. Women were given questionnaires in the postpartum period for the Edinburg Postnatal Depression Scale (EPDS), and the Perceived Stress Scale (PSS). Demographics for mothers and neonates were extracted from medical records.

RESULTS:

There were 34 pregnant women in the weaning group, with 13 women in the nonweaning group. Polysubstance use and low-birth-weight infant were excluded from neonatal outcome measures for the length of neonatal stay in hospital analysis for obvious reasons. The mean buprenorphine dose in the weaning group was significantly lower (1.9 versus 11.7 [mean] with P<.0001 [T test]). Also, the length of neonatal stay was significantly lower (4.9 versus 7.2, P<.05) and a trend towards higher birth weight (3,137 versus 3,018 g) and decreasing morphine requirement (62 versus 249 doses) in weaning group. PSS and EPDS scores did not show statistically significant differences with lower scores in the weaning group.

CONCLUSION:

Our results show that weaning of buprenorphine in OUD women during pregnancy in an outpatient setting is possible and improves outcomes for neonates and mothers.
Uterine and Ovarian Histopathology in Transmasculine and Nonbinary Patients on Testosterone Compared to Cisgender Control Patients [ID: 1381367]
Authors: Toland Maris , Bentz Jessica , Bonasia Kyra , Damiano Ella , DelBaugh Regina , Gerjevic Kristen
Published: May 2023

INTRODUCTION:

Hormonal treatment is a critical aspect of health care for transgender and nonbinary patients, but scientific literature describing ovarian and uterine histopathology in the setting of testosterone therapy remains limited and conflicted.

METHODS:

After IRB approval and patient consent, uterine and ovarian histopathology was prospectively evaluated in 22 gender-diverse patients on testosterone compared with 21 premenopausal cisgender controls not on hormones undergoing hysterectomy.

RESULTS:

Average duration of testosterone administration was 54.9 months. Average age was 30 years in the testosterone group and 40.6 years in the control group. Average body mass index was 28 kg/m2 in the testosterone group and 31 kg/m2 in the control group. 18 (82%) patients in the testosterone group had inactive/atrophic endometria, compared with 2 (10%) in the control group. 4 (18%) patients in the testosterone group had proliferative endometria, compared to 10 (48%) in the control group. No patients on testosterone had secretory endometrium, compared to 6 (29%) in the control group. Leiomyoma were noted for 5 (23%) in the testosterone group and 4 (19%) in the control group. Adenomyosis was present in 1 (5%) in the testosterone group, compared to 5 (24%) in the control group. Low rates of preoperative cervical dysplasia were reported in both groups. All cervical and fallopian tube specimens in both groups were benign.

CONCLUSION:

Compared to a cisgender control group, patients on long-term testosterone therapy were more likely to have inactive/atrophic endometrium. Increasing our knowledge of the effects of testosterone has implications for preoperative surgical assessment and surveillance for patients not undergoing surgery.
Association of the Cervicovaginal Microbiome With Contraceptive Methods in Hispanic Women Living in Puerto Rico [ID: 1376364]
Authors: Oliveras-Alsina Nicole , Navarrete-Cortés Marilís , Romaguera Josefina , Tosado-Rodríguez Eduardo
Published: May 2023

INTRODUCTION:

Recent studies have demonstrated an association linking the cervicovaginal microbiome with susceptibility to infectious diseases and overall cervical health. We aimed to evaluate the effect of contraceptive methods used by Hispanic females living in Puerto Rico on their cervical microbiome.

METHODS:

An analysis of 85 women, aged 21–45, grouped by the contraceptive method used at time of sampling, was performed. The methods included birth control pills, intrauterine devices (IUDs), injectable progesterone, male condoms, and female sterilization. The control group did not use any contraception. Swabs collected from the posterior fornix underwent DNA extraction and sequencing of the 16S rRNA gene, being characterized for microbial diversity, and taxonomic composition. IRB approval was obtained.

RESULTS:

Women using male condoms or sterilization had the highest microbiome richness, and those using IUDs and female sterilization had the highest microbiome diversity. Birth control pills and male condoms had the least effect on the microbiota as participants had a dominance of Lactobacillus. Injectable progesterone and IUDs use were associated with increased levels of Gardnerella. The IUDs group has a noticeable presence of Clostridium when compared to other groups. The female sterilization group is copious in Atopobium and Streptococcus. The injectable progesterone group has an elevated abundance of Megasphaera.

CONCLUSION:

Preliminary analyses indicate that contraceptive methods may affect the cervicovaginal microbiome, injectable progesterone and IUDs being the methods most associated with vaginal dysbiosis. These findings allow information about the microbiome of Hispanic women living in Puerto Rico to guide further investigations that could contribute to better gynecologic care.
Levonorgestrel Emergency Contraception Availability in Louisiana Independent and Chain Pharmacies Post-Dobbs v Jackson Women’s Health Organization [ID: 1376654]
Authors: Shu Sharon , Bergeron Lauren , Juracek Kali , Sisk Charles , Williams Frank
Published: May 2023

INTRODUCTION:

Following recent legal changes, there is increased confusion regarding availability of medications for reproductive health, including emergency contraception (EC). We aimed to quantify over-the-counter (OTC) access to levonorgestrel EC in three metropolitan Louisiana parishes (counties) among chain and independent pharmacies.

METHODS:

This cross-sectional study took place during August and September 2022. Secret shoppers surveyed all retail pharmacies in Jefferson, Orleans, and Terrebonne parishes. Pharmacies were classified as independent or chain based on affiliation with supermarket or drug store chains. Odds ratios (ORs) with 95% CIs were used to compare availability of OTC EC.

RESULTS:

Among 212 retail pharmacies, 55% (n=117) were large chain pharmacies and 45% were independent stores. Only 67% (n=141) had EC in stock. Chain pharmacies were more likely to offer EC than independent pharmacies (92% versus 35%, OR 22.6, 95% CI [10.1, 50.2]). Independent pharmacies were more likely to keep OTC EC behind the counter (91% versus 11%, OR 80.0, 95% CI [21.2, 302.5]), require identification (45% versus 4%, OR 21.7, 95% CI [6.5, 72.7]), and carry no EC less than $50 (24% versus 2%, OR 17.0, 95% CI [3.4, 84.8]). Among pharmacies without EC available, no chain pharmacies described recent changes in EC stock, while 5 out of 28 (18%) respondent independent pharmacies attributed loss of EC stock to recent legislation.

CONCLUSION:

Independent pharmacies were less likely to carry OTC EC and more likely to enforce multiple barriers to purchase. Recent legislation has disproportionately further reduced EC availability at these pharmacies.
Assessing the Effect of Telemedicine Implementation on Patient Satisfaction With and Adherence to Gynecologic Appointments [ID: 1344973]
Authors: Junn Sue , Desai Andrea , Hurvitz Julie , Lahti Elizabeth
Published: May 2023

INTRODUCTION:

The COVID-19 pandemic led to a rapid increase in telemedicine visits to ensure delivery of essential health services while minimizing infection exposure. While there have been studies related to telemedicine in other specialties, there is a paucity of data assessing the effect of telemedicine visits in gynecology. The purpose of this study is to evaluate whether and how implementation of telemedicine affects patient adherence to and satisfaction with scheduled gynecologic appointments.

METHODS:

A retrospective review of 1,170 patients who participated in gynecologic telemedicine visits and 5,303 patients who participated in in-person gynecologic visits between March 1, 2020, and December 1, 2021, was performed to evaluate demographic information, chief complaint, and visit attendance. A cross-sectional survey of 1,248 patients who participated in gynecologic telemedicine visits between these dates was also performed to evaluate perceptions of satisfaction, access, quality and safety, and convenience of telemedicine. Institutional review board exempt protocol HP-00099093.

RESULTS:

The average no-show rate for gynecologic telemedicine visits was 2% compared to 22% for in-person gynecologic visits (P<.001). 33/1,249 patients responded to the survey. Sixty-nine percent (23/33) of survey respondents were satisfied with telemedicine visits.

CONCLUSION:

This study supports the continued incorporation of telemedicine into standard gynecologic practice to increase patient adherence with visits. Our gynecologic telemedicine no-show rates are significantly lower than patients’ overall no-show rates for in-person visits. These outcomes may be associated with patients’ satisfaction with telemedicine visits because of their being convenient, time saving, and less disruptive to their day.
Relugolix Combination Therapy in Women With Uterine Fibroids and Adenomyosis: LIBERTY 1 and 2 Trials [ID: 1345355]
Authors: Catherino William , Al-Hendy Ayman , Munro Malcolm , Proehl Sarah , Wu Rui , Zaim Souhil
Published: May 2023

INTRODUCTION:

Adenomyosis and uterine fibroids (UFs) may coexist in women with heavy menstrual bleeding (HMB). Relugolix combination therapy (Relugolix-CT: relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) is approved in the United States to treat HMB associated with UFs and moderate-to-severe pain associated with endometriosis. A post-hoc analysis of the pivotal, 24-week LIBERTY 1 and 2 studies evaluated the efficacy of Relugolix-CT versus placebo in the subgroup with ultrasound evidence of adenomyosis.

METHODS:

Baseline ultrasound images from women enrolled in the replicate, IRB-approved LIBERTY studies were evaluated for adenomyosis using predefined criteria. Primary endpoint: proportion of study completers with baseline adenomyosis who were HMB responders, defined as 50% or higher reduction in menstrual blood loss (MBL) volume from baseline and less than 80-mL MBL over the last 35 days. Pooled LIBERTY 1 and 2 results are presented.

RESULTS:

Of women who completed the LIBERTY studies, 111/610 (18.2%) had ultrasound evidence of adenomyosis at study entry. The prevalence of adenomyosis was similar between treatment groups (18.3% and 14.0% for Relugolix-CT and placebo, respectively). In this subgroup, 83.8% of women treated with Relugolix-CT were HMB responders versus 27.6% of women who received placebo; responders in the overall population were 72.3% and 16.8%, respectively. Additionally, 64.9% of women in this subgroup who received Relugolix-CT were amenorrheic over the last 35 days of treatment, versus 6.9% of women treated with placebo.

CONCLUSION:

Relugolix-CT effectively reduced HMB in women with UFs and adenomyosis through 24 weeks. Efficacy in this subgroup of women was generally similar to the overall study population.
Effect of Clinical Setting on Prevalence of Pregnancy of Unknown Location: A Retrospective Cohort Study [ID: 1377630]
Authors: Javlekar Ashwini , Flink-Bochacki Rachel , Piatelli Alissa , Vinner Amanda
Published: May 2023

INTRODUCTION:

Pregnancy of unknown location (PUL) is the diagnosis of a positive pregnancy test without ultrasonographic confirmation of pregnancy location. Using varying diagnostic criteria, studies from the 1980s to early 2000s estimated the prevalence of PUL diagnoses at 8–31%. With advances in ultrasound technology and increasing use of early ultrasound, we aimed to determine current prevalence of PUL and differences by clinical setting.

METHODS:

With IRB approval, we conducted a retrospective cohort study of all initial pregnancy ultrasounds less than 14 weeks performed at a single academic medical center from January 1, 2018, to December 31, 2019. Ultrasounds occurred in the outpatient perinatal ultrasound suite or inpatient radiology suite via the emergency department. We compared diagnoses by setting via chi-square tests and logistic regression using Stata SE.

RESULTS:

Of 1,775 ultrasounds, only 81 (4.6%) were PULs, while 308 (17.4%) were intrauterine pregnancies of uncertain viability (IPUV). Both types of uncertain pregnancy diagnosis were more common in the emergency department than the outpatient obstetrics and gynecology setting (PUL: 8.3% versus 2.0%, P<.001; IPUV: 23.8% versus 12.9%, P<.001). Patients with symptoms of cramping or vaginal bleeding were more likely to have uncertain diagnoses (33.1% versus 16.8%, P<.001); however, presence of symptoms was not independently associated with uncertain diagnosis after controlling for setting.

CONCLUSION:

Diagnoses of PUL have declined, largely replaced by diagnoses of IPUV. Differences in diagnosis prevalence unexplained by patient symptoms support existing evidence of disparate early pregnancy experiences between the outpatient and emergency settings. As over one-fifth of patients will have an uncertain pregnancy diagnosis on initial ultrasound, safe, efficient, and patient-centered follow-up protocols are crucial.
Disparities and Patterns of Pain Management, Pharmacologic Therapies, and Surgical Treatments for Leiomyomas in the 2017–2019 National Survey of Family Growth [ID: 1380252]
Authors: Rennie Christopher , Andelija Sanela , Prol Barbara
Published: May 2023

INTRODUCTION:

Leiomyomas affect most women throughout their lifetime with an incidence of roughly 80%. Approximately 30% of these women develop symptomology that warrants intervention. With such a large prevalence, it is important to highlight patterns in treatment modalities to guide effective management for all women with this condition.

METHODS:

We utilized weighted survey results from the Centers for Disease Control and Prevention’s 2017–2019 National Survey of Family Growth. After isolating data to those who reported a leiomyoma diagnosis, we performed a test of equal proportions (P<.05) among the nine listed therapies compared to the following socioeconomic factors: race, age, education, and insurance status.

RESULTS:

The incidence of leiomyomas was 7.3% (449/6,141). Hispanic women and those with state-sponsored or uninsured status were more likely to report receiving none of the listed treatments (P=.05 and .02). Women who marked “Other” were most likely to seek alternative medicine (P=.03). Hysterectomy was most likely for Black, White, and 40- to 49-year-old women (P=.02 and P<.001). Nonhysterectomy procedures were most seen with government-sponsored health care, private insurance, and women with graduate degrees (P<.001 and P=.02). Pharmacologically, White women were more likely to receive progesterone-releasing intrauterine devices (P=.02), women 19–29 were more likely to use hormonal medicine (P<.001), and those with government insurance were more likely to receive narcotics (P=.006).

CONCLUSION:

All socioeconomic factors held significant inconsistencies in the utilization of various leiomyoma treatments. As this condition will affect most women, this analysis highlights the need for future standardization to ensure optimal treatment implementation and patient outcomes.
Emergency Department Readmission for Early Pregnancy Concerns Among Patients Who Speak Spanish [ID: 1366721]
Authors: Taper Gabrielle , Alvarez Miriam , Thaxton Lauren , Tristan Sigrid
Published: May 2023

INTRODUCTION:

The purpose of this study was to compare readmission rates for early pregnancy concerns in the emergency department (ED) among patients that speak English versus Spanish as their primary language.

METHODS:

From January 1, 2020 to June 1, 2021, we conducted a chart review to identify pregnant patients presenting to the ED using ICD-10 codes for pregnancy and first-trimester diagnoses (n=383). Charts were excluded if pregnancy was beyond 13 weeks or an ultrasound-confirmed ectopic pregnancy. Readmission was a separate ED encounter during the first trimester of that same pregnancy. Preventable readmission was one that could have been prevented if the patient had received correct counseling, diagnosis, or management at the index admission. Our primary outcome was frequency of ED readmission among English versus Spanish speakers. This protocol was approved for IRB exemption by the University of Texas.

RESULTS:

Threatened abortion was the most common diagnosis among both groups. Readmissions were more frequent among Spanish speakers (40% versus 26% [P=.01]). Preventable readmissions were more common among Spanish speakers (31% versus 25%). The majority of preventable readmissions (81%) among Spanish speakers could have been prevented if correct management was offered, compared to 25% in English speakers (P=.03).

CONCLUSION:

Spanish and English speakers present with similar types of early pregnancy concerns, but Spanish speakers are not offered management of early pregnancy concerns at the same frequency. Standardization of care for early pregnancy concerns in the ED may help reduce language-based disparities in quality and equity of care.
Black Race and Racism Affect Likelihood of Undergoing Surgery After Referral to a Minimally Invasive Gynecologic Surgeon [ID: 1377814]
Authors: DeGaia Ayana , Louie Michelle , McClurg Asha , Silverstein Gina
Published: May 2023

INTRODUCTION:

Significant racial and ethnic disparities persist in access and outcomes for patients with benign gynecologic disorders. The role of sociodemographic factors in surgical delays after referral to a minimally invasive gynecologic surgery (MIGS) specialist is unknown.

METHODS:

A retrospective cohort study of patients who completed a MIGS consultation at a single, large academic hospital between March 2015 and July 2016 (n=1,110) was performed. Logistic regression was used to assess effect of age, self-reported race and ethnicity, primary language, and insurance type on likelihood of surgical intervention within 12 months of consultation.

RESULTS:

Of patients undergoing surgery, the average wait time after consultation was 86 days (SD 69). Black patients had 2.6 times the odds of having surgery within 12 months of consultation (odds ratio [OR] 2.6, 95% CI 1.96–3.47) compared to White patients. Patients with Medicare had lower odds of completing surgery (OR 0.4, 95% CI 0.21–0.72) compared to those with other insurance or no insurance. Age, ethnicity, and primary language were not found to be correlated with surgical intervention.

CONCLUSION:

Race was found to be independently associated with likelihood of surgical intervention. Black patients in our study had more than twice the odds of having surgery compared to White patients, irrespective of age, ethnicity, primary language, or insurance. This may be due to more advanced disease at time of presentation secondary to care delays as well as surgeon bias in more readily pursuing surgery for Black patients, both of which stem from racism.