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Webs within webs: the role of epistemic injustice in creating barriers to public legal information in a digital age
Get PDFDespite concerns over the ability of citizens to understand and act on their legal rights, there has been little debate about what the effective provision of public legal information about rights entails. Through the lens of epistemic injustice, this article reveals the ways in which organizations with epistemic privilege can obfuscate the understanding of rights by resorting to displays of epistemic superiority and pre-emptive smothering of testimony. The article draws on the results of a critical discourse analysis of over 250 authoritative webpages that provide information on how to complain about healthcare provision. Focusing on tone, language, vocabulary, and format, the analysis looks at the role played by political design and fragmented discursive infrastructures, the characterization of information seekers as occupying liminal spaces, the use of professional and rarefied language in pre-emptively undermining the testimony of the laity, and the ways in which the internet and hyperlinks facilitate epistemic obfuscation
Introduction of confidential enquiry into maternal deaths in Ethiopia: Implementation and methodological considerations
Get PDFBackgroundDespite having high maternal mortality, no recent confidential enquiry into maternal deaths (CEMD) has been implemented in Ethiopia. This paper outlines the introduction of the CEMD, major findings, and key methodological considerations.MethodsWe embedded this CEMD in the ongoing Ethiopian Obstetric Surveillance System (EthOSS), a regional system that monitors a range of major obstetric conditions in eastern Ethiopia. Multiple methods (both qualitative and quantitative) were used to collect, analyse and report the data. A multidisciplinary committee was established and trained on principles and methodology of CEMD by international experts. The CEMD committee conducted two plenary CEMD sessions to review maternal deaths reported from April 1, 2021, to March 31, 2022, from 13 hospitals in the EthOSS consortium. Each case was assessed for causes, contributing factors, delays in care using the three-delays model, preventability, and recommendations for improving care.ResultsOut of 70 maternal deaths, in 59 there was enough information to enable a review by the committee; 27/59 (46%) and 15/59 (25%) were caused by obstetric haemorrhage and hypertensive disorders of pregnancy respectively. In 55/59 (93%), at least one of the three delays was identified: delay one (seeking care) in 48 (81%), delay two (reaching an appropriate facility) in 52 (88%), and delay three (receiving adequate care) in 54 (92%). The review indicated that almost all reported deaths could have been prevented with better care.ConclusionsAlmost all the maternal deaths in the region were considered preventable. Training for improving providers' clinical skills, improving availability of blood and basic supplies, strengthening postpartum monitoring, and referrals were recommended for saving lives through reducing preventable maternal deaths
Seasonal dynamics, antimicrobial resistance, and genetic lineages of thermotolerant <i>Campylobacter</i> isolates from South American camelids
Get PDFBackgroundSouth American camelids (SACs) are increasingly kept as companion animals, but their role in zoonotic transmission is poorly understood. Thermotolerant Campylobacter spp. are a leading cause of bacterial zoonoses globally. This study investigated the occurrence and zoonotic potential of thermotolerant Campylobacter spp. in SACs on German farms.MethodsFecal swabs from up to 20 animals on 10 farms were collected across four seasons. Campylobacter spp. were isolated, and genomes were typed to assess multilocus sequence types (STs), virulence, and antimicrobial resistance.ResultsCampylobacter spp. were detected in 23/717 samples (3.2 %), including 16 Campylobacter jejuni from seven farms and seven Campylobacter coli from two farms. Detection was higher in alpacas (4.9 %, 21/427) than in llamas (0.7 %, 2/288), with higher rates in summer. Molecular typing revealed high genetic heterogeneity, though some STs recurred across timepoints, animals, and farms, suggesting potential endemic colonization. Nine distinct C. jejuni STs and two C. coli STs were identified, many belonging to clonal complexes (CCs) common in livestock and humans. All isolates carried virulence-associated genes for motility, adhesion, invasion, and toxin production, while several from CC21 harbored genes linked to Guillain-Barré syndrome. Antimicrobial susceptibility testing showed wild-type phenotypes for erythromycin, gentamicin, and chloramphenicol. Ciprofloxacin resistance, with T86I mutation in gyrA, was found in three isolates; one C. jejuni isolate carried tet(O) conferring tetracycline resistance.ConclusionSACs harbor Campylobacter strains related to human and livestock lineages, with virulence and resistance traits relevant for zoonotic transmission. Their presence on German farms highlights the need targeted surveillance and biosecurity within a One Health framework
No error on the side of safety: No representational momentum for auditory looming stimuli
Get PDFThe looming bias describes systematic differences in the perception of looming as compared to receding stimuli. To date, the most prominent and successful theory put forward to account for this bias is the adaptive bias theory, based on the more general error management theory framework, which argues for a perceptual bias for looming stimuli to err on the side of safety. We challenge this notion by providing evidence using the established probe comparison task from the representational momentum literature, in which the final stimulus configuration is probed. For intensity-changing sounds indicating looming/receding sound sources, no systematic overestimation in intensity change direction for the perceived final sound intensity of looming, approaching stimuli was observed. Across two auditory experiments using either classical sine wave (Experiment 1) or more complex tones (Experiment 2), we replicated the finding of no shift in intensity change direction for looming stimuli, even when accounting for general, change-independent biases. We provide an alternative framework, the speed prior account of motion perception, to explain the present, as well as further, currently unexplained findings in the literature
Comparing three approaches to modelling the effects of temperature and rainfall on malaria incidence in different climatic regions
Get PDFBackground: Malaria transmission is primarily limited to tropical regions where environmental conditions are conducive for the survival of Plasmodium parasites and Anopheles mosquitoes. Adequate rainfall provides breeding sites, while suitable temperatures facilitate vector mosquito life-cycles and parasite development. Evaluating the efficacy of vector control interventions is crucial to determine their effectiveness in reducing malaria transmission. The aim of this study was to explore how these factors affect transmission dynamics at varying levels of vector control efficacy. Methods: We developed a vector-host compartmental mathematical model to compare three published approaches to incorporating weather influences on malaria transmission. The first approach examines mosquito biting behaviour and mortality rates in larval and adult stages. The second focuses on temper- ature effects on mosquito life-cycle characteristics throughout the aquatic and adult stages. The third considers how temperature and rainfall influence adult mosquito behaviour, environmental carrying capacity, and survival during the aquatic stages. Model simulations were conducted at different annual vector con- trol coverage levels, to identify variations in transmission patterns and seasonal variability in daily and annual incidence across three climate regions. Results: The first approach indicates sustained seasonal transmission, with lower cases per 1,000 in tropical regions compared to semi-arid and sub-tropical regions, even with enhanced vector control reducing cases. The second approach projects extended seasonal peaks in malaria transmission in tropical and semi- arid regions, driven by prolonged warm periods, while sub-tropical regions show lower incidence due to cooler temperatures limiting mosquito survival. In con- trast, the third approach projects multiple irregular peaks, with transmission ceasing in winter across all regions. Conclusions: Simulations indicate that climatic events like heatwaves or flood- ing, can trigger mosquito population surges and malaria outbreaks, even in areas previously free of malaria, despite strong vector control efforts. However, the results demonstrate that sustained and effective vector control, particularly in regions with moderate temperatures, can substantially reduce malaria inci- dence. Effective malaria control requires incorporating weather predictions into intervention plans, and enhancing current vector control strategies with supple- mentary measures like larval source management. Accurate timing and targeting of these interventions, based on transmission season projections, are crucial for maintaining robust control as weather conditions evolve and to prepare for future challenges
Deep cytomorphology identifies erythroid skewing and monocytic morphology to predict TKI sensitivity in CML patients
Get PDFThe cellular composition of the chronic myeloid leukemia (CML) bone marrow (BM) beyond granulocyte enrichment remains poorly understood. We analyzed 1548 routinely stained BM aspirate slides from 598 patients across seven sites using deep learning‐based image analysis to identify cytomorphological markers predictive of major molecular response. Erythroid precursor enrichment, monocyte nuclear lobulation, and low peripheral leukocyte count were associated with improved tyrosine kinase inhibitor (TKI) response. These features were validated both visually and computationally in two independent cohorts. We developed a Morphoclinical model integrating these image‐derived and clinical variables, outperforming (area under the receiver‐operating curve [AUROC] 0.76) the clinically used EUTOS long‐term survival score (AUROC 0.53) and BCR::ABL1 halving time (AUROC 0.61). Notably, poor‐risk patients treated with second‐generation TKIs achieved outcomes similar to favorable‐risk patients on imatinib. These results underline the overlooked prognostic value of BM cytomorphology to refine risk stratification and support more personalized frontline therapy in CML
Liberated by the spirit from the law of sin and death: pre-Nicene Christian writers on νόμος ‘law’ in Romans 7:21–8:2: Pre-Nicene Christian Writers on νόμος ‘Law’ in Romans 7:21–8:2
Get PDFThis dissertation is a study of the reception history of selected verses from Romans 7:21–8:2 in the first three centuries of the Common Era, up to and including Origen. The large range of interpretations of Romans 7:21–8:2 and its νόμος ‘law’ phrases in today’s scholarship has led to division among Pauline scholars. As yet, no comprehensive study on the interpretation of Rom. 7:21–8:2 by the early church has been undertaken and deployed in the study of this passage. This dissertation fills this lacuna by investigating four of the most pressing questions that continue to divide today’s Pauline scholars through the lens of the early writers: (1) whether the text should be understood as autobiographical (who is the ‘I’ of Rom. 7:21–8:2, and more broadly, 7:14–8:2?), (2) the meaning of νόμος in the νόμος phrases in Rom. 7:21–8:2, (3) the manner in which the νόμος phrases work on human beings, whether they are internal or external to the human being, and (4) to what extent did Greco-Roman thought impacted the early Christian understanding of this passage. The authors studied in this dissertation are Tertullian, Theodotus the Valentinian, Clement of Alexandria, and Origen. There are three primary reasons that Origen was chosen as the end terminus. Firstly, the proximity of Origen and those who wrote before him to the language and culture of Paul would have given them a privileged access to Paul’s world. Secondly, Origen, the latest of these authors, was the first extant Christian author to write biblical commentaries, and especially a commentary on Romans. Therefore, the dissertation examines the earliest readings of these verses before the authors’ interpretations were coloured by myriads of biblical commentaries. And thirdly, these authors wrote before the Roman Empire officially embraced Christianity (325 CE), and thus before there was a stricter oversight of theological works; these authors would have been less constrained by authority when they wrote. These criteria helpfully limit the number of authors studied because the extant references to and comments on Rom. 7:21–8:2 significantly increases from the fourth century onwards, which would have made it unmanageable for a dissertation. This dissertation argues that the early writers were primarily preoccupied with promoting self-mastery (a virtuous life) and keeping the vices at bay when they made use of Rom. 7:21–8:2. It further argues that the authors were primarily interested in the struggle or combat between that which is worldly and that which is otherworldly as depicted in Rom. 7:23, the verse that was by far the most popular and most referred to by the four authors. Furthermore, although the four authors interpreted the νόμος phrases in similar ways, not one author understood every νόμος phrase in the same way as another author. In stark contrast to contemporary scholarship of Rom. 7:21–8:2, the dissertation demonstrates that not a single early author understood any of the occurrences of νόμος to refer to ‘the Law of Moses’ (the Torah). Still further, the earliest readers of Rom. 7:21–8:2 approached the text with predominantly Greek philosophical categories and these early authors––apart from Origen, who addressed nearly all of the questions that contemporary scholars raise––had no problems with this passage (none but Origen raised any concerns about any of the verses in their extant writings), including the identity of the ‘I’. Moreover, only Tertullian and Origen explicitly mentioned external forces as connected to ‘the law of sin’, whereas Theodotus and Clement do so too, although not when they addressed Rom. 7:21–8:2. Finally, all authors understood the ‘I’ to be applicable to Paul and to the audience of the writers, who were presumably fellow Christians, but possibly all people. The dissertation contributes to today’s scholarship by presenting for the first time a comprehensive study of the earliest extant readers of Rom. 7:21–8:2. The findings will enrich contemporary scholars’ readings of Rom. 7:23–8:2 and will shift the concerns and focus that scholars have concerning this passage, such as putting too much emphasis on the identity of the ‘I’ or reading all or most occurrences of νόμος ‘law’ as referring to the Law of Moses. The dissertation further contributes to scholarship by demonstrating that the primary use this passage had for the early authors was as a proof text for arguments concerning the interior struggle that every human feels when faces with the choice to embrace either worldly things or heavenly things, or in arguments to show the struggle between that which is good in the person (the body, created good by God) and that which is evil in the person (sin, or sinful and disordered thoughts, created by the freedom of the will to choose evil). As such, these findings lend further support to certain ways of reading Romans 7–8 in contemporary scholarship. The methodology used in this dissertation closely follows that of Jennifer Strawbridge: for each early Christian author who made use of the passage, I present a thorough analysis of the context in which it occurs, the manner in which it is used, and the distribution of its use throughout different genres. Finally, the dissertation is structured around the four early Christian authors, with emphasis on their interpretations in the light of the four significant dividing questions mentioned above
The molecular consequences of hypertension on the human prefrontal cortex
Get PDFVascular disorders are important risk factors for cognitive decline and dementia, yet their molecular and cellular impact of these disorders on the human brain and its vasculature remains poorly understood. In this study, a large-scale single-nucleus atlas of the human prefrontal cortex vasculature was generated, comprising 671,162 high-quality nuclei from 43 donors—including both control and hypertensive or diabetic individuals—following strict quality control from an initial cohort of 48 donors. This atlas comprises both parenchymal and vascular compartments, including vascular, glial, neuronal, and immune cell populations, providing a comprehensive architecture of human cortical tissue. Strikingly, hypertension induced substantial transcriptional changes, particularly in vascular cell types (endothelial cells, mural cells, and endothelial-mesenchymal transition cells) and astrocytes. In contrast, no significant transcriptomic changes were observed in diabetes, suggesting that the prefrontal cortex is preferentially vulnerable to hypertension. Among hypertension-affected cell types, endothelial cells, which are key components of the blood-brain barrier (BBB), were the most affected, highlighting their high vulnerability to hypertensive stress. Notably, genes related to cell adhesion, synaptic function, and neuronal guidance were significantly downregulated, suggesting a novel role for traditional ‘neuronal’ genes in maintaining vascular integrity. Their dysregulation in endothelial cells and astrocytes may thus impair the neurovascular unit by affecting BBB integrity and angiogenesis. Many of the downregulated genes have previously been implicated in angiogenesis, and the findings position angiogenesis inhibition as a central mechanism of hypertension-induced neurovascular dysfunction. Cognitive decline associated with hypertension may therefore be a consequence of loss of BBB integrity and perfusion. Whilst hypertension-associated GWAS genes were significantly enriched in vascular cell types, there was minimal overlap between GWAS genes and differentially expressed genes. This suggests that observed transcriptomic changes may reflect secondary consequences of disease or long-term epigenetic changes. This study provides valuable insights into the molecular consequences of hypertension on the human prefrontal cortex
Synthesis and properties of allylic, benzylic, propargylic and allenylic oxonium ions
Get PDFDespite numerous studies of trialkyloxonium ions in the literature, investigations into the chemistry of allylic, benzylic, propargylic and allenylic oxonium ions are rare. Existing reports on well-characterized allylic and benzylic oxonium ions invariably construct these species based on constrained tricyclic oxatriquinane or oxatriquinacene scaffolds, with only limited studies reported on unconstrained benzylic oxonium ions. Here we report an investigation on a collection of allylic, benzylic and hitherto unknown propargylic and allenylic oxonium ions prepared on unconstrained scaffolds by a general, modular and unified strategy. Permutation of the substitution pattern of these oxonium ions allowed the extension of the strategy for the syntheses of various doubly substituted oxonium ions. Most of these oxonium ions could be characterized at room temperature by NMR spectroscopy, and a series of unexpected reactions and chemical behaviours pertinent to these species are briefly described