Inconsistent Treatment Research Articles

Mandating nerve biopsy: A step towards personalizing therapy in pure neuritic leprosy.

Pure neuritic leprosy (PNL) accounts for 5% to 10% of leprosy patients who usually present with asymmetrical neuropathy in the absence of lepra bacilli on slit-skin smears. However, nerve biopsies in PNL lack appropriate categorization in current immunologic terms. We aimed to classify nerve biopsies according to the immune spectrum of leprosy and assess the role of histologic classification of nerve biopsies in treating PNL. Patients from two tertiary care referral centres were enrolled in this incident case study. Patients presenting with mononeuropathy and multiple mononeuropathies presumably with leprosy, without skin lesions, underwent nerve biopsy and slit-skin smear examination. Amongst 78 patients with mononeuropathy, 38 were diagnosed with leprosy on nerve biopsy. Leprosy was classified as tuberculoid in 16, lepromatous in 5 and borderline in 17 patients. Lepra bacilli were present in 15 biopsies. On comparing histologic subtypes with number of nerves involved clinically, a significant number of cases with single nerve involvement showed multibacillary (BB, BL or LL) histology and vice versa. Nerve biopsy helps in diagnosing patients presenting with PNL and aids in classifying it to customize the treatment for best results. Current treatment recommendations for PNL from WHO and National Leprosy Eradication Program are based on clinical assessment only, which are likely to result in inconsistent treatment and possibly relapse in cases where histomorphology shows disparity. Inclusion of nerve biopsy to guide therapy in patients with PNL is suggested.

Fractures of the lateral process of the talus-snowboarder's ankle

Fractures of the lateral tubercle of the talus (PLT) are rare. With the increasing popularity of the trend sport snowboarding, the incidence of PLT fractures has increased. The most common classification of PLT fractures is the Hawkins classification. The aim of this review was to raise awareness for the injury and discuss the current evidence. A literature search revealed eight studies, each including at least seven patients. Six out of the eight studies were descriptive, retrospective case series without predefined treatment concepts. These resulted in only moderate treatment outcomes. Due to the low number of patients, the lack of computed tomography (CT) or magnetic resonance imaging (MRI) and inconsistent treatment approaches, these studies do not allow to draw conclusions on atreatment concept for PLT fractures. The other two studies validated existing treatment regimens. Overall, surgical treatment of dislocated fractures and conservative treatment of non-dislocated fractures was carried out with satisfactory results. The outcome of conservative treatment of dislocated factures remains unclear. A reason for the inconsistent treatment results could be the observed concomitant injuries, including dislocation of the tendons of the peroneus muscles (46%), calcaneal chondral injuries (48%) and subluxation of the subtalar joint (7%). Based on the limited evidence available, the authors recommend the application of CT and MRI for PLT fractures to assess concomitant injuries, which are the primary indication for surgery. Dislocated typeI and II fractures (>2 mm) should be treated operatively, typeIII and non-dislocated typeI and II fractures can be treated conservatively by immobilization and partial weight-bearing for 6weeks.

Ultrasonographic Findings in 41 Dogs Treated with Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma for a Supraspinatus Tendinopathy: A Retrospective Study.

Objective To report sonographic findings for dogs with a supraspinatus tendinopathy (ST) treated with an ultrasound-guided intratendinous injection of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP).Methods Medical records for dogs diagnosed with an ST and treated with a BMAC-PRP injection were reviewed. Data collected included patient signalment, radiographic findings at the time of initial evaluation, and sonographic findings, including cross-sectional area (CSA), fiber pattern, and echogenicity.ResultsOf 70 records reviewed, 41 met the inclusion criteria. Mean CSA of the supraspinatus tendon decreased by 0.06 cm2 between baseline and 45 days post-treatment (p = 0.0025), and 0.09 cm2 between baseline and 90 days post-treatment (p < 0.0001). Analysis of CSA in dogs with a unilateral ST at baseline revealed a difference of 0.08 cm2 between the affected and unaffected tendon at baseline, with the affected tendon measuring larger than the contralateral tendon (p < 0.0001). This difference became statistically insignificant by 45 days after treatment (u1-u0 = 0.04 cm2, p = 0.2855) and remained so 90 days post-treatment (u1-u0 = 0.03 cm2, p = 0.1910). In most cases (90.6%), the fiber pattern and echogenicity was considered improved 90 days post treatment. In a minority of these cases (13.8%) the fiber pattern and echogenicity abnormalities were considered resolved.Conclusions Using qualitative and quantitative sonographic measures, BMAC-PRP was associated with an improvement in supraspinatus tendon size, fiber pattern, and echogenicity. Given the protracted nature of tendon healing, long-term evaluation may reveal continued improvements in chronic structural changes not captured during the current study. Functional studies are required to evaluate the clinical benefits of BMAC-PRP in the treatment of STs in dogs.Clinical significance An ST is a common contributor to forelimb lameness in dogs and remains notoriously difficult to treat. Previous studies have been associated with inconsistent treatment outcomes. In the current study, BMAC-PRP is investigated as a minimally invasive treatment option, revealing positive sonographic results.

NHL in adolescents and young adults: A unique population.

Non-Hodgkin lymphoma (NHL) is a heterogeneous group of lymphoid malignancies with high incidence in adolescents and young adults (AYAs). The most common diseases include diffuse large B-cell lymphoma, anaplastic large cell lymphoma, Burkitt lymphoma, lymphoblastic lymphoma, and primary mediastinal large B-cell lymphoma. In comparison to younger children and adults, AYAs (15-39 years) with NHL present a specific set of challenges including variations in tumor biology, inconsistent treatment, pharmacodynamics, and psychosocial barriers. While survival of AYAs with NHL has improved, cure rates remain suboptimal. Incorporation of novel agents into pediatric-inspired treatment regimens specifically designed for NHL in AYAs has led to improved outcomes. Consideration of AYAs as a distinct population in the diagnosis and treatment of NHL is encouraged.

Towards Single Supervision and Resolution of Systemically Important Non-Bank Financial Institutions in the European Union

The global financial crisis proved that banks are not the sole source of systemic risk to the financial system and the wider economy. Indeed, systemic risk emanating from non-bank financial institutions proved to be a key vulnerability of the financial system. Such risks occurred, above all, when leveraged non-bank financial institutions performed bank-like activities such as maturity and/or liquidity transformation. However, the increasingly blurred distinction between markets, financial institutions, services and products is not matched in the European Union by an integrated regulatory and supervisory approach. Instead, regulation was and remains largely organised along sectoral lines, with an emphasis on the banking sector. As the global financial crisis shows, this creates a risk of gaps in the coverage of regulation and supervision, leading to inconsistent regulatory treatment of equivalent products and/or services. This in turn causes an unlevel playing field and increases the potential for regulatory arbitrage. In consequence, risky activities migrate to less regulated or unregulated parts of the financial system, leading to a largely unchecked build-up of systemic risk. Drawing inspiration from the reforms in the United States, we propose that the EU’s system of financial regulation be complemented by a robust body charged with identifying and monitoring non-bank financial institutions that are systemically important. This EU authority should have the discretion to designate a non-bank financial institution as a Non-Bank Systemically Important Financial Institution (non-bank SIFI). A logical choice would be to confer such powers on the European Systemic Risk Board. Designated non-bank SIFIs should be placed under direct prudential supervision by an EU body. This EU supervisor would have to establish, on an individual or categorical basis, appropriate enhanced prudential requirements tailored to the nature, risks and activities of the relevant non-bank SIFI. Additionally, a single European resolution regime should be in place to ensure that non-bank SIFIs can fail without destabilising the financial system. This would avoid a possible ‘Too-Big-To-Fail’ status, remove implicit government guarantees and subject the institution to market discipline. Our proposal aims to ensure that non-bank SIFIs are brought within a regulatory perimeter and supervisory scrutiny consistent with the risk they pose to financial stability. Such a regime would (i) help to eliminate (national) supervisory and regulatory gaps, (ii) reduce regulatory arbitrage activities, and (iii) contribute to the stability of the financial system and a level playing field.

The nutty world of hazel names – a critical taxonomic checklist of the genus Corylus (Betulaceae)

Hazelnuts (Corylus L.) are the source of one of the globally most important nut crops. Despite their economic and cultural importance, taxonomic knowledge is poor, even the number of species is equivocal. Weak morphological differentiation, the inconsistent taxonomic treatment of horticultural selections and cultivars, and uncritical regional treatments generated a multitude of names. The situation is further complicated by an ancient history of use (at least 10 400 years), trade (at least 4000 years) and domestication (at least 2000 years). Here, we present an annotated checklist of the taxa in the genus Corylus based on an extensive literature review, electronic database research, and visits to some European herbaria. Full citations are given for all names, typifications are provided for the majority of them. Cultivars are listed if described under the rules of the ICN. We designate lectotypes and neotypes for 28 names, and discuss the identity of enigmatic C. maxima Mill., a taxon not known from the wild.

The effect of non-uniform bending on the lateral stability of steel beams with slender cross-section at elevated temperatures

In this paper, the effect of non-uniform bending on the lateral torsional buckling (LTB) of steel beams with slender cross-sections subjected to elevated temperatures is numerically investigated. Local buckling is the main failure mode for slender sections whereas the lateral torsional buckling is one of the principal failure modes for beams, thus the interaction between these two failure modes greatly affects the load-bearing capacity of the beams. In the case of fire, recent studies have shown that the design procedures of Part 1–2 of Eurocode 3 are unreliable and too conservative due to the inconsistent treatment of such interaction phenomena. On the other hand, it is known that non-uniform bending has a beneficial effect on the ultimate capacity of beams but there is limited knowledge about its influence on beams with slender cross-sections. This work aims at studying the influence of non-uniform bending on the combined local-global interaction response of beams with slender open I-sections in the case of fire. The inclusion of the factor “f” in a recently proposed LTB design procedure that groups the response of the beams into different ranges of effective section factors is analysed and the accuracy of such proposal is demonstrated against around 20,000 GMNIA (Geometrically and Material Non-Linear Analyses with Imperfections) simulations. Finally, the improvements of this proposal on the current Eurocode 3 design procedure are highlighted.

The Registration of Customary Marriages: Banda v General Public Service Sectoral Bargaining Council (JR3273/2009)

Case Note

Interobserver and intraobserver reliability of radiographic classification of acromioclavicular joint dislocations

The classification and treatment of acromioclavicular (AC) joint dislocations remain controversial. The purpose of this study was to determine the interobserver and intraobserver reliability of the Rockwood classification system. We hypothesized poor interobserver and intraobserver reliability, limiting the role of the Rockwood classification system in determining severity of AC joint dislocations and accurately guiding treatment decisions. We identified 200 patients with AC joint injuries using the International Classification of Diseases, Ninth Revision code 831.04. Fifty patients met inclusion criteria. Deidentified radiographs were compiled and presented to 6 fellowship-trained upper extremity orthopedic surgeons. The surgeons classified each patient into 1 of the 6 classification types described by Rockwood. A second review was performed several months later by 2 surgeons. A κ value was calculated to determine the interobserver and intraobserver reliability. The interobserver and intraobserver κ values were fair (κ = 0.278) and moderate (κ = 0.468), respectively. Interobserver results showed that 4 of the 50 radiographic images had a unanimous classification. Intraobserver results for the 2 surgeons showed that 18 of the 50 images were rated the same on second review by the first surgeon and 38 of the 50 images were rated the same on second review by the second surgeon. We found that the Rockwood classification system has limited interobserver and intraobserver reliability. We believe that unreliable classification may account for some of the inconsistent treatment outcomes among patients with similarly classified injuries. We suggest that a better classification system is needed to use radiographic imaging for diagnosis and treatment of AC joint dislocations.

High variability of TB, HIV, hepatitis C treatment and opioid substitution therapy among prisoners in Germany

BackgroundIn Germany, medical care of prisoners is completely separated from extramural health care. The extent and quality of medical care among prisoners in Germany are therefore largely unknown. We performed a secondary data analysis of pharmacy sales data for tuberculosis (TB), HIV, hepatitis C (HCV) and opioid substitution treatment (OST) delivered to prisons in 11 federal states (FS) in Germany between 01/2012 and 03/2013. The aims of this study were to assess (i) the treatment availability for the selected diseases and OST in German prisons, (ii) the proportion of prisoners treated per FS and overall for TB, HIV, HCV and OST during the study period.MethodsSubstances unique to or typically used for the treatment of each disease were defined as marker substances with defined daily doses (DDD).For each marker substance we assessed the cumulative number of DDD, the average daily number of DDD (DDDd) and average treatment prevalence per day in percent (adTP). Accordingly, the DDDd represents one person treated per day and the adTP means the proportion of prisoners treated per day. We compared the adTP of the diseases with previously measured prevalences.ResultsWe obtained data from pharmacies supplying prisons in 11 of 16 German FS. Of the included prisons, 41% were supplied with medicines for TB, 71% for HIV and 58% for HCV and OST. Twice as many delivered marker substances for TB were indicated for the continuation phase and chemoprevention than the intensive phase. The HIV adTP ranged from 0.06% to 0.94%, HCV adTP ranged from 0.03% to 0.59% and OST adTP ranged from 0% to 7.90%. The overall adTP for the respective treatment was 0.39% for HIV, 0.12% for HCV and 2.18% for OST.ConclusionsAccording to our findings treatment rates for TB were consistent with the expected TB prevalence, at least in Berlin. HIV treatment seems to be offered to an adequate proportion of estimated infected prisoners. In contrast, the HCV treatment prevalence was low. High variation among FS in provision of all treatments, particularly of OST, point to inconsistent treatment practices, although nationwide extramural treatment guidelines for Germany exist.

Correction.

Inconsistent treatment estimates from mis-specified logistic regression analyses of randomized trials, by J.N.S. Matthews and N.H. Badi, Statistics in Medicine, 2015;34:2681-2694. There is a misprint in Table I of this paper. The entries in the first block of the table (ie, α=0.5, βk=0.5) for the case p=2,q=3, namely, 0.308, 0.330, and 0.309, should be 0.437, 0.446, and 0.434, respectively, as they must coincide with the values in the first column of the final block of Table II. We apologize to the readers of the journal and thank Professor Mike Campbell of the University of Sheffield for drawing our attention to this error.

Delegated Legislation: The Tangled World of Grounds and Standards of Review

This paper considers the current state of judicial review of delegated legislation in Canada as it has been most recently articulated in a series of decisions of the Supreme Court of Canada. The paper begins by considering the application of the standard of review analysis – or not – to the judicial review of delegated legislation and the inconsistent treatment of municipal by-laws and professional regulations, on the one hand, and regulations of the executive branch, on the other. It then considers how the three interpretive principles that the Supreme Court in its decision in Katz Group outlined as the cornerstones for the judicial review of delegated legislation have been applied in recent cases. Finally, it argues for the application of the standard of review analysis to all delegated legislation, including the potential for applying a reasonableness standard that amalgamates the traditional grounds of review into this standard, as the Court has already done in relation to municipal by-laws and professional regulations.

Surgical management of spinal osteoblastomas.

OBJECTIVE Osteoblastoma is a rare primary benign bone tumor with a predilection for the spinal column. Although of benign origin, osteoblastomas tend to behave more aggressively clinically than other benign tumors. Because of the low incidence of osteoblastomas, evidence-based treatment guidelines and high-quality research are lacking, which has resulted in inconsistent treatment. The goal of this study was to determine whether application of the Enneking classification in the management of spinal osteoblastomas influences local recurrence and survival time. METHODS A multicenter database of patients who underwent surgical intervention for spinal osteoblastoma was developed by the AOSpine Knowledge Forum Tumor. Patient data pertaining to demographics, diagnosis, treatment, cross-sectional survival, and local recurrence were collected. Patients in 2 cohorts, based on the Enneking classification of the tumor (Enneking appropriate [EA] and Enneking inappropriate [EI]), were analyzed. If the final pathology margin matched the Enneking-recommended surgical margin, the tumor was classified as EA; if not, it was classified as EI. RESULTS A total of 102 patients diagnosed with a spinal osteoblastoma were identified between November 1991 and June 2012. Twenty-nine patients were omitted from the analysis because of short follow-up time, incomplete survival data, or invalid staging, which left 73 patients for the final analysis. Thirteen (18%) patients suffered a local recurrence, and 6 (8%) patients died during the study period. Local recurrence was strongly associated with mortality (relative risk 9.2; p = 0.008). When adjusted for Enneking appropriateness, this result was not altered significantly. No significant differences were found between the EA and EI groups in regard to local recurrence and mortality. CONCLUSIONS In this evaluation of the largest multicenter cohort of spinal osteoblastomas, local recurrence was found to be strongly associated with mortality. Application of the Enneking classification as a treatment guide for preventing local recurrence was not validated.

Estimating Available Abandoned Cropland in the United States: Possibilities for Energy Crop Production

Abandoned cropland (ACL) is often cited as a land resource on which to produce energy crops while reducing the negative impacts of broad-scale energy crop production; for example, carbon emissions from land-cover change and competition with food production. In contrast to marginal land, which refers to a set of biophysical and economic criteria usually imposed by experts or policymakers, the designation of ACL refers to a land-use decision by a land owner. As such, ACL is argued to be a more appropriate indication of land availability for dedicated energy crop production. Prevailing estimates of ACL in the United States vary widely due to inconsistent treatment of land-use conversions away from cropland and overreliance on remote sensing methods that measure land cover, even though ACL is a category of land use. This article develops and applies a replicable and flexible methodology to estimate available abandoned cropland (AACL) at the county level in the United States, which accounts for conversion of ACL to forest cover, urban development, or permanent pasture. Estimates of AACL are derived for two scenarios: (1) land abandoned between 1978 and 2012, which excludes lands with meaningful forest regrowth, and (2) land abandoned between 2007 and 2012, which corresponds to land-use constraints imposed by the Renewable Fuel Standard. Results show that 15.0 and 4.9 Mha of AACL exist in the United States in the two scenarios, respectively, amounting to between only 3 and 8 percent of total light-duty gasoline consumption in the United States. The policy implications of these findings and the need for future research are discussed.

Central Retinal Artery Occlusion: Acute Management and Treatment.

This review will seek to answer if advances in ophthalmic imaging and evolution of treatment modalities have shed further light on the epidemiology, pathophysiology, diagnosis, and acute management of acute CRAO. Imaging characteristics of acute CRAO have been further characterized with the use of fluorescein angiography, optical coherence tomography (OCT), OCT-angiography, and indocyanine-green angiography. Layer segmentation of OCT imaging has found inner retinal layer hyper-reflectivity to be a common finding in acute CRAO. Non-invasive therapies, fibrinolytic delivery, and surgical interventions for acute CRAO have been further evaluated as potential management tools. A large body of literature reports very inconsistent treatment success with a wide variety of modalities. Currently, there is no clear evidence supporting the use of fibrinolytics in acute CRAO. Large, multicenter, randomized control trials are necessary to elucidate the role of the various acute treatment options in the management of CRAO.

The association of hemodialysis and survival in intubated salicylate-poisoned patients

IntroductionSalicylate poisonings are common due to their multiple uses and wide availability. The variation of presenting symptoms contributes to inconsistent treatments in the emergency department. Patients with severe salicylate overdose require a high minute ventilation. Early in the course of an overdose, a patient will require hyperventilation. If they become too fatigued to compensate, mechanical ventilation may be needed. It can be impossible to recreate such a high minute ventilation with mechanical ventilation. This places patients at a high risk for decompensation and death. Hemodialysis is an effective elimination technique for salicylate overdose and should be considered early. MethodsAll salicylate cases reported to the Illinois Poison Center were reviewed from 2003–2014. All intubated patients with a salicylate level >50mg/dl were included for analysis. Survival was compared to measured serum salicylate level and the administration of hemodialysis. Results56 Cases were identified with an overall survival rate of 73.2% in patients with a serum salicylate level >50mg/dl. When patients did not receive hemodialysis, a peak salicylate level >50mg/dl had a 56% survival rate and 0% survival when the level was >80mg/dl. In the patients who received hemodialysis, a peak salicylate level >50mg/dl had a 83.9% survival rate and 83.3% survival when the level was >80mg/dl. ConclusionSurvival was decreased in these patients if hemodialysis was not performed. Mortality increases with the measured serum salicylate level. Timely hemodialysis for intubated salicylate overdose patients decreases mortality.

Do Serials Have a Place in the Institutional Digital Repository?

ABSTRACTThe institutional repository (IR) can provide a system for digitizing print serials for online delivery and a way to archive and preserve serial content already available online. Organizing serial content in IRs varies based on the architecture of each repository. In this presentation, Kay Teel of the Metadata Department at Stanford University Libraries discussed different approaches IRs use to manage serial content. She gave examples illustrating the inconsistent treatment of serials in the Stanford Digital Repository (SDR) and described a conceptual model for serials in the SDR to provide an improved user experience finding and accessing digital serial content.

Towards Single Resolution and Single Supervision of Systemically Important Financial Institutions in the European Union?

The Global Financial Crisis proved that not only banks can cause systemic risk to the financial system and the wider economy. Indeed, systemic risk from nonbank financial undertakings proved to be a key vulnerability to the financial system. Such risks manifested when leveraged nonbank financial institutions provided bank-like activities, especially maturity and/or liquidity transformation. The increasingly blurred distinction between markets, financial institutions, services and products was, however, not matched by an integrated regulatory and supervisory approach.Instead, regulation remained sectorally organised, emphasizing on the banking sector. This created gaps in the coverage of regulation and supervision, leading to an inconsistent regulatory treatment of equivalent products and/or services. In turn this caused an unlevel playing field, provoking regulatory arbitrage behaviour leading to a migration of activities, and a build-up of systemic risk, in the less regulated or unregulated parts of the financial system.We propose a systemic approach, at the European level, to the monitoring of risks to financial stability posed by nonbank financial institutions. An EU institution, for example the European Systemic Risk Board, should be charged with identifying systemic risks in nonbank financial institutions. It should, subsequently, have the discretion to designate a nonbank financial firm as a Systemically Important Financial Institution (SIFI). Such designation would ensure that the level of regulatory and supervision commensurate with the risks to financial stability posed by a financial institution.Consequently, a European supervisor should have the possibility to impose enhanced prudential standards on designated firms. Additionally a single European resolution regime should be in place to ensure that vital functions of nonbank SIFIs remain operative even when they are failing or likely to fail, in order to guarantee the stability of the financial system.Such a regime would contribute to the elimination of supervisory and regulatory gaps, decrease regulatory arbitrage activities, and contribute to the stability of the financial system and a level-playing-field

Tennessee Williams and Italy: A Transcultural Perspective by Alessandro Clericuzio

Reviewed by: Tennessee Williams and Italy: A Transcultural Perspective by Alessandro Clericuzio Felicia Hardison Londre TENNESSEE WILLIAMS AND ITALY: A TRANSCULTURAL PERSPECTIVE. By Alessandro Clericuzio. Palgrave Macmillan, 2016; pp. xv + 225; 6 b/w illus. Italy and Italian culture held special allure for Tennessee Williams, as attested by his Memoirs, his published letters and notebooks, and some of his literary work. His close friendship with actress Anna Magnani, his liaison with Sicilian American Frank Merlo, and his working relationship with director Luchino Visconti all profoundly impacted his outlook and even directly stimulated his novel The Roman Spring of Mrs. Stone and play The Rose Tattoo. Alessandro Clericuzio's transcultural study not only fills gaps in our knowledge about the particulars of Williams's affinity for Italy, but also explores the chequered history of reception of Williams's work by Italian directors, audiences, critics, and censors. Clericuzio's transcultural approach takes the analysis beyond simple cross-fertilization of cultures; he shows how various forces in the evolving cultural climate—from lingering fascist elements in the wake of World War II, to the cold war, to the new freedoms of the 1960s, and so on—factored into the relentless ups and downs of Williams's reputation in Italy. Clericuzio's second chapter surveys these vicissitudes, tracing awareness of the young playwright back to the December 1945 and January 1946 issues of the monthly theatre journal Il dramma; the latter issue included an Italian transcription of an otherwise unavailable radio interview, which Clericuzio renders back into English, in which Williams segues from comments on The Glass Menagerie to his vision for theatre as a basis for "international comprehension" (12). Yet, the first Italian production of a Williams play, Visconti's Lo zoo di vetro (The Glass Menagerie) in Rome in December 1946, was hissed and booed by audiences resentful of an American presence on the Italian stage (17). For one critic, The Glass Menagerie exemplified the "new mental structure" of a nation that had no fear of being colonized (20); others were confused as they tried to reconcile the apparent symbolism of the play with their expectation of the neo-realism that had made Visconti's reputation as a film director. But most critics ignored the author as they focused on the celebrity director's stage work. The critical survey chapter shows that even during the golden years of Williams's reputation in Italy, roughly 1957 to 1964, there were some harsh assessments. The negative responses to his experimental plays of the later 1960s in Italy paralleled criticisms in the United States and elsewhere. Then the playwright's death in 1983 brought a new wave of appreciation for the canon as a whole, for his great female characters, and for his willingness to represent the underside of American culture. This chapter, the longest in the book, is a heroic effort, as Clericuzio waded through hundreds of reviews to cull and translate the pithiest or most revealing observations; it is also the toughest going for the reader, with its complicated interweaving of ideas from so many reviewers and publications. An appendix listing of major Italian productions partially compensates for the lack of play titles in the people-names-only index. In the chapter on Visconti's productions of The Glass Menagerie and A Streetcar Named Desire, Clericuzio deftly pulls together biographical details about the director and the playwright and information on leading Italian stage artists, as well as accounts of Visconti's directorial approach to the plays and of the major impact that Italian censorship had on their collaboration. Unfortunately, Visconti's attempt to skirt censorship by slipping some vulgar words back into the opening-night performance of his 1949 Streetcar had an adverse effect on subsequent dealings with censors and may have thwarted not only the director's hope of directing Cat on a Hot Tin Roof, but Hollywood's distribution of Williams films in Italy as well. Questions of censorship, including inconsistent treatment of allusions to homosexuality, crop up also in the chapters on subsequent productions of Streetcar, The Rose Tattoo, and The Roman Spring of Mrs. Stone, and on the plays of the "golden years." In the final two chapters, Clericuzio...

The Genesis of Liberation: Biblical Interpretation in the Antebellum Narratives of the Enslaved by Emerson B. Powery and Rodney S. Sadler Jr

Reviewed by: The Genesis of Liberation: Biblical Interpretation in the Antebellum Narratives of the Enslaved by Emerson B. Powery and Rodney S. Sadler Jr Kimberly D. Russaw emerson b. powery and rodney s. sadler jr., The Genesis of Liberation: Biblical Interpretation in the Antebellum Narratives of the Enslaved (Louisville: Westminster John Knox, 2016). Pp. xvii + 182. $35. In the television series Underground, Aisha Hinds masterfully commands the attention of viewers in her portrayal of Harriet Tubman, and the show’s director, Anthony Hemingway, often shoots the action such that viewers transgress the theatrical fourth wall. Viewers were drawn in to the rich story of Harriet because of the choices made by the actor and director. Similarly, because of the choices made by the book’s authors, Emerson Powery and Rodney Sadler, readers are drawn into the rich use of the biblical text by antebellum African Americans. Instead of simply drawing conclusions about how the formerly enslaved may have employed and interpreted the biblical text based on third-party historical reports, P. and S. center the voices of the formerly enslaved in Genesis. In so doing, P. and S. allow the ante-bellum interpreters to draw readers into their rich stories and help readers transgress the literary fourth wall. This is the genius of Genesis. Intrigued by the possibility of unique approaches of biblical interpretation among formerly enslaved African Americans, P. and S. set out to unearth reading strategies in the texts produced by antebellum African Americans. Bound by an introductory first chapter and a summary sixth chapter, Genesis is divided into four chapters. In chap. 2, “The Bible and the Freedom Narrative, “the authors consider how the formerly enslaved read the Bible. Beginning with James Gronniosaw’s writings, P. and S. take up the trope of the “talking book” and then examine the use of particular biblical passages by individuals such as James Pennington and Harriet Jacobs. P. and S. include throughout the book writings produced by both males and females. These examples, along with the work of Frederick Douglass, Henry Highland Garnet, Sojourner Truth, and Richard Allen point to how biblical literacy signaled the beginning of the challenge to an interpretive worldview that had dehumanized black identity and black humanity (p. 60). While readers may be familiar with the accomplishments of Douglass, Truth, or Allen, P. and S. use their writings to demonstrate how antebellum African Americans employed the biblical text in their quest for freedom—both sociopolitical and religious freedom. In chap. 3, “The Sabbath and the Freedom Narrative,” the authors consider the antithetical and inconsistent treatment of the enslaved on the day the biblical writers designated for rest. For some enslaved it was a time to hear the preaching of the white slaveholders’ gospel. For others, it was a time to visit with distanced family members. While many slave owners encouraged the enslaved to use the Sabbath as a time to engage in less productive activities like gambling and carousing, some among the enslaved used Sabbath to gather as community to learn to read, discuss freedom, or plan their escape. The testimonies of Mary Prince, Henry Bibb, and Peter Randolph avow that what slaveholders wanted the enslaved [End Page 718] to do on the Sabbath did not always align with what the enslaved actually did on the Sabbath, or what the enslaved hoped to achieve on the Sabbath (p. 63). In chap. 4, “The Origins of Whiteness and the Black Biblical Imagination,” P. and S. explore the “curse” of Ham and the “one blood” tradition in chap. 4, The authors use the work of William J. Anderson (Life and Narrative of William J. Anderson, Twenty-four Years a Slave [Chicago: Daily Tribune Book and Job Printing Office, 1857]) and others to counter the popular idea of whiteness as virtuous. Anderson critiques white interpretive tendencies in his reading of 2 Kings 5 alongside the story of Ham in Genesis and sheds light on the inconsistencies of the hermeneutical traditions of the pro-slavery school (p. 110). I found chap. 5, “Reading Paul with the Formerly Enslaved: Emancipation from the ‘Master’s Minister,’” most instructive. Grounded in the story of Howard Thurman’s grandmother, who rejected the words of...