ABSTRACT
Regnant public accounts of Jewish sexual ethics—both external and internal—fall short of what they could accomplish. Using a Twitter thread on sexual ethics which falls into some key errors ...as a case study, I argue that Jewish ethicists are poised to address the thread's errors by offering sources for alternative moral frameworks. I examine how thinking with this Twitter thread can help us clarify what we mean by public scholarship more generally, what is wrong with some common public deployments of specifically Jewish sources, and some implications of this for both Jewish and non‐Jewish publics. I conclude with some reflections about the role of traditional academic venues, such as the
Journal of Religious Ethics
, within this.
PERSON‐SHAPED HOLES Epstein‐Levi, Rebecca J.
The Journal of religious ethics,
06/2021, Letnik:
49, Številka:
2
Journal Article
Recenzirano
Abstract
While much Jewish thought, culture, and professional ethics increasingly accommodate a range of gender roles and expressions, sexualities, and family structures, they also remain deeply ...pronatalist. This overwhelmingly frames reproduction as a core Jewish value and the choice not to bear or raise children as contrary to Jewish values. I argue that Jewish pronatalism masks the true extent to which the whole community must support the care and formation of all its generations. Through a counter‐reading of a passage from the Babylonian Talmud in which three sages neglect their wives and children in various ways that allow a careful reader to notice “person‐shaped holes”—narrative features whose presence implies various people’s nonparental labor—I argue that multiple people in multiple roles within a community make it possible to sustain its continuity in a robust and all‐encompassing way.
Arthopods such as Ixodes scapularis ticks serve as vectors for many human pathogens. The arthropod gut presents a pivotal microbial entry point and determines pathogen colonization and survival. We ...show that the gut microbiota of I. scapularis, a major vector of the Lyme disease spirochete Borrelia burgdorferi, influence spirochete colonization of ticks. Perturbing the gut microbiota of larval ticks reduced Borrelia colonization, and dysbiosed larvae displayed decreased expression of the transcription factor signal transducer and activator of transcription (STAT). Diminished STAT expression corresponded to lower expression of peritrophin, a key glycoprotein scaffold of the glycan-rich mucus-like peritrophic matrix (PM) that separates the gut lumen from the epithelium. The integrity of the I. scapularis PM was essential for B. burgdorferi to efficiently colonize the gut epithelium. These data elucidate a functional link between the gut microbiota, STAT-signaling, and pathogen colonization in the context of the gut epithelial barrier of an arthropod vector.
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•Tick gut microbiota modulate Borrelia burgdorferi colonization of the gut•Gut microbiota maintain the integrity of the peritrophic membrane of the tick gut•The integrity of the peritrophic membrane promotes Borrelia colonization
The tick Ixodes scapularis is a major vector of the Lyme disease spirochete Borrelia burgdorferi. Narasimhan et al. find that tick gut microbiota affect spirochete colonization by regulating the integrity of the peritrophic matrix, a mucus-like lining of the arthropod gut, via transcription factor STAT-mediated control of peritrophin expression.
•Dose-escalation was associated with greater prostate ablation and PSA decay.•All dose groups in our study achieved median nPSAs of ≤0.2 ng/mL.•Dose-escalation to 40/5, but not beyond, was associated ...with improved BCRFS.•Rates of BCR were low across all dose groups, with 5-year BCRFS estimates of at least 93%.
The optimal dose for prostate stereotactic body radiotherapy (SBRT) is still unknown. This study evaluated the dose–response relationships for prostate-specific antigen (PSA) decay and biochemical recurrence (BCR) among 4 SBRT dose regimens.
In 1908 men with low-risk (50.0%), favorable intermediate-risk (30.9%), and unfavorable intermediate-risk (19.1%) prostate cancer treated with prostate SBRT across 8 institutions from 2003 to 2018, we examined 4 regimens (35 Gy/5 fractions 35/5, n = 265, 13.4%, 36.25 Gy/5 fractions 36.25/5, n = 711, 37.3%, 40 Gy/5 fractions 40/5, n = 684, 35.8%, and 38 Gy/4 fractions 38/4, n = 257, 13.5%). Between dose groups, we compared PSA decay slope, nadir PSA (nPSA), achievement of nPSA ≤0.2 and ≤0.5 ng/mL, and BCR-free survival (BCRFS).
Median follow-up was 72.3 months. Median nPSA was 0.01 ng/mL for 38/4, and 0.17–0.20 ng/mL for 5-fraction regimens (p < 0.0001). The 38/4 cohort demonstrated the steepest PSA decay slope and greater odds of nPSA ≤0.2 ng/mL (both p < 0.0001 vs. all other regimens). BCR occurred in 6.25%, 6.75%, 3.95%, and 8.95% of men treated with 35/5, 36.25/5, 40/5, and 38/4, respectively (p = 0.12), with the highest BCRFS after 40/5 (vs. 35/5 hazard ratio HR 0.49, p = 0.026; vs. 36.25/5 HR 0.42, p = 0.0005; vs. 38/4 HR 0.55, p = 0.037) including the entirety of follow-up, but not for 5-year BCRFS (≥93% for all regimens, p ≥ 0.21).
Dose-escalation was associated with greater prostate ablation and PSA decay. Dose-escalation to 40/5, but not beyond, was associated with improved BCRFS. Biochemical control remains excellent, and prospective studies will provide clarity on the benefit of dose-escalation.
Steroid-induced ocular hypertension (OHTN) after penetrating keratoplasty (PKP) may cause irreversible damage to the optic nerve and graft failure. The purpose of this study is to report the first ...case of a post PKP patient with poorly controlled IOP, successfully treated with Kahook Dual Blade (KDB) goniotomy in both eyes.
The patient was a 62-year old male with prior PKP in both eyes for lattice corneal degeneration. After an uncomplicated phacoemulsification in the left eye, his IOP increased to 32 mmHg on maximum tolerated IOP lowering therapy, including oral acetazolamide. This patient was dependent on scleral contact lenses for his irregular astigmatism post PKP to achieve his best-corrected visual acuity. Thus, we needed to consider a conjunctival sparing procedure and decided to proceed with performing a KDB goniotomy in the left eye. At 29 months follow up the visual acuity (VA) remained at 20/20 and IOP 13 mmHg on dorzolamide/timolol combination drop. A year following, his right eye also required KDB goniotomy combined with cataract surgery to treat his cataract and elevated IOP of 28 mm Hg. At 18 months post KDB goniotomy, the right eye VA was 20/50 and IOP 13 mmHg on dorzolamide/timolol combination drop.
This case demonstrates KDB goniotomy may be a good surgical alternative for post PKP steroid-induced OHTN or glaucoma, especially in patients requiring scleral contact lens for their visual rehabilitation.
Abstract Objective To evaluate the efficacy of postoperative fractionated stereotactic radiosurgery (FSRS) and hypofractionated stereotactic radiotherapy (SRT) to large surgical cavities following ...gross-total resection of brain metastases. Methods A retrospective analysis of 41 patients who had received tumor-bed FSRS (5 fractions) or SRT (10 fractions) following resection of brain metastasis between 2005 to 2015 was performed. All resection cavities were treated with a frameless LINAC-based system. Patients who underwent subtotal resection, single dose SRS to the resection cavity, or treated with a fractionation schedule other than 5 or 10 fractions were excluded. Results Twenty-six patients were treated with 5 fractions and fifteen patients with 10 fractions. The median planning target volume was 19.78 cm3 (12.3 – 28 cm3 ) to the 5-fraction group and 29.79 cm3 (26.3 – 47.6 cm3 ) to the 10-fraction group (p=0.020). The 1-year and 2-year local control rates to all patients were 89.4% and 77.1%, respectively, and 89.6% and 78.6% were free from distant intracranial progression, respectively. No difference was observed in local control or distant intracranial free from progression between 5 or 10 fractions groups. The median overall survival was 28.27 months (95% CI 19.42 – 37.12) for all patients. No patient developed necrosis at the resection cavity. Conclusions Fractionation offers the potential to exploit the different biologic responses between neoplastic and normal tissues to ionizing radiation. The use of 5 daily doses of 5-6Gy or 10 daily doses of 3Gy is a good strategy to have a reasonable local control and avoid neurotoxicity.
Dosimetric predictors of toxicity after Stereotactic Body Radiation Therapy (SBRT) are not well-established. We sought to develop a multivariate model that predicts Common Terminology Criteria for ...Adverse Events (CTCAE) late grade 2 or greater genitourinary (GU) toxicity by interrogating the entire dose-volume histogram (DVH) from a large cohort of prostate cancer patients treated with SBRT on prospective trials.
Three hundred and thirty-nine patients with late CTCAE toxicity data treated with prostate SBRT were identified and analyzed. All patients received 40 Gy in five fractions, every other day, using volumetric modulated arc therapy. For each patient, we examined 910 candidate dosimetric features including maximum dose, volumes of each organ CTV, organs at risk (OARs), V100%, and other granular volumetric/dosimetric indices at varying volumetric/dosimetric values from the entire DVH as well as ADT use to model and predict toxicity from SBRT. Training and validation subsets were generated with 90 and 10% of the patients in our cohort, respectively. Predictive accuracy was assessed by calculating the area under the receiver operating curve (AROC). Univariate analysis with student
-test was first performed on each candidate DVH feature. We subsequently performed advanced machine-learning multivariate analyses including classification and regression tree (CART), random forest, boosted tree, and multilayer neural network.
Median follow-up time was 32.3 months (range 3-98.9 months). Late grade ≥2 GU toxicity occurred in 20.1% of patients in our series. No single dosimetric parameter had an AROC for predicting late grade ≥2 GU toxicity on univariate analysis that exceeded 0.599. Optimized CART modestly improved prediction accuracy, with an AROC of 0.601, whereas other machine learning approaches did not improve upon univariate analyses.
CART-based machine learning multivariate analyses drawing from 910 dosimetric features and ADT use modestly improves upon clinical prediction of late GU toxicity alone, yielding an AROC of 0.601. Biologic predictors may enhance predictive models for identifying patients at risk for late toxicity after SBRT.
Glaucoma patients undergoing phacoemulsification alone have a higher rate of refractive surprise compared to patients without glaucoma. This risk is further increased with combined filtering ...procedures. Indeed, there are few and conflicting reports on the effect of combined phacoemulsification and micro-invasive glaucoma surgery (MIGS). Here, we look at refractive outcomes of glaucoma patients undergoing phacoemulsification with and without Kahook Dual Blade (KDB) goniotomy.
Retrospective chart review of 385 glaucomatous eyes of 281 patients, which underwent either phacoemulsification alone (
= 309) or phacoemulsification with KDB goniotomy (
= 76, phaco-KDB) at the University of Colorado. The main outcome was refractive surprise defined as the difference in target and postoperative refraction spherical equivalent greater than ±0.5 Diopter (D).
Refractive surprise greater than ±0.5 D occurred in 26.3% of eyes in the phaco-KDB group and 36.2% in the phacoemulsification group (
= 0.11). Refractive surprise greater than ±1.0 D occurred in 6.6% for the phaco-KDB group and 9.7% for the phacoemulsification group (
= 0.08). There was no significant difference in risk of refractive surprise when pre-operative IOP, axial length, keratometry or performance of KDB goniotomy were assessed in univariate analyses.
There was no difference between refractive outcomes of glaucomatous patients undergoing phacoemulsification with or without KDB goniotomy.
To assess the optimal planning target volume (PTV) margins for stereotactic body radiotherapy (SBRT) of prostate cancer based on inter- and intra-fractional prostate motion determined from daily ...image guidance.
Two hundred and five patients who were enrolled on two prospective studies of SBRT (8 Gy × 5 fractions) for localized prostate cancer treated at a single institution between 2012 and 2017 had complete inter- and intra-fractional shift data available. All patients had scheduled kilovoltage planar imaging during SBRT with rigid registration to intraprostatic fiducials prior to each of four half-arcs delivered per fraction, as well as cone beam CT verification of anatomy prior to each fraction. Inter- and intra- fractional shift data were obtained to estimate the required PTV margins based on the classic van Herk formula. Inter- and intra-fractional motion were compared between patients with and without severe toxicities using the independent two-sample Wilcoxon test.
The margins required to account for inter-fractional motion were estimated to be 0.99, 1.52, and 1.45 cm in lateral (LR), longitudinal (SI), and vertical (AP) directions, respectively. The margins required to account for intra-fractional motion were estimated to be 0.19, 0.27, and 0.31 cm in LR, SI and AP directions, respectively. Large intra-fractional shifts were mostly observed in the SI and AP directions, with 2.0 and 5.4% of patients experiencing average intra-fractional motion >3 mm in the SI and AP directions, respectively, compared with none experiencing mean shifts >3 mm in the LR direction. Six patients experienced grade 3 gastrointestinal or genitourinary toxicity. There were no significant differences in mean inter- or intra-fractional motion in any of the cardinal directions compared to patients without severe toxicity (inter-fractional
= 0.46-0.99, intra-fractional
= 0.10-0.84).
The inter- and intra-fractional margins estimated from this study are in line with prior reported values. Intra-fractional prostate motion was generally small with larger margins required for the SI and AP directions, notably just slightly exceeding the commonly used 3 mm posterior PTV margin even with realignment between half-arcs. Development of severe toxicity was not significantly associated with the degree of inter- or intra-fractional motion.
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