bluuebunny/crossref_metadata_2025 huggingface dataset:
Manipulating Life at Its Beginning
Authors: Chiarella Joe ,   The National Catholic Bioethics Center
Published: January 2021

Academic researchers, national labs, and private labs worldwide are experimenting with CRISPR-based gene editing. They are editing mice genes to make the mice better models for human disease research. They are editing mosquito genes to make them less able to carry the malaria parasite. Scientists are also experimenting with editing human somatic cells (cells that are not reproductive cells or embryonic stem cells). Because gene-edited somatic cells live and die inside our bodies and are not passed on to our offspring, there is little chance of passing on unintended consequences. It is tempting to say that those raising the alarm over CRISPR are overreacting. But the alarm isn’t only about CRISPR; it’s about the steady march of science, which clearly illustrates man’s determined pursuit of ways to manipulate life at its earliest stages. It is foolish to think that this trend will stall or reverse without some external motivator.
Three’s a Crowd
Authors: Markette Jo ,   The National Catholic Bioethics Center
Published: January 2021

Undoubtedly, the deep pain associated with mitochondrial disease tempts suffering families to grasp at any scientific solution that promises hope. Yet the high stakes do not justify mitochondrial replacement. While biotechnology allows scientists to reconstruct embryos, the serious ethical concerns surrounding this procedure negate its liceity. The gift of human life and its inestimable and irreplaceable value are reduced to a person’s utility as components of a manufactured product. Additionally, the sexual union between a married couple is denied its nature of exclusivity. Finally, those most vulnerable face possible exploitation and experimentation: poverty-stricken women who seek recompense for their sex genes, and preborn children who face the unknown ramifications of germ-line alteration. While compassion drives us to find a remedy for mitochondrial disease, strong evidence suggests that mitochondrial replacement therapy fails to meet this need.
Bias and POLST Facilitation
Authors: Brugger Christian ,   The National Catholic Bioethics Center
Published: January 2021

In order to maximize POLST usage in particular populations, especially among residents at elder-care facilities, the POLST model relies on what it refers to as facilitators, that is, nonphysician health care personnel such as nurses, social workers, chaplains, admissions coordinators, and nursing home administrators. Facilitators initiate advance planning conversations, explain end-of-life options, answer questions about benefits and burdens of various options, help patients fill out forms, and refer completed forms to clinicians for their signatures. This is problematic because educating and counseling for informed consent, especially when life and death are at stake, are chiefly the role of a physician. Widespread use of the POLST paradigm risks the marginalization of the role of physicians in an area of medical care involving life-and-death decision making.
Two Alternatives to Intensive Care
Authors: Fleming Alex ,   The National Catholic Bioethics Center
Published: January 2021

The overall quality of life in palliative and hospice care facilities differs greatly from that in intensive care units. For example, the use of mechanical ventilation and powerful anesthetics and sedatives in the ICU can often leave otherwise informed patients incapacitated and unable to make their own health care decisions. Thus, discussions between patients and families about treatment options can be difficult, and families and surrogates are often left to do this on their own Treatments performed in the ICU are likely to be disproportionate to their needs, adding to suffering and distrust on the part of family members. To avoid this, it is important for health care providers to assess patients early and often and to discuss the proportionality of different treatments with their families and surrogates. Additionally, providers should encourage palliative and hospice care as alternatives to the many costly and likely disproportionate interventions taken in the ICU.
The Needfor a Catholic Neuroethics
Authors: Beauregard James ,   The National Catholic Bioethics Center
Published: January 2021

Neuroethics is a developing clinical and academic field that considers ethical issues in the neurosciences. At this time, it would be premature to argue that there is a well-developed Catholic neuroethics. There is obviously overlap, as Catholic bioethics already addresses issues involving neurological illness. But we do not have a systematic Catholic approach to neuroethics that addresses specific ethical concerns and the underlying theoretical foundations of the field. A fully conceived Catholic neuroethics would be grounded in the nature of the human person created in the image of God. From that center, it would examine the numerous issues that arise in neurology and psychiatry as well as more fundamental philosophical and theological issues concerning the nature of the human person. It would involve sustained ethical reflection on the development and use of new technologies.
The Ethical Challenges of Gene Editing
Authors: Zalot Jozef , Pacholczyk Tadeusz ,   The National Catholic Bioethics Center
Published: January 2021

In August 2017, researchers at the Oregon Health and Science University announced that they had successfully used a gene editing technique known as CRISPR-Cas9 to repair disease-causing genes in human embryos. Some members of the scientific and medical communities have hailed the development as a way to ensure that life- threatening diseases are not passed on to future generations. But is gene editing always a good thing? The Catholic Church encourages scientific research that is ethical and serves the human good. In the future, CRISPR may be used to treat people with serious genetic diseases, such as hemophilia and sickle-cell anemia. However, for research on human beings to be ethical, it must be strictly therapeutic and must respect the dignity and sacredness of human life. Gene-editing techniques raise profound ethical challenges in both respects.
The Problem of Informed Consent in Egg Donation
Authors: Lefor Andi ,   The National Catholic Bioethics Center
Published: January 2021

The success of the mass-market fertility industry is wholly dependent on the willingness of young women to donate their eggs to couples using assisted reproductive technologies. Though the industry commonly refers to this as donation, women rarely transfer their eggs without the guarantee of financial compensation. In fact, the economic advantages are often a coercive factor in a woman’s decision to participate in egg harvesting.
Suicide and the Death of Freedom
Authors: Williams Gavin ,   The National Catholic Bioethics Center
Published: January 2021

As end-of-life care has increased in scope and proficiency, there has also arisen an approach that seeks to end suffering not by treating the patient, but by allowing him to actively end his own life. Offered as a merciful action that brings to a close the suffering of the patient, this option is justified as a natural exercise of his autonomy as a person. As long as his decision is not coerced, then the person has the authority to end the life that belongs to him. This view of the person grants the individual an almost boundless scope of action and raises freedom above all other goods of the person. If freedom is elevated to the status of an absolute, then one can say that its authentic exercise has no limits. Paradoxically, this view of freedom actually constrains the person, who becomes a victim of freedom itself.
Medical Futility in the Context of ECMO
Authors: Reynolds Patrick ,   The National Catholic Bioethics Center
Published: January 2021

Medical futility theory has become an enduring topic of discussion among medical practitioners and bioethicists of all persuasions. This is not necessarily surprising in light of the constant advances in pharmacokinetics and medical technology. Extracorporeal membrane oxygenation has existed since the early 1970s but was used primarily to treat neonates. Simplistically defined, an ECMO is a smaller, transportable version of the heart–lung bypass machine used during open-heart surgery. It can be used as a temporary rescue device for severe pulmonary or cardiac failure and is very frequently deployed during an acute cardiac emergency, such as cardiac arrest that does not respond to CPR or cardiogenic shock. The increasing use of ECMOs highlights the problem of identifying and understanding medical futility.
New Forms of Discrimination against the Disabled
Authors: Forr Mary ,   The National Catholic Bioethics Center
Published: January 2021

Society has reached a point where individuals with disabilities face the highest form of discrimination possible—their very right to live is challenged. This discrimination grows through abortion and in vitro fertilization, practices that advance a culture hostile to individuals who have genetic anomalies. As these practices have become more prevalent, so too have other forms of discrimination against individuals with disabilities. Unless stopped, this discrimination will continue to grow.
Lessons Learned in Palliative Care
Authors: Burke Greg F. ,   The National Catholic Bioethics Center
Published: January 2021

The Catholic Church has a long history of providing health care, particularly for the dying as an extension of Christ’s command of charity to one’s neighbor. The Western medical tradition has in most ways adopted this approach. However, such an approach is clearly under assault in an increasing secular medical world view dominated by utilitarian ethics and an idea of autonomy that recognizes no moral boundaries. The support for physician-assisted suicide and euthanasia, as well as threats at the beginning of life, can be understood as a logical conclusion to this expansive view, which puts man at the center of all existence. The Christian health profession must answer this movement with reason animated by love.
Prenatal Testing and the Denial of Care
Authors: Mora Bridget ,   The National Catholic Bioethics Center
Published: January 2021

Doctors and parents may have very different motivations when it comes to prenatal screening. Parents often agree to prenatal tests without enough knowledge about their purpose to give genuine informed consent. Parents may not understand the difference between screening and diagnostic tests or be prepared for the consequences of a poor diagnosis or prognosis. Very few genetic conditions can be treated prenatally, so if a disability is found, the “cure” proposed by the medical team is frequently abortion. In our utilitarian culture, prenatal screening has increasingly become a search-and-destroy mission to detect and eliminate babies with disabilities as early in pregnancy as possible. Pressure to abort quickly, before they have had time to process a poor diagnosis and grieve the loss of the healthy child they expected, can throw parents off their usual moral compass.
The Limits of “Actively Dying” as a Moral Concept
Authors: Ratuiste Kyle ,   The National Catholic Bioethics Center
Published: January 2021

For the term “actively dying” to contribute to ethical decision making, it must communicate morally relevant information. For instance, concerning the principle of proportionality, the phrase must indicate a physiological condition of the patient that obviates the benefits of intervention, exacerbates existing burdens, or introduces new ones. Furthermore, it must relate this information accurately and in a timely fashion. The initial challenge is that terms like “actively dying” appear to be loosely defined and equivocally employed. While many people may presume that the final phase of one’s life prior to death is distinctive and therefore distinguishable from preceding phases, people employ a variety of terms to signify what they intuitively recognize. Further complicating the matter, there is an apparent divergence in what precisely people are trying to describe.
Chaplain “DOs and DON’Ts” on Organ Donation
Authors: Zalot Jozef ,   The National Catholic Bioethics Center
Published: January 2021

This guide was developed in collaboration with LifeCenter Organ Donor Network (Cincinnati, OH) to offer chaplains a framework for the best possible course of action when they provide spiritual care to family members of patients who are potential vital organ donors. Some organ procurement organizations (OPOs) may want to control the donation process. They are thus hesitant to invite in—let alone collaborate with—any “outsiders” who they believe might undermine the likelihood of procuring vital organs. So how should a chaplain respond when ministering to potential vital organ donors and their families? Should they speak with family members about donation? What should they say? Do OPOs want chaplains to speak with family members? Should there be limits to these conversations? This can be a touchy area, because vital organ donation necessarily entails the death of the patient. This makes the relationship between chaplains and OPOs sometimes strained.
The Need for Guidelines in Periviable Infant Care
Authors: Carden Mary Clare ,   The National Catholic Bioethics Center
Published: January 2021

there is wide variation across the nation in the obstetric management of periviable births, from “doing everything” to “doing nothing.” Most institutions do not have formal policies for the management of periviable infants. It is important that all providers across a health care system agree on guidelines for the management of extremely premature infants. The rationale for a consensus approach rests on the need for practicality and consistency in hospital settings, where multiple physicians provide and hand-off care, as well as on the need for fairness and consistency in counseling the parents of extremely premature infants. Practitioners in neonatology and maternal–fetal medicine programs have very different educational backgrounds, and many lack training in ethics, communication skills, and counseling.
Preserving Consciousness at the End of Life
Authors: Ruzicka Diana L. ,   The National Catholic Bioethics Center
Published: January 2021

Both the principle of double effect and the teaching of the magisterium allow for the use of opioids for the suppression of pain and consciousness as death approaches, even if one foresees that the use of narcotics will shorten life. But the principle of double effect should not be used to justify the administration of large doses of opiates or other mind-altering medications under the assumption that a dying patient should or might be having pain, anxiety, or dyspnea. What makes a dying patient uncomfortable or causes them suffering must be determined and appropriately treated. The assessment should include the following questions: Is the patient experiencing physiological pain? Is the discomfort caused by psychological, emotional, or spiritual distress (suffering)? Or is there a particular distressing symptom that needs to be identified and appropriately treated? Medicine and nursing practice are based on the assessment and treatment of disease and symptoms.
Same-Sex Attractionand the Priesthood
Authors: McTavish James ,   The National Catholic Bioethics Center
Published: January 2021

Should a person with same-sex attraction live chastely? Can a person with SSA live celibately? Should a person with SSA be ordained? Care has to be taken in asking such questions, remembering that the person with SSA should be treated fairly and with equality. We could also ask these questions of heterosexual persons. In line with current pronouncements of Church teaching, the priestly life appears unsuited for persons with deep-seated SSA. If the SSA is transitory or passing, and the candidate is open to be formed, then there may be no impediments to future ordination. Where the same-sex feelings lie somewhere in between, careful and prudent discernment (as for heterosexual candidates, too) is needed.
Safe Injection Sites and the Ethic of Harm Reduction
Authors: Lefor Scott R. ,   The National Catholic Bioethics Center
Published: January 2021

While the concept of safe injection sites, which are geared toward addressing harms related to illicit drug consumption and addiction, has been around for several decades—such facilities were operational in the Netherlands as early as the 1970s—it has again been brought to the fore due to developments in California. Other large American cities, such as Philadelphia, have also proposed such sites. The debate over these sites often takes a public policy focus, weighing societal costs and benefits, but these ultimately fail to justify moral liceity. After describing what safe injection sites are and what they seek to accomplish, a general argument in defense of these sites will be constructed based primarily on Andrew Hathaway and Kirk Tousaw. I will argue against such facilities because they are ultimately founded on a framework with a fundamentally flawed consequentialist outlook and because they encourage illicit cooperation in immoral acts.
Hurtling toward Germline Gene Editing
Authors: Mason Veronica R. J. M. ,   The National Catholic Bioethics Center
Published: January 2021

Genetic enhancement runs up against several moral issues, perhaps the chief of which is the inevitable eugenic attitude it would foster and the associated inequality it would create between those who have the “proper” enhancements and those who do not. For simplicity’s sake, this analysis leaves aside questions related to genetic enhancement and considers only changes made for therapeutic purposes. Regardless, most of the censure of He Jiankui focuses on the results of human modification and often overlooks the prior question of how gene editing research itself conducted. Germline gene editing in humans is not safe or morally licit under current practices and technology, because of its reliance on technologies such as IVF, the danger to and destruction of the embryos used, and the unknown consequences of changing the germline.
A Material History of the Bible, England 1200-1553
Authors: Poleg Eyal
Published: January 2021

This book examines the production and use of Bibles in late medieval and early modern England. The analysis of hundreds of biblical manuscripts and prints reveals how scribes, printers, readers, and patrons have reacted to religious and political turmoil. Looking at the modification of biblical manuscripts, or the changes introduced into subsequent printed editions, reveals the ways in which commerce and devotions joined to shape biblical access. The book explores the period from c.1200 to 1553, which saw the advent of moveable-type print as well as the Reformation. The book’s long-view places both technological and religious transformation in a new perspective. The book progresses chronologically, starting with the mass-produced innovative Late Medieval Bible, which has often been linked to the emerging universities and book-trade of the thirteenth century. The second chapter explores Wycliffite Bibles, arguing against their common affiliation with groups outside Church orthodoxy. Rather, it demonstrates how surviving manuscripts are linked to licit worship, performed in smaller monastic houses, by nuns and devout lay women and men. The third chapter explores the creation and use of the first Bible printed in England as evidence for the uncertain course of reform at the end of Henry VIII’s reign. Henry VIII’s Great Bible is studied in the following chapter. Rather than a monument to reform, a careful analysis of its materiality and use reveals it to have been a mostly useless book. The final chapter presents the short reign of Edward VI as a period of rapid transformation in Bible and worship, when some of the innovations introduced more than three hundred years earlier began, for the first time, to make sense.
Insane Acquaintances
Authors: Moore Daniel
Published: January 2021

Insane Acquaintances charts the varied encounters between artistic modernism and the British public in the years between ‘Manet and the Post-Impressionists’ (1910) and the Festival of Britain (1951). Through a range of case studies which explore the work of the ‘mediators’ of modernism in Britain – those individuals, groups and organisations which facilitated the introduction of modernist art and design to public audiences during the first part of the twentieth century – Insane Acquaintances explores the social, political and cultural impact of visual modernism over the course of four decades. Focusing on the efforts to legitimise, explain and make authentic the abstract (and often continental) modernist aesthetics that shaped British artistic culture during the years 1910-1951, this study charts the changing taste of the nation, through chapters on Postimpressionist art and crafts, modernist art in schools, the home design and decoration, Surrealism and revolution and the post-War institutionalisation and funding of the arts.
Village Institutions in Egypt in the Roman to Early Arab Periods
Authors: Langellotti Micaela , Rathbone D. W.
Published: January 2021

This volume is the first to survey village institutions in Egypt during the first eight centuries AD, from the beginning of Roman rule to the early Arab period. Despite the many studies of society and administration in Ptolemaic and Roman Egypt, there are no general studies of village institutions or communities in any one period, let alone in a long-term perspective, or integrated investigation of their relationship to the wider state. This volume, which represents a first response to fill this gap in the current scholarship, aims to demonstrate that Egypt is a particularly productive place to develop study of this subject because the rich documentary evidence of the papyri, a large majority of which comes from village sites, permits us both to study specific topics in detail by place and time, as the eleven papers of this volume do, and also to make comparisons across a long chronological period. These comparisons across time are beneficial because they raise questions about changing patterns and perspectives of the surviving documents, which may skew interpretation, and enable us to outline what seem to emerge as recurrent issues in the power-relationships between central and regional authorities and the rural population, as well as some preliminary indications of the trends in those developments across our period.
Determinação dos campos de velocidades de escoamentos bifásicos usando PIV-PTV
Authors: Aleixo Rui , Carvalho Elsa , Lima Maria Manuela C.L. , Ferreira Rui M. L.
Published: January 2021

No domínio da hidráulica fluvial, é fundamental conhecer o campo de velocidades das fases sólida (sedimentos) e líquida (água). A partir do campo de velocidades instantâneas é possível quantificar diversas variáveis incluindo intensidades da turbulência e tensões de corte e identificar zonas de separação, recirculação, etc. O desenvolvimento de técnicas óticas permitiu o desenvolvimento de instrumentos de medição baseados na aquisição e no processamento de imagens, nomeadamente o PIV (particle image velocimetry) e o PTV (particle tracking velocimetry). Neste artigo, apresenta-se um algoritmo que combina ambas as técnicas, PIV e PTV, permitindo assim, juntar os pontos fortes de cada uma das técnicas e possibilitando a medição simultânea do campo de velocidades da água e dos sedimentos e estudar mais detalhadamente a interação fluido-sedimentos. As vantagens e limitações do algoritmo proposto são exploradas e discutidas com recurso a um conjunto de experiências laboratoriais.
El proceso de radicalización yihadista de mujeres en España
Authors: García García María Isabel
Published: January 2021

La radicalización violenta es un fenómeno complejo que debe ser explicado a través de un enfoque multidisciplinar. El objetivo de este artículo es explicar cómo y por qué se ha producido la radicalización violenta de 22 mujeres en España tras la irrupción de Daesh en el panorama internacional. Para logarlo, el estudio analiza los factores sociopolíticos que conducen a un individuo a abrazar la militancia islámica a través de tres niveles: macro, micro y meso. La investigación se sustenta en entrevistas a mujeres que han sido detenidas por integración en dicha organización terrorista, así como en un sumario y resoluciones de la Audiencia Nacional.Violent radicalization is a complex phenomenon that must be explained through a multidisciplinary approach. The aim of this article is to explain how 22 women in Spain became radicalised. To achieve this, the study analyses the socio-political factors that lead an individual to get involved with the Islamic militancy through three levels: macro, micro and meso. The research is supported by interviews with females in Spain who were convicted of terrorist offences and experts in the field; by judgement and indictments ordered by the Audiencia Nacional.
A vueltas con la dispensa del deber de declarar de las víctimas de violencia de género a propósito de la sentencia del Tribunal Supremo 389/2020, de 10 de julio
Authors: De la Herrán Ruiz-Mateos Sergio
Published: January 2021

En el presente trabajo se analiza la reciente sentencia de la Sala Segunda del Tribunal Supremo 389/2020, de 10 de julio, por la que se discute de nuevo el reconocimiento del derecho a la dispensa del deber de declarar a las víctimas del delito y su repercusión en el ámbito de la violencia de género. Los razonamientos expuestos en la sentencia permiten reflexionar sobre las deficiencias de la regulación, la deriva jurisprudencial y las necesidades de reforma.The article analyses the recent judgment 389/2020, of 10th July, rendered by the Supreme Court. The decision deals once again with the right not to declare that is recognised to victims of gender-based violence. The reasoining in the judgment allows a reflection about the shortages in the regulation, the jurisprudential leeway and the need for a reform.
Profanación, exhumación y violación de los enterramientos: arqueología penal de su regulación en el siglo XIX
Authors: Castro Liñares David
Published: January 2021

Este trabajo tiene como finalidad analizar el tratamiento penal que durante el siglo XIX se dispensó a los actos indebidos para con el cuerpo y memoria de las personas fallecidas. Para ello, este texto se inicia con un recorrido normativo por los Códigos Penales españoles del siglo XIX (1822-1848-1850-1870) con el propósito de analizar la forma en que el Legislador penal fue incorporando esta cuestión en los distintos textos normativos. A continuación, y como forma de continuar este análisis, se estima adecuado detenerse en las razones político criminales subyacentes a la tipificación de estas conductas. De esta forma, se intenta realizar una aproximación a las lógicas punitivas decimonónicas inherentes a una esfera tan particular como el castigo penal a los actos irrespetuosos para con los difuntos. Por último, se incorpora un apartado conclusivo en el que abordar algunas ideas que, por razón de estructura narrativa no encontraban un acomodo idóneo en otras partes del texto pero que igualmente resultan de importancia para esta propuesta de análisis político-criminal histórico.This work aims to analyse the criminal law treatment that during the 19th century is dispensed to wrongdoing with the body and memory of deceased people. For that purpose, this text begins with a normative view of the Spanish Criminal Codes of the 19th century (1822-1848-1850-1870) in order to investigate how the Criminal Legislator incorporated this issue into the various normative texts. Hereunder, as a way to continue this analysis, it is considered appropriate to dwell on the criminal political reasons typification of these conducts. In this way, an attempt is made to approximate the decimonic punitive logics inherent in an area as particular as criminal punishment to disrespectful acts with the deceased. Finally, a concluding section is incorporated in order to address some ideas that, by reasons of narrative structure, did not find an appropriate accommodation in other parts of the text but which are also relevant for this proposal of historical political-criminal analysis.
Amnistías, dictaduras y transición: recensión de “Il potere di non punire. Uno studio sull’amnistia Togliatti” de Paolo Caroli. Napoles, ESI, 2020
Authors: Maculan Elena
Published: January 2021

-
Vascularized bone grafts for post-traumatic defects in the upper extremity
Authors: Petrella Giovanna , Tosi Daniele , Pantaleoni Filippo , Adani Roberto
Published: January 2021

Vascularized bone grafts (VBGs) are widely employed to reconstruct upper extremity bone defects. Conventional bone grafting is generally used to treat defects smaller than 5–6 cm, when tissue vascularization is adequate and there is no infection risk. Vascularized fibular grafts (VFGs) are mainly used in the humerus, radius or ulna in cases of persistent non-union where traditional bone grafting has failed or for bone defects larger than 6 cm. Furthermore, VFGs are considered to be the standard treatment for large bone defects located in the radius, ulna and humerus and enable the reconstruction of soft-tissue loss, as VFGs can be harvested as osteocutaneous flaps. VBGs enable one-stage surgical reconstruction and are highly infection-resistant because of their autonomous vascularization. A vascularized medial femoral condyle (VFMC) free flap can be used to treat small defects and non-unions in the upper extremity. Relative contraindications to these procedures are diabetes, immunosuppression, chronic infections, alcohol, tobacco, drug abuse and obesity. The aim of our study was to illustrate the use of VFGs to treat large post-traumatic bone defects and osteomyelitis located in the upper extremity. Moreover, the use of VFMC autografts is presented.
Nasal alar rim redraping method to prevent alar retraction in rhinoplasty for Asian men: A retrospective case series
Authors: Choi Jun Ho , Yoo Hyokyung , Kim Byung Jun
Published: January 2021

Background For an attractive and natural tip contour in Asian rhinoplasty, insertion of a nasal implant and reinforcement of the cartilaginous framework are essential. However, scar contracture, which often results from augmentation with implant insertion and inadequate soft tissue coverage of the framework, is one of the most common causes of alar retraction. This study reports a novel method of redraping soft tissue along the alar rim to prevent alar retraction in Asians.

Methods Twenty young Asian men who underwent primary rhinoplasty with septoplasty were retrospectively reviewed. After the usual rhinoplasty procedures, alar rim redraping was conducted for the soft tissue along the transcolumellar and bilateral infracartilaginous incisions. The longest axis of the nostril (a) and the height of the nostril from that axis (b) were measured in anterior-posterior and lateral views. The preoperative and postoperative ratios (b/a) were analyzed using the paired t-test.

Results All 20 patients showed natural contours of the nasal tip, nostrils, and alae after a mean follow-up of 53.6 weeks (range, 52–60 weeks). The ratio of the nostril axes significantly decreased postoperatively in all patients except one, by an average of 11.08%±6.52% in the anterior-posterior view and 17.74%±8.49% in the lateral view (P<0.01). There were no complications, including asymmetry, contracture, subdermal plexus injury, flap congestion, or infection.

Conclusions A quantitative analysis of alar retraction by evaluating the ratio of nostril axes showed that alar rim redraping is a simple and effective adjuvant technique for preventing alar retraction in rhinoplasty for young Asian men.
The pedicled anterolateral thigh flap for trochanteric pressure sore reconstruction: Technical notes to optimize surgical outcomes
Authors: Hifny Mahmoud A.
Published: January 2021

Background The pedicled anterolateral thigh (ALT) flap has become more popular for the reconstruction of soft-tissue defects in neighboring areas. Nonetheless, few studies in the literature have explored the use of this flap for trochanteric ulcer reconstruction. The aim of our study is to present the author’s experience of utilizing the ALT flap, with a focus on technical elements regarding the flap design and the tunneling method to maximize the reach of the flap.

Methods The medical records of patients who received pedicled ALT flaps for the reconstruction of trochanteric pressure sores were retrospectively reviewed. The patients’ demographic data, operative details, and postoperative complications were evaluated.

Results Between October 2018 and December 2019, 10 consecutive patients (age range, 13–45 years) underwent 11 pedicled ALT myocutaneous flaps for trochanteric pressure sore reconstruction. Each flap was designed around the most distal cutaneous perforator that was included in the proximal third of the skin paddle. The flaps ranged in size from 11×6 to 14×8 cm. The ALT flap was transposed through a lateral subcutaneous tunnel in five patients, while the open tunnel technique was used in six patients. All flaps survived, and no vascular compromise was observed.

Conclusions The pedicled ALT flap is a safe and reliable option for reconstructing trochanteric pressure sores. An appropriate flap design and a good choice of the tunneling method are crucial for successful flap transposition.
Thoracodorsal artery flaps for breast reconstruction–the variants and its approach
Authors: Thomsen Jørn Bo , Rindom Mikkel Børsen , Rancati Alberto , Angrigiani Claudio
Published: January 2021

Thoracodorsal artery (TDA) flaps, ranging from the vascular-pedicled thoracodorsal artery perforator (TDAP) flap, the propeller TDAP flap, and the muscle-sparing latissimus dorsi (MSLD) flap to the conventional latissimus dorsi (LD) flap and the extended LD flap, can all be used for breast reconstruction. The aim of this paper and review is to share our experiences and recommendations for procedure selection when applying TDA-based flaps for breast reconstruction. We describe the different surgical techniques and our thoughts and experience regarding indications and selection between these procedures for individual patients who opt for breast reconstruction. We have performed 574 TDA flaps in 491 patients: 60 extended LD flaps, 122 conventional LD flaps, two MSLD flaps, 233 propeller TDAP flaps, 122 TDAP flaps, and 35 free contralateral TDAP flaps for stacked TDAP breast reconstruction. All the TDA flaps are important flaps for reconstruction of the breast. The LD flap is still an option, although we prefer flaps without muscle when possible. The vascular-pedicled TDAP flap is an option for experienced surgeons, and the propeller TDAP flap can be used in most reconstructive cases of the breast, although a secondary procedure is often necessary for correction of the pedicle bulk. The extended LD flap is an option for women with a substantial body mass index, although it is associated with the highest morbidity of all the TDA flaps. The MSLD flap can be used if the perforators are small or if dissection of the perforators is assessed to be hazardous.
Case-control study of the treatment of postaxial polysyndactyly of the foot: Comparison of surgical results after removal of the fifth or sixth toe
Authors: Woo Soo Jin , Kim Byung Jun , Kwon Sung Tack
Published: January 2021

Background In postaxial polysyndactyly of the foot, the choice of which toe to excise is controversial. It is often treated by resection of the fifth toe to save the lateral neurovascular bundles of the sixth toe. However, the sixth toe is often short and laterally deviated, which may require wedge osteotomy, potentially shortening the phalanx and compromising circulation. This study outlines an individualized method to spare the length and axis of the fifth toe in polysyndactyly with a short and deviated sixth toe.

Methods We retrospectively analyzed 38 patients who underwent surgery between 2006 and 2019. The fifth toe was spared in 18 cases, and the sixth toe in 20 cases. The ratios of the forefoot width, angle difference, and toe length were compared between the affected and unaffected sides postoperatively. Complications and subjective judgments on cosmetic results were recorded and compared.

Results No significant between-group differences were observed for sex, age at surgery, or the follow-up period. The forefoot width ratio did not significantly differ between the groups. However, the angle difference and toe length ratios showed significantly better results in the fifth toe-spared group than in the sixth toe-spared group (P<0.05 and P<0.01, respectively). There were no cases of impaired circulation, and subjective evaluations revealed satisfactory results in the fifth toe-spared group.

Conclusions In cases with short and deviated sixth toes, sparing the fifth toe is an effective method of cosmetic treatment. The surgical results were satisfactory, with an improved appearance and no residual deformities.
Stromal vascular fraction injection to treat intractable radiation-induced rectovaginal fistula
Authors: Kim Mijung , Lew Dae Hyun , Roh Tai Suk , Song Seung Yong
Published: January 2021

Rectovaginal fistula, which can arise after an injury to the vaginal canal or rectum, is a troublesome obstacle for patients’ everyday life. In most cases, it can be covered with a local flap, but previous radiation therapy increases the recurrence rate, making it especially difficult to cure. As the application of stromal vascular fraction (SVF) obtained from enzymatically digested autologous adipose tissue has become increasingly common, several reports have advocated its effectiveness for the treatment of refractory wounds. In light of the angiogenic, regenerative characteristics of SVF, it was incorporated as a treatment option in two cases of rectovaginal fistula discussed here. As described in this report, irradiated rectovaginal fistulas in rectal cancer patients were successfully treated with SVF injection, and we suggest SVF as a feasible treatment option for cases of rectovaginal fistula that would otherwise be very difficult to cure.
Inferomedially impacted zygomatic fracture reduction by reverse vector using an intraoral approach with Kirschner wire
Authors: Jang Jin Woo , Cho Jaeyoung , Burm Jin Sik
Published: January 2021

Background In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome.

Methods Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed.

Results Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection.

Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.
Narratives of Loss: Exploring Grief through Photography
Authors: Jiménez-Alonso Belén , De Luna Ignacio Brescó
Published: January 2021

Grief is not an exclusively private and intrapsychic phenomenon but a dynamic process whereby the bereaved negotiates the meaning of the loss in a way that may challenge his/her personal self-narrative. Drawing on a social constructionist model of grief, this paper features a case study where we analyse narratives of mourning elicited through a personal photographic project. The visual-based narrative methodology used in our study (photo-production) not only allows for multi-modal forms of expression and communication in the study of grief, but it also serves as an aid for individuals to scaffold further meaning-making processes which cannot be conveyed through narrative alone. The paper concludes with an invitation to reflect on the use of photography as both a possible methodological tool to explore narratives of grief and a therapeutic tool for the construction of meanings and continuing bonds with the deceased.
Mothering Death: A Psychosocial Interpretation of Breast Cancer Biography
Authors: Gripsrud Birgitta Haga
Published: January 2021

In this article I take as my point of departure a puzzle presented by a woman who had an apparently ‘bizarre’ reaction to a breast cancer diagnosis. In the clinic, she had exclaimed: “I would rather die than lose the breast!”. My aim is to unpack layers in this woman’s embodied and enculturated experience, with a view towards developing a psychosocial interpretation of breast cancer biography. The single case on which the present study is based, was extracted from a larger longitudinal data set which allowed me to follow ‘Ella’s’ transition from diagnosis to survivorship. I relied on five sources of data to unfold the case: two participant-generated texts (expressive writing and a Breast Biography), two interviews, and my own field notes. The two texts that Ella wrote provided a participant-led frame for depth-hermeneutic group interpretation sessions, the first of which, synergistically, produced a scenic voicing of latent content in the sub-text of Ella’s expressive writing: the fantasy of mothering death. This subsequently became a lead for my further interpretation of the case, and for methodological reflections on the value of shared thinking in qualitative data interpretation. Crucially, and with some bearing on the current healthcare context, this interpretive study sheds light on what goes on beneath the surface of an apparently ‘irrational’ and ‘recalcitrant’ patient, evidenced by Ella’s entry into what I call a ‘vortex of suffering’. Findings point towards her suffering as an expression of a psychosocial reality, against the backdrop of hope and ideals contained within a psychosocial imaginary that revolves around biomedical cure and reparation.

 

Keywords: breast cancer biography; the breast; psychosocial studies; depth-hermeneutics; vortex of suffering; psychosocial reality
Negotiating languages of suffering in northern Uganda
Authors: Williams Lars Hedegaard
Published: January 2021

Drawing on ethnographic fieldwork in northern Uganda, I argue that psychiatric notions of suffering brought into the region by humanitarian intervention programs interact with local concepts of suffering (based in spirit-idioms) in two ways: In some cases, the diagnostic notion of PTSD and its vernacular counterpart “trauma” psychologize the local cosmology, transforming local spirit concepts from social or moral categories, to psychological ones. In other cases, psychiatric discourses hinged around “trauma” become spiritualized or enchanted, where the concept of trauma becomes usurped by and part of local cosmology. In an attempt to understand these processes, I suggest understanding concepts of suffering through their use in social practice and based on pragmatist epistemology. If viewed as a pragmatist concepts, I argue, it becomes possible to understand the social life of concepts of suffering (such as “trauma”) when they become globalized and negotiated in new contexts and social practices.
Education and the Pandemic: Distance Learning and the School-Family Relationship
Authors: Crescenza Giorgio , Fiorucci Massimiliano , Rossiello Maria Concetta , Stillo Lisa
Published: January 2021

In this paper we present the preliminary results of a survey administered to Italian stu- dents, teachers and families to detect the conditions prevailing in the education sector in the time of Covid-19. The aims of the study were to analyze teachers’ new citizenship skills and families’ relationship skills in order to create a new school-family agreement that is suitable not only for face-to-face lessons but also for distance learning and that incorporates new participation compe- tences from all those involved. Responses to the questionnaires, created in semi-structured format, were received from 2,000 teachers, families and students from all over Italy. This explorative phase highlighted the profound distance-learning revolution that has been adopted by over 90% of edu- cation systems but that has also created enormous difficulties from the emotional and relational perspectives. Aspects such as personalization and individuality in the learning process have been deferred, especially for those with disabilities. The conclusions intend to open to feasible social- pedagogical projects that respond to educational, digital and social needs drawn from this research, heralding that the pandemic has brought us into a new age of education.
El viaje in situ. De cómo el caminar en espacios confinados puede potenciar la imaginación
Authors: Apolonio Laura
Published: January 2021

Durante la pandemia de COVID-19 nos hemos encontrado de repente confinados en casa, reducidos a una mínima interacción social y un limitado desplazamiento físico. Con este artículo queremos mostrar cómo esta condición reductiva del confinamiento puede revertirse y transformarse en un recurso que potencia la creatividad. Partiendo de ejemplos históricos (como el viaje recluido en su habitación de Xavier de Maistre) y artísticos (desde Francis Alÿs a William Kentridge, Francesco Careri y otros colectivos artísticos contemporáneos) y basándonos en investigaciones antropológicas (David Le Breton) y neurológicas (Shane O’Mara), mostraremos cómo la simple actividad de caminar tiene una increíble capacidad de estimular nuestra creatividad, abriendo en nosotros un espacio infinito –nuestra imaginación– que representa una zona de libertad siempre a nuestro alcance. Concluiremos, junto con Didi-Huberman y Tim Ingold, en la necesidad de rescatar nuestra facultad imaginativa que, contrariamente a lo que se piensa, no nos aleja de la realidad, sino que nace precisamente de una atenta observación y un sumergirnos en su densidad para despertar el deseo de transformación.