bluuebunny/crossref_metadata_2025 huggingface dataset:
Visual Experience
Authors: Sundström Pär
Published: July 2020

A visual experience, as understood here, is a sensory event that is conscious, or like something to undergo. This chapter focuses on three issues concerning such experiences. The first issue is the so-called ‘transparency’ of experiences. The chapter distinguishes a number of different interpretations of the suggestion that visual experiences are ‘transparent’. It then discusses in what sense, if any, visual experiences are ‘transparent’, and what further conclusions one can draw from that. The second issue is which properties we are presented with in visual experiences. It is widely accepted that we sometimes experience red for example. But exactly which properties do we sometimes visually experience, and which properties do we never visually experience? The third issue is which particulars, if any, we are presented with in visual experiences. Do we, for example, sometimes visually experience mind-independent particulars like trees? Do we sometimes visually experience mind-dependent, particular ‘sense-data’?
Consciousness and Intentionality
Authors: Mendelovici Angela , Bourget David
Published: July 2020

Philosophers traditionally recognize two key features of mental states: intentionality and phenomenal consciousness. To a first approximation, intentionality is the ‘aboutness’ of mental states, and phenomenal consciousness is the felt, experiential, qualitative, or ‘what it’s like’ aspect of mental states. In the past few decades, these features have been widely assumed to be distinct and independent. But several philosophers have recently challenged this assumption, arguing that intentionality and consciousness are importantly related. This chapter overviews the key views on the relationship between consciousness and intentionality and describes our favored view, which is a version of the phenomenal intentionality theory, the view that the most fundamental kind of intentionality arises from phenomenal consciousness.
Consciousness and Morality
Authors: Shepherd Joshua , Levy Neil
Published: July 2020

This chapter considers three connections between consciousness and issues in ethics: first, the relevance of consciousness for questions surrounding an entity’s moral status; second, the relevance of consciousness for questions surrounding moral responsibility for action; and third, the relevance of consciousness for the acquisition of moral knowledge. This is a disparate set of connections, prompting a question: is there anything about consciousness these connections have in common? One might expect the answer to be no. But debate in each area has thus far failed to settle just what about consciousness is so intuitively important for moral status, moral responsibility, and moral knowledge. Given this fact, it remains possible that there is some common connection of these different issues in ethics to consciousness. The chapter takes up this possibility in its conclusion.
Introduction
Authors: Kriegel Uriah
Published: July 2020

Consciousness is one of the most elusive phenomena of the natural world. But it is, after all, part of the natural world. It has presumably evolved at some point, as a result of certain natural processes taking place within the causally integrated spatiotemporal system we call Nature. What need is there, then, for a philosophy of consciousness? As a natural phenomenon, should it not submit to theoretical explanation by the natural sciences? What do philosophers have to contribute here? The assumption behind the present volume is that philosophy may have a more significant role to play in shaping our understanding of consciousness; that even a complete science of consciousness may involve certain lacunae calling for philosophical supplementation. The plausibility of this notion depends in part on what one calls ‘a science.’ To bracket verbal issues, we will concern ourselves here with three areas in which the science of consciousness as pursued today leaves certain questions unaddressed. The Introduction’s three sections introduce and discuss these three areas; each serves as a motivating introduction to one of the volume’s three parts.
Conscious Thought
Authors: Bayne Tim
Published: July 2020

Conscious thought has been neglected, but it has not been entirely overlooked. Discussion of the topic has focused on three sets of questions. The first set of questions focuses on the kinds of states (events, episodes) that qualify as forms of conscious thought. What might a taxonomy of conscious thought look like? A second set of questions concerns the kind(s) of consciousness that characterizes thought. Are thoughts conscious in the same fundamental way that other mental phenomena are, or is ‘cognitive consciousness’—that is, the consciousness associated with thought—sui generis? A third set of questions concerns the relationship between consciousness and thought. Is consciousness essential to thought, or is it an accidental and contingent feature of thought—a feature that some thoughts possess but others lack? This chapter provides an opinionated point of entry into these and other questions.
The Struggle for Sexual Minority Rights in Zimbabwe in Context
Authors: Epprecht Marc , Clark Bev
Published: July 2020

This chapter examines the history of sexual minority rights activism in Zimbabwe in its wider context. It situates advocacy over sexual minority rights in the context of broader struggles for gender equality and the women’s movement in Zimbabwe, as well as in relation to the instrumental deployment of homophobia and homonationalism by African political and religious leaders. This latter has been part of the process of constructing a new hegemony in post-colonial and post-apartheid southern Africa. The chapter first provides an overview of the coming out by Zimbabwean sexual minorities and the reactions against this within society and by the state. We discuss the factors that have enabled GALZ and other sexual minority activists to survive for nearly three decades against compelling odds, and what this may mean for the struggle for gender equality in the future.
The Making of a System of Partisan Authority on Commercial Farmlands in Post-2000 Zimbabwe
Authors: Chamunogwa Arnold
Published: July 2020

This chapter illustrates how powerful ruling parties can sidestep strong state institutions by pursuing and enforcing their political and developmental agendas through ‘twilight institutions’ operating on the state’s margins. It discusses the rapid displacement and remaking of power and authority on white-owned commercial farms in Zimbabwe, following the spectacular upheavals of the Fast Track Land Reform Programme (FTLRP) in 2000. The chapter specifically explains how local ZANU-PF structures together with their allies—war veterans, youth militias, and others—constructed and established a new system of partisan authority that became the dominant mode of governing commercial farming areas from 2000 to 2002. These actors sought to use the system of partisan authority to recreate the terms of existence on occupied farms, to govern and regulate political conduct, and to control access to land and related resources.The chapter also brings into consideration farm occupiers’ experiences, responses, and adaptations of the system of partisan authority, an aspect neglected in the wider literature on FTLRP, which presents farm occupiers as accomplices and allies of ZANU-PF. Specifically, it illustrates how social categorizations and hierarchical ordering on occupied farms enabled ordinary occupiers to contest claims to authority and resources by local ZANU-PF structures, war veterans, and youth militias under the system of partisan authority.
Paul the Letter Writer
Authors: Dingeldein Laura
Published: July 2020

This essay focuses on the social functions of Paul’s letter writing activities, with the purpose of helping to situate such activities within the landscape of ancient Mediterranean epistolography and religion. After briefly identifying major areas of interest in recent research on Paul’s letter writing activities, the author examines the ways in which Paul’s epistolary practices advanced his goals in social positioning, community building, and virtue cultivation among Christ recruits. Letters were understood within classical antiquity to facilitate conversations among friends, reveal a writer’s character, and provide clear and concise instruction on a given subject. Letter writing also often contributed to the social capital of a letter’s author, insofar as letter writing displayed skills in literacy and textual production. Each of these epistolary functions would have advanced Paul’s goals regarding social positioning, community building, and moral development, thus making letters the ideal written medium for Paul to use in his apostolic activities.
Paul and Economic Resources
Authors: Longenecker Bruce W.
Published: July 2020

This essay surveys some prominent economic features of the Roman world (e.g., benefaction, patronage, status-capture, and elite allegiance to Rome) and situates the realities of structural poverty within that context. It then underscores some of the economic commitments and strategies that Paul envisioned for Jesus-groups he had founded, noting how the responsible use of economic resources was deeply rooted in his theological programme.
Social-Scientific Approaches to Paul
Authors: Still Todd D.
Published: July 2020

This chapter considers how Pauline interpreters have used and are using the social sciences to study the apostle and his letters. Before turning to the social-scientific study of Paul in particular, the advent and initial growth of the social-scientific study of the New Testament in general is considered. A treatment of prominent pioneers in and primary approaches to the social-scientific study of Paul comprises the majority of this essay, which concludes with a treatment of the identifiable developments both within and alongside the discipline.
Paul and Pistis Christou
Authors: Gupta Nijay K.
Published: July 2020

An enduring discussion in Pauline studies is the so-called pistis Christou debate. This involves the half-dozen cases in the undisputed Pauline letters where this genitive phrase appears and it is unclear whether the phrase should be read ‘faith in Christ’ or ‘the faithfulness of Christ’. Over the past several decades, numerous books, articles, and essays have engaged vigorously on this issue; more than Greek syntax and proper translation appears to be at stake. This debate involves important questions related to Paul’s understanding of the means and manner of justification with God. How important is human faith and agency in Paul’s theology? To what degree does Paul present Christ not only as saving agent of God’s righteousness but also a model of faithfulness? What exactly does Paul mean when he refers to pistis?
Paul the Apostle
Authors: Alexander Loveday
Published: July 2020

The question of church order—specifically, of the relationship between Paul the apostle and the churches he founded, and of the patterns of authority and leadership that emerge from his letters—is an essential component in our understanding of Paul: unexamined assumptions about leadership and authority colour our reading of his letters in profound ways. This chapter argues that the letters presuppose a distinctive leadership structure that is built on (a) dispersed authority: leadership is found both locally (elders) and translocally (apostles); and (b) displaced authority: both local and apostolic leadership are directly authorized by and accountable to God. This creates a strong relational network which the letters themselves reinforce and sustain.
Archaeology and the Pauline Letters
Authors: Concannon Cavan
Published: July 2020

Archaeological materials and research have long informed the study of the Pauline letters. These materials have typically been used to provide a ‘background’ to Paul’s writings, to solve interpretive problems, or to ‘prove’ the veracity of a detail in Paul’s biography, as recorded in canonical Pauline literary sources. This chapter looks at the history of how archaeological research has been used to interpret the Pauline letters and the methodological issues that such interdisciplinary conversations touch upon. It pays particular attention to the perils and the promise of bringing archaeological research into conversation with Pauline studies. It then turns to explore case studies of interdisciplinary research by scholars of early Christianity on four cities connected to the Pauline letters: Thessaloniki, Philippi, Ephesos, and Corinth. These projects point to promising avenues forward for how Pauline studies might engage archaeological work. (N.B. This article is a distilled, adapted, and updated version of Concannon 2013.)
Paul and the Construction of Early Christian Identity
Authors: Zetterholm Magnus
Published: July 2020

E. P. Sanders’ reconstruction of ancient Judaism resulted in an increasing interest in Paul’s relation to Judaism. While scholars before Sanders commonly assumed that Paul converted to Christianity and thus developed a religious identity separate from Judaism, Sanders’ view of Judaism as a religion of grace forced scholars to problematize Paul’s relation to his religious identity. Three major scholarly trends can be distinguished. Some scholars maintain, in spite of Sanders, that Paul rejected Judaism and developed a ‘Christian’ identity of sorts. Others take an intermediate position, arguing that Paul only repudiated those parts of Jewish tradition that separated Jews from non-Jews while otherwise being basically faithful to his religious heritage. Finally and most recently, still other scholars argue that Paul remained fully Jewish after becoming a follower of Jesus and that, consequently, he never developed a religious identity separated from Judaism.
Paul the Philosopher
Authors: Engberg-Pedersen Troels
Published: July 2020

This essay first situates Paul as a philosopher, or a writer who ‘philosophizes’, within the major developments of Pauline scholarship since 1977. Three trends have led away from a ‘philosophical’ Paul, emphasizing either the ‘inconsistent’ Paul, a ‘social historical’ and ‘cultural anthropological’ Paul, or his Jewishness (either the ‘new perspective’ on Paul or, much more strongly, the ‘radical’ Paul). Three other trends have been more congenial to a ‘philosophical’ Paul by analysing the rhetoric of Paul’s letter writing, the paraenesis of the letters, or directly his affinities with Graeco-Roman philosophy. Neither trend, it is claimed, must be played out against one another. Next, the essay defines a set of criteria for finding ‘philosophy’ in Paul. Finally, it is shown how a number of central Pauline texts fulfil these criteria. Here the topics are three: how Christ believers should live in the present, how they will live in the future, and how Paul himself has entered the world of Christ faith. Two features are further noted that are distinctly characteristic of Paul’s ‘philosophizing’: the anchorage in what God has done to the world at large and what he has done to Paul himself. But these do not suddenly imply that Paul is not doing philosophy.
Newton’s Mathematics
Authors: Malet Antoni
Published: July 2020

This article introduces a number of critical features of Newton’s mathematics with specific reference to his views on controversial contemporary topics, including mathematical notations, infinitesimals, and the relationship between geometry and algebra. It pays attention to Newton’s lengthy discussion of the solution of the “inverse problem” by transformation of areas, its partial publication in De Quadratura curvarum (1704), and the Continental influence this treatise exerted. The substantial gap between Newton’s unpublished contributions and the published record is introduced as essential background for the priority quarrel and for the reception of Newton’s calculus generally. The paper argues that Newton’s uncommon (for the period) views on algebra and his cavalier attitude towards symbolization were major factors in shaping Newton’s fluxional calculus at variance with Leibnizian infinitesimal calculus.
Social protection response to the COVID-19 crisis: options for developing countries
Authors: Gerard François , Imbert Clément , Orkin Kate
Published: July 2020

The public health response to COVID-19 in many countries has involved strict restrictions on movement and economic activity which threaten the livelihoods of economically vulnerable households. In response, governments are adopting emergency economic measures to provide households with some safety net. We provide an overview of the policies that could form a comprehensive social protection strategy in low-income and middle-income countries, with examples of specific policies that have been adopted. Our core argument is that these countries can cast an emergency safety net with extensive coverage if they use a broader patchwork of solutions than higher-income countries. These strategies could include expanding their social insurance system, building on existing social assistance programmes, and involving local governments and non-state institutions to identify and assist vulnerable groups who are otherwise harder to reach.
Aspartate Residues in a Forisome-Forming SEO Protein Are Critical for Protein Body Assembly and Ca2+ Responsiveness
Authors: Liu Yan , Peters Winfried S , Froelich Daniel R , Howell Alexander H , Mooney Sutton , Evans James E , Hellmann Hanjo A , Knoblauch Michael
Published: July 2020

Forisomes are protein bodies known exclusively from sieve elements of legumes. Forisomes contribute to the regulation of phloem transport due to their unique Ca2+-controlled, reversible swelling. The assembly of forisomes from sieve element occlusion (SEO) protein monomers in developing sieve elements and the mechanism(s) of Ca2+-dependent forisome contractility are poorly understood because the amino acid sequences of SEO proteins lack conventional protein–protein interaction and Ca2+-binding motifs. We selected amino acids potentially responsible for forisome-specific functions by analyzing SEO protein sequences in comparison to those of the widely distributed SEO-related (SEOR), or SEOR proteins. SEOR proteins resemble SEO proteins closely but lack any Ca2+ responsiveness. We exchanged identified candidate residues by directed mutagenesis of the Medicago truncatula SEO1 gene, expressed the mutated genes in yeast (Saccharomyces cerevisiae) and studied the structural and functional phenotypes of the forisome-like bodies that formed in the transgenic cells. We identified three aspartate residues critical for Ca2+ responsiveness and two more that were required for forisome-like bodies to assemble. The phenotypes observed further suggested that Ca2+-controlled and pH-inducible swelling effects in forisome-like bodies proceeded by different yet interacting mechanisms. Finally, we observed a previously unknown surface striation in native forisomes and in recombinant forisome-like bodies that could serve as an indicator of successful forisome assembly. To conclude, this study defines a promising path to the elucidation of the so-far elusive molecular mechanisms of forisome assembly and Ca2+-dependent contractility.
Distinct oxygen environments shape picoeukaryote assemblages thriving oxygen minimum zone waters off central Chile
Authors: De la Iglesia Rodrigo , Echenique-Subiabre Isidora , Rodríguez-Marconi Susana , Espinoza Juan Pablo , von Dassow Peter , Ulloa Osvaldo , Trefault Nicole
Published: July 2020

Oxygen minimum zones (OMZs) support ocean biogeochemical cycles of global importance. The OMZ off central Chile is characterized by seasonally variable oxygen concentrations due to upwelling events. Bacterial and archaeal communities from this area have been previously described; however, picoeukaryote communities remain largely unexplored. In order to improve our knowledge on picoeukaryote ecology and the effect of controlling factors on its community structure, environmental parameters and 18S rRNA metabarcoding analyses were performed in water samples collected at several depths at a time series station on the continental shelf in March, May and August. Our results showed that oxygen, nitrate, silicate and temperature are relevant factors shaping the picoeukaryote community structure. Overall, according to our sequence dataset, the OMZ was dominated by Dinophyceae members including marine parasitic dinoflagellates. Moreover, dysoxic and suboxic conditions were enriched by fungi and phagotrophic protists from Ustilaginomycetes, Bicoecea and Choanoflagellatea. The latter is particularly relevant in the understanding of metazoan evolution and the origins of multicellularity in low-oxygen environments. Picoeukaryote communities changed significantly over the 3 months sampled with variations in water column stratification, including the occurrence of a winter bloom of Mamiellales. Altogether, this study reveals a great diversity and dynamics of picoeukaryotes inhabiting a coastal OMZ.
Pregnancy outcome in systemic lupus erythematosus patients: a monocentric cohort analysis
Authors: Ceccarelli Fulvia , Pirone Carmelo , Perricone Carlo , Selntigia Aikaterina , Orefice Valeria , Pacucci Viviana Antonella , Truglia Simona , Spinelli Francesca Romana , Galoppi Paola , Alessandri Cristiano , Valesini Guido , Brunelli Roberto , Perrone Giuseppina , Conti Fabrizio
Published: July 2020

Objective

SLE is an autoimmune disease, mainly affecting women of childbearing age, with possible impact on pregnancy. In this study, we evaluated pregnancy outcomes in all pregnant patients affected by SLE, followed in the context of a rheumatology/gynaecology multi-disciplinary team.

Methods

Since 2008, we evaluated 70 consecutive pregnancies occurring in 50 SLE patients referring to the Lupus Clinic of Sapienza University of Rome; as controls we evaluated 100 consecutive pregnancies in 100 women without autoimmune diseases.

Results

By comparing SLE patients and controls, we did not find differences in terms of pregnancy outcomes, except for the occurrence of small for gestational age, which was significantly higher in the SLE group (22.8% vs 11%, P =0.003). Small for gestational age was associated with the positivity for anti-dsDNA, anti-Sm and anti-RNP (P =0.009, P =0.02, P =0.002, respectively). A disease flare was reported in 28 pregnancies (40%) and in 31 puerperium periods (44.3%). Flare during pregnancy was associated with anti-SSA (P =0.02), while puerperium relapse with previous MMF treatment (P =0.01) and haematological flare during pregnancy (P =0.03).

Conclusion

The present study confirms how pre-gestational counselling and a multi-disciplinary approach could result in positive pregnancy outcomes for SLE patients. The high percentage of disease relapse justifies even more the need for multi-disciplinary management.
Abnormal Auditory Processing and Underlying Structural Changes in 22q11.2 Deletion Syndrome
Authors: Cantonas Lucia-Manuela , Mancini Valentina , Rihs Tonia A , Rochas Vincent , Schneider Maude , Eliez Stephan , Michel Christoph M
Published: July 2020

The 22q11.2 deletion syndrome (22q11.2 DS), one of the highest genetic risk for the development of schizophrenia, offers a unique opportunity to understand neurobiological and functional changes preceding the onset of the psychotic illness. Reduced auditory mismatch negativity response (MMN) has been proposed as a promising index of abnormal sensory processing and brain pathology in schizophrenia. However, the link between the MMN response and its underlying cerebral mechanisms in 22q11.2 DS remains unexamined. We measured auditory-evoked potentials to frequency deviant stimuli with high-density electroencephalogram and volumetric estimates of cortical and thalamic auditory areas with structural T1-weighted magnetic resonance imaging in a sample of 130 individuals, 70 with 22q11.2 DS and 60 age-matched typically developing (TD) individuals. Compared to TD group, the 22q11.2 deletion carriers reveal reduced MMN response and significant changes in topographical maps and decreased gray matter volumes of cortical and subcortical auditory areas, however, without any correlations between MMN alteration and structural changes. Furthermore, exploratory research on the presence of hallucinations (H+\H−) reveals no change in MMN response in 22q11.2DS (H+ and H−) as compared to TD individuals. Nonetheless, we observe bilateral volume reduction of the superior temporal gyrus and left medial geniculate in 22q11.2DSH+ as compared to 22q11.2DSH− and TD participants. These results suggest that the mismatch response might be a promising neurophysiological marker of functional changes within the auditory pathways that might underlie elevated risk for the development of psychotic symptoms.
Comparing the Temporal Development of Wheat Spike Blast Epidemics in a Region of Bolivia Where the Disease Is Endemic
Authors: Mills Karasi B. , Salgado Jorge D. , Cruz Christian D. , Valent Barbara , Madden Laurence V. , Paul Pierce A.
Published: July 2020

Epidemics of wheat blast, caused the Triticum pathotype of Magnaporthe oryzae, were studied in the Santa Cruz del la Sierra region of Bolivia to quantify and compare the temporal dynamics of the disease under different growing conditions. Six plots of a susceptible wheat cultivar were planted at Cuatro Cañadas (CC), Okinawa 1 (OK1), and Okinawa 2 (OK2) in 2015. Spike blast incidence (INC) and severity (SEV) and leaf blast severity (LEAF) were quantified in each plot at regular intervals on a 10 × 10 grid (n = 100 clusters of spikes), beginning at head emergence (Feekes growth stage 10.5), for a total of nine assessments at CC, six at OK1, and six at OK2. Spike blast increased over time for 20 to 30 days before approaching a mean INC of 100% and a mean SEV of 60 to 75%. The logistic model was the most appropriate for describing the temporal dynamics of spike blast. The highest absolute rates of disease increase occurred earliest at OK1 and latest at OK2, and in all cases it coincided with major rain events. Estimated y0 values (initial blast intensity) were significantly (P < 0.05) higher at OK1 than at CC or OK2, whereas rL values (the logistic rate parameter) were significantly higher at OK2 than at CC or OK1. It took about 10 fewer days for SEV to reach 10, 15, or 20% at OK1 compared with OK2 and CC. Based on survival analyses, the survivor functions for time to 10, 15 and 20% SEV (ts) were significantly different between OK1 and the other locations, with the probabilities of SEV reaching the thresholds being highest at OK1. LEAF at 21 days after Feekes 10.5 had a significant effect on ts at OK1. For every 5% increase in LEAF, the chance of SEV reaching the thresholds by day 21 increased by 30 to 55%.
Amplicon Sequencing Reveals Extensive Coinfections of Foliar Pathogens in Soybean
Authors: Díaz-Cruz Gustavo A. , Cassone Bryan J.
Published: July 2020

Soybean (Glycine max) is one of the most economically important crops grown in North America and in other regions worldwide. However, the plant is susceptible to a variety of foliar pathogenic microorganisms, some of which are a significant threat to production. Several molecular and serological approaches are currently available to diagnose plant pathogens, but all have limitations including their capability to accurately detect coinfections of individual plants. We therefore used 16S and internal transcribed spacer amplicon sequencing to identify the suite of bacterial and fungal organisms infecting 96 soybean leaf samples collected throughout southern Manitoba, Canada, at two growth stages (V2/3 and R6). We were able to confirm the presence of pathogens previously known to our sampling regions, such as Septoria glycines, Alternaria alternata, and Pseudomonas spp. Importantly, we found that most of plants were infected by more than one putative pathogen, with 64% of V2/3 and 26% of R6 plants infected by three or more pathogens. Amplicon sequencing also indicated the presence of residual pathogens that infect crops other than soybean, as well as nonfoliar pathogens and nonpathogenic microorganisms. We discuss some of the benefits and drawbacks of using amplicon sequencing to detect foliar pathogens of soybean.
Genome Resource: Ralstonia solanacearum Phylotype II Sequevar 1 (Race 3 Biovar 2) Strain UW848 From the 2020 U.S. Geranium Introduction
Authors: Roman-Reyna Veronica , Truchon Alicia , Sharma Parul , Hand Francesca Peduto , Mazloom Reza , Vinatzer Boris A. , Jacobs Jonathan M. , Allen Caitilyn
Published: July 2020

Ralstonia solanacearum phylotype II sequevar 1 (RsII-1, formerly race 3 biovar 2) causes tomato bacterial wilt, potato brown rot, and Southern wilt of geranium. Strains in RsII-1 cause wilting in potato and tomato at cooler temperatures than tropical lowland R. solanacearum strains. Although periodically introduced, RsII-1 has not established in the United States. This pathogen is of quarantine concern and listed as a Federal Select Agent. We report a rapidly sequenced (<2 days) draft genome of UW848, a RsII-1 isolate introduced to the United States in geranium cuttings in spring 2020. UW848 belongs to the near-clonal cluster of RsII-1 global pandemic strains.
Examining the Association of Obesity With Postpartum Tubal Ligation
Authors: Byrne John J. , Smith Emma M. , Saucedo Alexander M. , Doody Kaitlin A. , Holcomb Denisse S. , Spong Catherine Y.
Published: July 2020

OBJECTIVE:

To evaluate the association of increasing body mass index (BMI) on postpartum tubal ligation safety and estimate the rates of procedure complication.

METHODS:

We conducted a single-institution, retrospective review. Women undergoing postpartum permanent contraception after vaginal delivery from August 2015 to March 2019 were studied. Our primary outcome included a composite morbidity of intraoperative complications (bleeding requiring additional surgery, and extension of incision), blood transfusion, aborted procedure, anesthetic complication, readmission, wound infection, venous thromboembolism, ileus or small bowel obstruction, incomplete transection, and subsequent pregnancy. Statistical analysis included t test, χ2 test, and Wilcoxon rank-sum test, with P<0.05 considered significant.

RESULTS:

During the study period, 3,670 women were studied: 263 were underweight or normal weight (BMI 24.9 or lower), 1,044 were overweight (25–29.9), 1,371 had class I obesity (30–34.9), 689 had class II obesity (35–39.9), and 303 had class III obesity (40 or higher) at the time of admission. Composite morbidity occurred in 49 cases (1.3%) and was not significantly different across the BMI categories (P=.07). Twelve cases of incomplete transection were noted on pathology reports; however, none of these accounted for the six subsequent pregnancies that were identified. There were no deaths or events leading to death noted in the study population. The length of time to complete the procedure increased across BMI categories (23 minutes in women with normal weight, and 31 in women with class III obesity) (P<.001).

CONCLUSION:

There was no association between increased BMI and morbidity with women undergoing postpartum tubal ligation. Postpartum tubal ligation should be considered a safe and reasonable option for women, regardless of BMI.
Histologically Diverse BAP1-Deficient Melanocytic Tumors in a Patient With BAP1 Tumor Predisposition Syndrome
Authors: Louw Amber , Creaney Jenette , Thomas Anitha , Van Vliet Chris , Harvey Nathan Tobias , Wood Benjamin Andrew , Mesbah Ardakani Nima
Published: July 2020

BRCA1-associated protein-1 (BAP1)-deficient cutaneous tumors are common in patients with BAP1 tumor predisposition syndrome, frequently presenting before other associated neoplasms, and can serve as an early marker to identify individuals with this disease. The typical lesions are dermal based and composed of a combination of larger epithelioid melanocytes with abundant glassy cytoplasm and smaller cells resembling those of a conventional nevus. There is often a component of interspersed lymphocytes. However, BAP1-deficient melanocytic tumors can show a spectrum of histologic appearances, ranging from lesions with pure epithelioid, pure conventional nevus, or rhabdoid cells and tumors with an intraepidermal component. To demonstrate such morphologic variation, we present a case of a 50-year-old woman with multiple histologically diverse BAP1-deficient melanocytic tumors and germline BAP1 mutation, identified after a diagnosis of pleural mesothelioma. We also discuss the pathogenesis and potential histopathological and clinical indications of germline versus sporadic etiology in the assessment of BAP1-deficient melanocytic tumors.
CONSEQUENCES OF LAPSES IN TREATMENT WITH VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN ROUTINE CLINICAL PRACTICE
Authors: Greenlee Tyler E. , Wang Victoria Y. , Kang Hannah , Ohlhausen Marc E. , Chen Andrew X. , Hom Grant L. , Conti Thais F. , Briskin Isaac , Babiuch Amy S. , Singh Rishi P.
Published: July 2020

Purpose:

Evaluating outcomes in patients receiving intravitreal antivascular endothelial growth factor (VEGF) inhibitors for neovascular age-related macular degeneration whom experience a lapse in treatment.

Methods:

A retrospective chart review evaluating 3,304 patients ≥18 years who experienced treatment lapses ≥3 months compared with control counterparts. Demographic information, macular thickness as measured by central subfield thickness, and visual acuity were collected at baseline, the first postlapse appointment, and at 3, 6, and 12 months after the lapse for the study group.

Results:

Lapse (n = 241) and control patients (n = 241) had similar baseline visual acuity and central subfield thickness (Early Treatment Diabetic Retinopathy Study: 58.9 ± 20.2 [20/63] vs. 59.2 ± 20.1 [20/63]; central subfield thickness: 252.4 ± 63.2 µm vs. 259.8 ± 66.2 µm, P = 0.21). Analysis revealed that lapse patients experienced a significant increase in central subfield thickness after lapse when compared with controls (279.4 ± 86.9 µm vs. 253.7 ± 65.9 µm, P < 0.01), which normalized on resumption of treatment (259.1 ± 79 µm vs. 246.8 ± 57.6 µm, P = 0.06). Study patients also experienced loss in the visual acuity after lapse when compared with controls (52.9 ± 23.6 Early Treatment Diabetic Retinopathy Study [20/100] vs. 59.9 ± 20.8 [20/63] Early Treatment Diabetic Retinopathy Study, P < 0.01) that did not recover through 12 months of follow-up.

Conclusion:

Patients with neovascular age-related macular degeneration who have lapses in care are at risk for poorer outcomes. Although macular thickness normalizes on resumption of treatment, their decline in the visual acuity does not recover.
Implementation of an Alcohol Screening, Brief Intervention, and a Referral Program at a Community Level II Trauma Center
Authors: Palacio Carlos H. , PharmD Bianca Cruz , Salazar Mariselda , Cano Jose R. , Ortega Maria Alejandra , Hovorka John W.
Published: July 2020

Background:

Trauma is the leading cause of years of potential life lost in the United States. Alcohol and drug use is a significant contributing factor. In 2017, a Level II community trauma center was achieving less than 80% screening rate compliance utilizing blood alcohol level as a screening method for trauma patients. The purpose of this article is to evaluate the implementation of a screening, brief intervention, and a referral-to-treatment service program.

Methods:

In 2018, the trauma program adopted structured interviews as a screening method for trauma patients. The injury prevention coordinator conducted structured interviews as a screening method for trauma patients who met inclusion criteria. High-risk patients were referred to the social worker, who conducted a brief evaluation with subsequent referral to treatment.

Results:

One year after the implementation of a structured interview approach, 1,021 trauma patients met inclusion criteria for this retrospective evaluation. From 2017 to 2018, the program observed an 86% statistically significant increase in screening using the structured interview SBIRT program (p < .0001) compared with the prior alcohol-level screening approach.

Conclusions:

On the basis of these data, a structured interview screening method demonstrated a significant improvement in screening compliance rates.
Sacral Pressure Injury Prevention in Trauma Patients: Silicone-Bordered Multilayered Foam Dressing
Authors: Serrano Jan , Paiva Christopher Fernandes , Dong Fanglong , Wong David , Neeki Michael
Published: July 2020

Background:

Hospital-acquired pressure injuries are a chronic phenomenon in health care, and their prevention is an ongoing challenge. This study aims to investigate whether the application of a silicone-bordered multilayered foam dressing during the initial trauma resuscitation reduces sacral hospital-acquired pressure injury occurrence in trauma patients.

Methods:

This is a single-center quality improvement study using a nonequivalent control group posttest-only design to study the effect of silicone-bordered multilayered foam dressing on the incidence of hospital-acquired pressure injuries. The study population included admitted, highest tier trauma activations, age 18 years and older. Preimplementation 2014 data were compared with postimplementation 2018 data.

Results:

The result showed no statistically significant reduction in hospital-acquired pressure injury occurrence between the control and intervention groups. Incident rates for sacral hospital-acquired pressure injuries were 0.23% (2014) compared with 0.21% (2018). No statistically significant difference was found in the hospital and intensive care lengths of stay or injury severity. Preventive dressing costs were $7,689 annually compared with the estimated treatment costs of $70,000 per hospital-acquired pressure injury.

Conclusion:

Although this study's hospital-acquired pressure injury reduction rate was not significant, the inclusion of multidisciplinary team members in the quality improvement project led to the cultural hardwiring of hospital-acquired pressure injury prevention among all team members beyond that of just nursing.
Virtual Quality Control in Middle Ear Surgery: Is Image-guided Tympanoscopy a Valuable Tool for Depicting Borderline Situations?
Authors: Jakob Till F. , Zaoui Karim , Kromeier Jan , Baumann Tobias , Becker Christoph , Lasurashvili Nikoloz , Neudert Marcus , Beleites Thomas , Offergeld Christian
Published: July 2020

Hypothesis:

Before modern imaging was introduced, revision surgery was the only way to evaluate possible reasons for inadequate improvement in hearing after ossicular replacement during reconstructive middle ear surgery.

Background:

The aim of this study was to evaluate freely navigable virtual tympanoscopy using different computed tomographic modalities. We compared cone-beam computed tomography (CBCT), flat panel computed tomography (FPCT), and conventional computed tomography in helical mode (CTH), volume mode (CTV), and ultra high resolution mode (CTD).

Methods:

Four temporal bone specimens were reconstructed with partial or total ossicular replacement prostheses. The best functional results for prosthetic coupling were achieved under the control of laser Doppler vibrometry (LDV). Afterward, a progressive step-by-step decoupling of the prostheses was carried out. Different prosthesis positions were evaluated by LDV as well as different computed tomographic modalities with 3D reconstruction of each dataset.

Results:

Anatomical structures were better depicted and the best position and coupling of inserted prostheses were achieved using CBCT. All imaging techniques could be used to control the position of middle ear prostheses, but CBCT provided the highest resolution and the best image quality in both 2D and 3D reformations and in 3D-animated video representation.

Conclusion:

Compared with several other imaging modalities, CBCT was best at depicting miscellaneous coupling problems. Noninvasive detection of coupling problems caused by minimal loss of contact between prostheses and middle ear ossicles will influence the clinical outcome. This early detection will help to determine whether revision surgery is needed.
Risk Factors and Management of Postoperative Infection Following Cochlear Implantation
Authors: Nisenbaum Eric J. , Roland J. Thomas , Waltzman Susan , Friedmann David R.
Published: July 2020

Objective:

To determine factors associated with infection, management, and resultant outcomes following pediatric cochlear implantation.

Study Design:

Retrospective cohort study with nested case series.

Setting:

Tertiary academic medical center.

Patients:

Children who underwent either unilateral or bilateral cochlear implantation between June 2011 and September 2016 and were under the age of 18 at the time of surgery.

Intervention(s):

Subjects were compared based on age, cochlea malformation, revision surgery, operative time, device manufacturer, and antibiotic use. Infections were compared based on location, time, bacteria, management, and resolution.

Main Outcome Measure(s):

Rate of infection, rate of device explantation.

Results:

There were 16 infections among 246 surgeries, an infection rate of 6.5%. There was a significant age difference between infected and noninfected patients overall (n = 246, 1.4 versus 4.3 years, p = 0.005), but not within the cohort of patients five or younger (n = 172, 1.4 versus 1.8 years, p = 0.363). The most common infectious complication was skin infection, followed by device infection. No cases of meningitis were seen. The most common organism was S Aureus. The implant was salvaged in 9 of 16 patients (56.3%), with higher rates in patients treated with IV versus oral antibiotics (70 versus 40%).

Conclusions:

Postoperative infection is positively associated with younger age overall, but not in patients below the age of 5. With modern devices and surgical practices, risk of meningitis—though a concern—may be lower than cited in the literature. Prompt and aggressive therapy with IV antibiotics and operative intervention can allow for high rates of device salvage.
Balloon Eustachian Tuboplasty (BET) in Children: A Retrospective Multicenter Analysis
Authors: Tisch Matthias , Maier Susanne , Preyer Serena , Kourtidis Savvas , Lehnerdt Goetz , Winterhoff Sebastian , Dalchow Carsten V. , Mueller-Jenckel Friederike , Sudhoff Holger H. , Schröder Stefanie , Koitschev Assen , Amrhein Peter , Bruchhage Karl-Ludwig , Leichtle Anke , Güldner Christian , Grulich-Henn Juergen , Jensen Katrin , Pohl Moritz , Plinkert Peter K. , Euteneuer Sara
Published: July 2020

Objective:

Generation of pilot data for planning of prospective BET-studies for treatment of dilatory Eustachian tube (ET) dysfunction in children.

Study Design:

Retrospective multicenter analysis.

Setting:

Nine ENT departments at tertiary care teaching hospitals.

Patients:

4–12-year-old children with chronic otitis media with effusion (COME) for more than 3 months or more than 3 episodes of acute otitis media during the last year, having failed standard surgical therapy at least once.

Intervention:

BET with or without paracentesis, ventilation tube insertion, or tympanoplasty.

Main outcome measures:

Tympanic membrane appearance, tympanometry, and hearing threshold.

Results:

Two hundred ninety-nine ETs of 167 children were treated. Mean age was 9.1 years (95% confidence interval [95% CI]: 8.7–9.4 yr). In 249 ears (83.3%), COME and/or retraction of the tympanic membrane were the indication for BET. Median hearing threshold was 20 dB HL (95% CI: 0–46 dB). One hundred fifty-five ears (51.8%, 95% CI: 46.1–57.4%) showed a tympanogram type B. Treatment consisted of BET without other interventions (“BET–only”) in 70 children, 128 ears. Median length of follow-up for 158 (94.6%) children was 2.6 months (95% CI: 0.3–16.1 mo). After treatment, the tympanic membrane appeared normal in 196 ears (65.6%, 95% CI: 60.0–70.8%, p < 0.001). Median hearing threshold improved to 10 dB HL (95% CI: 0–45 dB, p < 0.001). Tympanograms shifted toward type A and C (type A: 39.1%, 95% CI: 33.7–44.7, p < 0.001). These improvements were also observed in subgroup analyses of “BET-only” treatment and the indication of “COME” respectively.

Conclusion:

BET is improving a variety of dilatory ET dysfunction-related ear diseases in children. This study provides detailed data for design and planning of prospective studies on BET in children.
Leukocyte Rho kinase activity and serum cystatin C affect cardiovascular events in acute coronary syndrome
Authors: Ma Li , Dai Wenqin , Lin Yongbo , Zhang Zhongyuan , Pan Yunhong , Han Hongyan , Jia Haizhen , Peng Jun , Zhao Jinhe , Xu Liang
Published: July 2020

Objective:

This study was designed to investigate the effects of leukocyte Rho kinase activity and serum Cystatin C (Cys C) on cardiovascular events in patients with acute coronary syndrome (ACS).

Methods:

A total of 48 patients with ST-segment elevation myocardial infarction (STEMI), 23 patients with non-ST-segment elevation myocardial infarction (NSTEMI), 25 patients with unstable angina (UA) and 20 patients with no-acute coronary syndrome as control from January 2017 to June 2018 in Tianyou Hospital affiliated to Wuhan University of Science and Technology were selected in this study. Western blot was used to detect the leukocyte Rho kinase activity and Elisa kit was used to measure serum Cys C. Univariate and multivariate analysis were used to analyze the influencing factors of cardiovascular events in ACS patients.

Results:

The activity of leukocyte Rho kinase and serum Cys C were gradually reduced in the STEMI, NSTEMI and UA patients, but all significantly higher than that in No-ASC patients, and there was a positive correlation between leukocyte Rho kinase activity and serum Cys C in ACS patients (r = 0.516,P < .001). The activity of leukocyte Rho kinase was positively correlated with the levels of serum TNF-α (r = 0.634,P < .001), IL-6 (r = 0.578,P < .001), IL-8 (r = 0.582,P < .001) in ACS patients, and the level of Cys C was positively correlated with the levels of serum TNF-α (r = 0.634,P < .001), IL-6 (r = 0.578,P < .001), IL-8 (r = 0.582,P < .001) in ACS patients. Univariate and multivariate analysis showed that the leukocyte Rho kinase activity (HR = 2.994, 95%CI = 1.328–6.054,P < .0001) and the levels of serum Cys C (HR = 1.692, 95%CI = 1.028–2.124,P < .0001) were independent influencing factors of cardiovascular events in ACS patients.

Conclusion:

The leukocyte Rho kinase activity and serum Cystatin C are high in acute coronary syndrome patients, and are the independent influencing factors of cardiovascular events in ACS patients.
A case of mammary analogue secretory carcinoma of the parotid gland
Authors: Kim Seong Hwan , Hong Min Eui , Lee Dong Jin
Published: July 2020

Rationale:

Mammary analogue secretory carcinoma is a low grade salivary gland malignancy, first described by Skalova et al in 2010. The histological, immunohistochemical, and molecular characteristics of this tumor resemble those of secretory carcinoma of the breast.

Patient concerns:

A 40-year-old male patient without any specific past history came with complaints of 4 cm-sized hard, fixed, right infra-auricular mass without tenderness. There was no enlarged or enhancing lymph node in both neck.

Diagnoses:

Fine needle aspiration biopsy was done for right parotid mass and pathologic report was ”lymphocytes only” that suggested benign or low-grade malignant parotid tumor.

Interventions:

Partial parotidectomy including mass excision was performed. Operative finding showed hard bluish mass located in deep lobe of right parotid gland.

Outcomes:

Final pathologic report revealed secretory carcinoma of parotid gland. Homogenous eosinophilic secretions were identified inside microcystic structure. The immunophenotype was positive for epithelial membrane antigen, vimentin, S-100 protein. After 15 months of the surgery, the patient showed negative evidence of disease state.

Lessons:

We present here a case of mammary analogue secretory carcinoma of the parotid gland to help further characterize this rare tumor.