Persistent Debate Research Articles

Objectivity in performance ranking of higher education institutions using dynamic data envelopment analysis

PurposeThere has been a persistent debate on measures of efficiency and ranking procedures of higher education institutions (HEIs). Deriving absolute efficiency measures and their ranking provide a critical input for the society to choose the appropriate educational institute. The purpose of this paper is to evaluate the relative performance of institutions in management education in different locations in India and propose a holistic efficiency measurement which can be applied to HEIs in general.Design/methodology/approachThis study uses dynamic data envelopment analysis (DDEA) as the primary methodology of analysis. Multiple measures of inputs and output have been defined to assess efficiency in institutions of management education. Some of the output variables used for measuring relative effectiveness are: the number of students placed, number of entrepreneurs, median CTC of placed students, total number of students passed, number of research publications, number of students and faculty who have participated in international exchange, input variables used, student intake, faculty profile, resource allocation on the development of student, faculty and staff, industry linkages, alumni network. The institutions under study are in three different locations in India, having distinct characteristics. The multiple measures of inputs and outputs defined have been used to measure efficiency, following which DDEA was used to rank the efficiency measures.FindingsVarious agencies use their framework to evaluate and rank HEIs; however, they are either subjective or less researched methodologies. The proposed method acts as a new researched and objective methodology for ranking of HEIs operating across regions with different societal, economic and political contexts. Efficiency in education is of high relevance today for various stakeholders such as students, parents, industry, policy-makers and government. An objective, such as the one proposed in this paper, would be helpful in satisfying the needs of various stakeholders. Furthermore, the government has policies of allocating funds, in case of public-funded institutions, based on efficiency levels in HEIs. The measure using DDEA suggested in this study provides a better measurement of efficiency.Research limitations/implicationsThis research is based on the extension of DDEA with slight modification to the denominator portion of efficiency calculation. The modification is accentuated by taking an industry benchmark or government benchmark. This may lead to slight difficulty in the appropriation of input parameters. Hence, selection of appropriate input and output parameters is the key limitation. To demonstrate capabilities of the proposed approach, this framework is implemented for performance evaluation of institutions of higher education in India. Some helpful policy-making and managerial insights are derived from the numerical results.Originality/valueThe uniqueness of this research is that it adds a well-researched methodology based on DDEA to measure efficiency and rank HEIs for effective assessment and benchmarking. The frameworks used so far have been either subjective or less researched methodologies.

Kafka, the Caribbean, and the Holocaust

This essay reexamines the figure of Franz Kafka (1883–1924) in light of his largely ignored, recursive links to circum-Caribbean and Black Atlantic processes of racialized exploitation and corporal punishment. When we centre Kafka's extensive biographical and literary engagements with these processes, the persistent debate over Kafka's status as a Holocaust prophet emerges in a new light. Kafka's archival trail connects his lifelong attention to African enslavement and New World plantation economies to his nightmarish vision of murderous bureaucracies – a connection that crystallizes concretely in his 1919 short story “In the Penal Colony.” The archival and aesthetic connections direct us to a historiographical one, namely the increasingly excavated genealogical linkages between the Holocaust and anterior genocidal depredations in Africa and the New World under the auspices of European colonialism. This historiographical reorientation allows us to recast, in a global frame, the debate over Kafka's status as a prophet of world history, a debate that has heretofore operated through the exclusion of the transatlantic slave trade. Kafka's extensively documented attunement to colonial political economies provides formal, figural mechanisms that not only link the juridical–economic worlds of Caribbean slavery and Hitler's Third Reich, but also anticipate, and disable, the dehistoricized, Eurocentric appropriation of his textual archive as a premonition of Auschwitz.

Abstract P4-08-23: EndoPredict prognostic signature in pN1mi, estrogen receptor-positive breast cancer: analysis of the French national registry for molecular signatures

Abstract Background The EndoPredict (EP) test has been developed and validated for assessing recurrence risk in patients with estrogen receptor (ER)-positive HER2-negative breast cancer (BC). This test is based on the expression of 12 genes (molecular score), combined with clinicopathological criteria (i.e. tumor size and nodal status) (EPclin risk score). For node-positive patients, the weight given to the node status in the EPclin score is similar when considering pN1mi (]0.2-2mm]) or pN1 (>2mm, 1-3 positive lymph nodes). Our aim was to characterize the EPclin classification of the pN1mi subgroup in the French national registry for molecular signatures in ER+ BC. Methods Since April 2016, nine French laboratories using EP test in clinical practice prospectively implement a national registry for molecular prognostic signatures in ER+ BC. We analyzed the pN1mi subgroup with regards to their clinico-pathological characteristics, molecular EP score and EPclin risk score. Using the definition formula of the EPclin score [EPclin=0.35t + 0.64n + 0.28EP, with n=1 for pN0, 2 for pN1mi/pN1, 3 for pN2, 4 for pN3], we could calculate a hypothetical EPclin score if the pN1mi had been considered as pN0 [n factor=1]. Results By the end of 2017, the database included 1246 EP tests performed in routine practice, including 67 (5.4%) pN1mi. The pN1mi BC were ER+ HER2- (67/67, 100%), invasive carcinoma of no special type in 52/67 (78%), with a median tumor size of 18 mm (range 7-45; pT1c in 40/67). Among these, 22 were classified as EPclin low and 45 as EPclin high, with a median EP score of 6 (range 2-14), a median EPclin score of 3.70 (range 3-6), and a median relapse risk at 10-year of 15%(range 5-73). Most interestingly, 23/67 (34%; i.e. 1.8% of all EP tests performed) pN1mi BC displayed an EPclin score comprised between 3.4 and 4, just above the cut-off value of 3.3: these cases (and only these cases) would have been classified in a different risk category (i.e. EPclin low risk) if the node status would have been considered as negative. Conclusion With regards to EndoPredict test in pN1mi BC - and the persistent debate as to whether they should bear the same weight as node-positive (pN1) or negative (pN0) tumors - categorization in the EPclin class is not likely to be impacted by the node factor weight in the vast majority (>65%) of the pN1mi cases and >98% of all patients tested with EP. Only cases with an EPclin between 3.4 and 4 might be impacted. Citation Format: LaCroix-Triki M, Arnould L, MacGrogan G, Penault-Llorca F, Haudebourg J, Tas P, Garnier A, Vincent-Salomon A, Miquel C, Lehmann-Che J, Callens C, Quillien V, Cayre A, Lamy P-J, Rouleau E, De Cremoux P. EndoPredict prognostic signature in pN1mi, estrogen receptor-positive breast cancer: analysis of the French national registry for molecular signatures [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-23.

Abstract P3-11-10: Prosigna prognostic signature in pN1mi, estrogen receptor-positive breast cancer:the pN categorization impacts the BC risk stratification

Abstract Background Several validated molecular subtyping tests for breast cancer based on gene expression profiling are now routinely used in clinical practice.The Prosigna® breast cancer (BC) prognostic gene signature assay identifies a gene-expression profile that permits the classification of tumors into subtypes and gives a score for the risk of recurrence (ROR) at 10 years. The assay uses the 50-gene expression profile, weighted together with clinical variables, to generate a risk category and numerical score. The score is reported on a 0-100 scale, for hormone receptor positive BC. Prosigna test results classified tumors according to intrinsic subtypes (Lum A, Lum B, HER2-enriched, basal-like) and ROR risk groups (low risk, 0-40; intermediate risk, 41-60; and high risk, 61-100). For node-positive patients, the weight given to the node status is similar when considering pN1mi ([0.2-2mm]) or pN1 (>2mm, 1-3 positive lymph nodes). Our aim was to characterize the Prosigna test classification of the pN1mi subgroup in the French national registry for molecular signatures in ER+ BC. Methods Since 2018, four French laboratories using Prosigna test in clinical practice retrospectively implement a national registry for molecular prognostic signatures in ER+ BC. We analyzed the pN1mi subgroup with regards to their clinico-pathological characteristics, Prosigna test results and ROR risk score. Using the definition formula of the prosigna algorithm, we could calculate a hypothetical score if the pN1mi has been considered as pN0 and redefine risk categories for pN1mi breast cancers. Results The database included 886 tests performed in routine practice, including 91 (10.3%) pN1mi. The pN1mi BC were ER+ HER2- (88/91, 96.7%), invasive carcinoma of no special type in 81/91 (89%), with a median tumor size of 23 mm (range 12-60). Among these, the median ROR score was 44, and 51/91 tumors (56%) were classified as LumA tumors, 34/91 (41%) as LumB, two asHER2-enriched and one as basal-like. Interestingly, the probability of distant recurrence was 26% if pN1mi BC were considered as N+ but lowered to 10% if considered as pN0. Among the different molecular subtypes, the change from pN1 top N0 has different weight: in Lum A tumors, the switch in the probability of distant recurrences was 13 to 6% according to pN categorization of the pN1mi BC, and the median ROR score moved from 27 to 6 with 15/51(29%) of Lum A tumors considered as high risk if pN1 but only 1/51 if pN0; 31/51 (61%) versus 14/51 (27.5%) were in the intermediate risk group, and only 5/51 (10%) versus 34 (67%) in the low risk group. For LumB tumors, the switch in the probability of distant recurrences was 29% to 17% according to pN categorization and and the median ROR score moved from 60 to 15 with 36/37(97.3%) of Lum B tumors considered as high risk if pN1but only 13/37(35%) ifp N0; 1/37 versus 20/37 (54%) were in the intermediate risk group, and none of the 37 LumB versus 1 in the low risk group. Conclusion With regards to Prosigna test in pN1mi BC - and the persistent debate as to whether they should bear the same weight as pN1 pN0 tumors - categorization in ROR risk group is likely to be impacted by the node factor weight, and more importantly among Lum B tumors. Citation Format: Charafe-Jauffret E, Duprez-Paumier R, Berghian A, Penault-Llorca F, Dauplat MM, Boucraut A, Cohen M, Houvenaeghel G, Maroc C, Pradines A, Cayre A, Etancelin P, Lacroix-triki M. Prosigna prognostic signature in pN1mi, estrogen receptor-positive breast cancer:the pN categorization impacts the BC risk stratification [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-11-10.

More Work for Hybrid Persistence

AbstractRecently I defended a hybrid view of persistence whereby simple objects endure while composite objects are stage related. I argued that it deserves further investigation given the explanatory work it does with regard to two problems raised in the literature on the metaphysics of the persistence of objects. In this paper I look at two further problems that have been raised—one from natural explanation, the other from time travel. I show how the hybrid view is able to deal with these problems. In doing so I further build the case that the hybrid view is a serious contender in the persistence debate based on the explanatory work it can do.

Unusual Presentation of a Rare Giant Fibroadenoma of the Breast

Giant fibroadenomas are exceptional in pregnancy and in most of cases, diameter doesn’t reach more than 15 cm. However, our case is a rare one that reached 18 cm in a 23-year-old female referred post-partum for evaluation of a huge left breast mass. On the other hand, there is a persistent debate regarding the best modality of the surgical approach to giant tumors; most of the experts recommend the enulceation of the tumor after delivery while others argue that extirpation during pregnancy is the best since we have to exclude malignancy. In our patient, the whole tumor was excised at the postpartum period and the pathology did not show any sign of malignancy. Even if our case does not clearly reveal the long term result of the postpartum excision of a giant fibroadenoma, the short term result we have had after this approach was satisfying. Further studies are important to be published in order to confirm pros and cons of the postpartum approach.

When and Why to Replicate: As Easy as 1, 2, 3?

The crisis of confidence in psychology has prompted vigorous and persistent debate in the scientific community concerning the veracity of the findings of psychological experiments. This discussion has led to changes in psychology’s approach to research, and several new initiatives have been developed, many with the aim of improving our findings. One key advancement is the marked increase in the number of replication studies conducted. We argue that while it is important to conduct replications as part of regular research protocol, it is neither efficient nor useful to replicate results at random. We recommend adopting a methodical approach toward the selection of replication targets to maximize the impact of the outcomes of those replications, and minimize waste of scarce resources. In the current study, we demonstrate how a Bayesian re–analysis of existing research findings followed by a simple qualitative assessment process can drive the selection of the best candidate article for replication.

Initia Reformationis. Wittenberg und die Frühe Reformation ed. by Irene Dingel et al.

Reviewed by: Initia Reformationis. Wittenberg und die Frühe Reformation ed. by Irene Dingel et al. Kurt K. Hendel Initia Reformationis. Wittenberg und die Frühe Reformation. Edited by Irene Dingel, Armin Kohnle, Stefan Rhein, and Ernst-Joachim Waschke. Leucorea-Studien zur Geschichte der Reformation und der Lutherischen Orthodoxie, vol. 33. Leipzig: Evangelische Verlagsanstalt, 2017. 445 pp. This volume is a collection of lectures presented at the XII. Frühjahrstagung zur Wittenberger Reformation, which took place in Wittenberg from March 17–19, 2016. Seventeen essays are organized into three sections, exploring 1) the piety and criticism of the church in the high and late Middle Ages, 2) the broader sixteenth-century context within which the Reformation movement emerged and expanded, and 3) particular aspects of the movement during its early years. It is likely that most readers of Lutheran Quarterly will be interested primarily in the essays in the first and third sections, although the chapters in the second section may spark interest inasmuch as they examine topics that are less familiar and provide information about the social, political, economic, and natural worlds within which the Wittenberg reform movement developed. The following essays may be of particular interest. In a carefully researched and nuanced study, Wolf-Friedrich Schäufele examines the criticism of the church in the high and late Middle Ages and concludes that medieval ecclesiastical critiques were primarily a self-critique by clerical leaders who sought to strengthen the church by reforming obvious abuses. Preserving ecclesiastical unity was a clear priority and reforms were pursued, in part, in order to achieve this goal. At the same time, [End Page 331] some voices were deemed to be heretical and resulted in schisms. These more radical voices at times anticipated the perspectives of sixteenth-century reformers. Temporal rulers, burghers, and peasants also voiced critiques. Their objective, however, was not to strengthen the church but to achieve political, economic, and social goals that threatened the institutional church. Schäufele concludes that medieval critiques were not a direct and certainly not the only cause of the Reformation. The new theological perspectives of Luther were the ultimate cause. Volker Leppin addresses the persistent debate regarding the nature and place of Luther's so-called evangelical discovery or tower experience in light of Luther's own comments. Leppin argues that Luther's evangelical identity emerged gradually. Leppin insists further that Luther's mention of the cloaca as the place of his discovery must be understood metaphorically. The Reformer used cloaca in his writings as a scatological description of the corruption of the papacy and the world. His point was, therefore, that he discovered the gospel in the midst of the corruption that was apparent in church and world. There was, therefore, also no tower experience. Irene Dingel addresses the question "How Lutheran was the Wittenberg Reformation?" She examines the early Wittenberg reform movement and its leaders and notes that, while Luther was clearly the chief Wittenberg reformer whose theology and personality impacted his colleagues, those colleagues, particularly Philip Melanchthon, also developed and transformed Luther's theology and reform proposals. The Wittenberg theology was, therefore, quite diverse. Nevertheless, that diversity did not result in schisms. Divisions and the emergence of competing camps occurred during the second half of the sixteenth century. Those divisions, fostered by a diversity of perspectives, especially the differences between Luther's and Melanchthon's theologies, were also given an impetus by the religious colloquies of the 1540s and 1550s which compelled the theologians to articulate their convictions in precise and clear ways. This tended to exacerbate differences. The quest for precision and the divisions that resulted were the impetus for the confessionalization of Lutheranism during the second half of the sixteenth century. Thus, as one answers the question of the Lutheran nature of the Wittenberg Reformation, it is appropriate to claim that during [End Page 332] the first decades of the sixteenth century it was Lutheran in the sense that it was identified with and closely related to the person of Luther. However, it was not Lutheran in a confessional sense until the latter half of the Reformation century. The essays are primarily historical, rather than theological studies. Their scholarly nature...

Her Voice Will Be on the Side of Right: Gender and Power in Women’s Antebellum Antislavery Fiction by Holly M. Kent

Reviewed by: Her Voice Will Be on the Side of Right: Gender and Power in Women’s Antebellum Antislavery Fiction by Holly M. Kent Kara B. Clevinger HER VOICE WILL BE ON THE SIDE OF RIGHT: GENDER AND POWER IN WOMEN’S ANTEBELLUM ANTISLAVERY FICTION, by Holly M. Kent. American Abolitionism and Antislavery. Kent, OH: Kent State University Press, 2017. 216 pp. $55.00 cloth; $46.99 ebook. Was the nineteenth-century woman empowered by the ideologies of true womanhood and separate spheres, or was she confined within the home? This question has defined a persistent debate for scholars of nineteenth-century American women’s literature since it was proposed by Ann Douglas and Jane Tompkins in the late 1970s and early 1980s. Douglas’s critique of the anti-intellectualism of much of women’s literature, clustered under the broad term “sentimentalism,” and Tompkins’s reclamation of that literature and the cultural work it performs, as well as the opening up of the canon of American literature, have inspired countless critical studies of women’s writing that have spanned the range of women’s empowerment. At this point, scholars of the nineteenth century agree: it is complicated. Holly M. Kent’s Her Voice Will Be on the Side of Right: Gender and Power in Women’s Antebellum Antislavery Fiction makes a significant contribution to this debate and the field of antebellum literary scholarship, as Kent explores how women writers intellectually and imaginatively considered the position of women as abolitionist activists and agitators in the United States between 1821 and 1861, arguing that white women writers conceived of gender, not race, as the most significant barrier to social justice and equality. Beginning with early antislavery fiction in the 1820s and the optimism of women writers’ belief that morally superior women could abolish slavery and de-corrupt men, Kent traces a decline in the hope for white women’s ability to effect change in a patriarchal society during each decade leading up to the Civil War. Much of the antislavery fiction Kent analyzes has received little attention from literary scholars, and thus her book is as much a recovery project as it is a compelling assessment of the productions of female antislavery fiction writers. Kent reads short and long-form fiction from well-known authors like Catharine Maria Sedgwick, Elizabeth Margaret Chandler, Lydia Maria Child, E. D. E. N. Southworth, and Harriet Beecher Stowe. She also introduces readers to a valuable sampling of lesser-known and [End Page 453] anonymous authors, such as African American writer Sarah Mapps Douglass, who contributed fiction for young readers to The Liberator, including a piece in August 1832 in which she does not reveal that the virtuous young female protagonist is African American until the end, hoping her young audience will learn a moral lesson in shame for their racist assumptions. Kent places Douglass’s short story within a fascinating comparison of African American and white women writers of antislavery fiction to demonstrate how African American authors took up debates about what society might look like after emancipation, while white authors focused on the liberation plot and held back from writing what came after emancipation. One of the more intriguing conclusions Kent comes to is that white women authors became increasingly uncomfortable with relinquishing conventional ideals of white middle-class femininity and could only imagine African American female characters embodying or desiring these traits rather than portraying new and diverse models of womanhood. The triumph of Kent’s book is the valuable contributions it makes to a number of scholarly conversations about the nineteenth century: antislavery fiction and abolitionist activism, domestic literature and separate spheres ideology, theories of public and private spheres, and the historiography of women and authorship. Kent intervenes in each of these conversations, placing her magnifying glass over fiction and examining how women imagined antislavery action rather than speculating on women’s lived experiences at the time. The result is an insightful and pure literary studies monograph, which is thoroughly researched with expert attention to secondary sources and a rich array of primary sources that made use of wonderful collections at the Boston Library, Smith College, and the Historical Societies of Massachusetts and...

Collective identity inside and out: Particularism through the looking glass

ABSTRACTThis article analyses literary sources that have influenced interpretations of the Italian collective identity, focusing on the conceptual pairing ‘familism-particularism’. In 1958 Edward Banfield coined the term ‘amoral familism’, generating an intense, persistent debate among Italian and foreign scholars. However, by expanding the analytical focus, similar explanations for Italian social, economic and political ‘backwardness’ can be traced much further back: to Alberti’s ‘land of self-interest’ or Guicciardini’s particulare. Representations of the cultural absence of civicness in Italy developed over the centuries, stemming initially from Italians’ own recognition of their self-image. It was only later, through the diaries of travellers on the Grand Tour, that this image was incorporated into the hetero-recognition of Italians by Northern Europeans and North Americans. When an identity feature maintains this ‘dual recognition’ for such a long historical period, it becomes a recurrent cardinal point in individual and collective representation of a people. Attempts to sustain theories conflicting with Banfield’s are confronted by other obstacles: the absence of comparable ethnographic studies translated into English and the rhetorical force of the expression ‘amoral familism’. The symbolic power of Banfield’s interpretation, which might be considered a stereotype, goes beyond its (in)ability to reflect social reality.

Extensionality for fusions and pluralities

One of the more persistent debates in mereology is whether distinct wholes can have the same parts. Extensional mereologists hold that if there is no part that makes the difference, then there is nothing to distinguish the wholes, so sameness of parts implies identity. Non-extensionalists, however, do think there are cases where distinct wholes share all their parts. This paper argues that the kind of argument non-extensionalists employ can also be levelled against a widely accepted extensionality principle of plural logic. Non-extensionalists thus face a dilemma: either give up the argument for non-extensional mereology, or deny both the extensionality principle of mereology and the analogous principle for plural logic.

Public Bureaucracy and Climate Change Adaptation

AbstractDespite recognizing the importance of public bureaucracies in governing climate change, our knowledge of how their behavioral and structural characteristics influence climate change adaptation policy is limited. This article provides an introduction to a collection of studies that seeks to explore the link between climate change adaptation and public bureaucracies, and to distill lessons for the scholarship on adaptation as well as the persistent debates on the role of administrative traditions in public policy. The articles in the special issue demonstrate that how state and social actors are organized, the ways in which scientific advice enters bureaucracies, and uniformity in the making and implementing of policy matter for adaptation policy. We conclude that the concept of administrative traditions is still necessary for understanding the choices made by public actors, but contend that other factors such as economic motives and political willingness should be considered more critically in the literature on administrative traditions.

Hunter-Gatherers and Human Evolution: New Light on Old Debates

One of the most persistent debates in anthropology and related disciplines has been over the relative weight of aggression and competition versus nonaggression and cooperation as drivers of human behavioral evolution. The literature on hunting and gathering societies—past and present—has played a prominent role in these debates. This review compares recent literature from both sides of the argument and evaluates how accurately various authors use or misuse the ethnographic and archaeological research on hunters and gatherers. Whereas some theories provide a very poor fit with the hunter-gatherer evidence, others build their arguments around a much fuller range of the available data. The latter make a convincing case for models of human evolution that place at their center cooperative breeding and child-rearing, as well as management of conflict, flexible land tenure, and balanced gender relations.

Who profits from legislative activism? An analysis of Presidential and Prime Ministerial popularity

Politicians are always seeking popularity, and they use several tools to try to influence their approval rate. We investigate the dynamic relationship between French executive politicians’ approval rates and three types of legislative acts (laws, ordonnances, and decrees) that they can use to signal their policy stance. Given the persistent debate over causality between public opinion and policy, our results show that a strong President (in terms of popularity) can rely more on ordonnances without damaging his/her popularity. Moreover, the use of ordonnances also benefits the Prime Minister’s popularity. Decrees are more beneficial to the Prime Minister than to the President. In terms of the agenda, if there is a honeymoon effect, legislative activism does nothing to prevent the fall in popularity at the end of a mandate. A winning strategy is thus to ‘wait and see.’ The results are robust to the inclusion of economic performance indicators, political and institutional factors.

North Pacific freshwater events linked to changes in glacial ocean circulation.

There is compelling evidence that episodic deposition of large volumes of freshwater into the oceans strongly influenced global ocean circulation and climate variability during glacial periods1,2. In the North Atlantic region, episodes of massive freshwater discharge to the North Atlantic Ocean were related to distinct cold periods known as Heinrich Stadials1-3. By contrast, the freshwater history of the North Pacific region remains unclear, giving rise to persistent debates about the existence and possible magnitude of climate links between the North Pacific and North Atlantic oceans during Heinrich Stadials4,5. Here we find that there was a strong connection between changes in North Atlantic circulation during Heinrich Stadials and injections of freshwater from the North American Cordilleran Ice Sheet to the northeastern North Pacific. Our record of diatom δ18O (a measure of the ratio of the stable oxygen isotopes 18O and 16O) over the past 50,000 years shows a decrease in surface seawater δ18O of two to three per thousand, corresponding to a decline in salinity of roughly two to four practical salinity units. This coincided with enhanced deposition of ice-rafted debris and a slight cooling of the sea surface in the northeastern North Pacific during Heinrich Stadials 1 and 4, but not during Heinrich Stadial 3. Furthermore, results from our isotope-enabled model6 suggest that warming of the eastern Equatorial Pacific during Heinrich Stadials was crucial for transmitting the North Atlantic signal to the northeastern North Pacific, where the associated subsurface warming resulted in a discernible freshwater discharge from the Cordilleran Ice Sheet during Heinrich Stadials 1 and 4. However, enhanced background cooling across the northern high latitudes during Heinrich Stadial 3-the coldest period in the past 50,000 years7-prevented subsurface warming of the northeastern North Pacific and thus increased freshwater discharge from the Cordilleran Ice Sheet. In combination, our results show that nonlinear ocean-atmosphere background interactions played a complex role in the dynamics linking the freshwater discharge responses of the North Atlantic and North Pacific during glacial periods.

Ventromedial medulla inhibitory neuron inactivation induces REM sleep without atonia and REM sleep behavior disorder

Despite decades of research, there is a persistent debate regarding the localization of GABA/glycine neurons responsible for hyperpolarizing somatic motoneurons during paradoxical (or REM) sleep (PS), resulting in the loss of muscle tone during this sleep state. Combining complementary neuroanatomical approaches in rats, we first show that these inhibitory neurons are localized within the ventromedial medulla (vmM) rather than within the spinal cord. We then demonstrate their functional role in PS expression through local injections of adeno-associated virus carrying specific short-hairpin RNA in order to chronically impair inhibitory neurotransmission from vmM. After such selective genetic inactivation, rats display PS without atonia associated with abnormal and violent motor activity, concomitant with a small reduction of daily PS quantity. These symptoms closely mimic human REM sleep behavior disorder (RBD), a prodromal parasomnia of synucleinopathies. Our findings demonstrate the crucial role of GABA/glycine inhibitory vmM neurons in muscle atonia during PS and highlight a candidate brain region that can be susceptible to α-synuclein-dependent degeneration in RBD patients.

Gastrectomy with Extended Lymphadenectomy: a North American Perspective

PurposeDespite evidence of oncologic benefits from extended (D2) lymphadenectomy in gastric cancer from many East Asian studies, there is persistent debate over its use in the West, mainly due to perceived high rates of morbidity and mortality. This study evaluates the safety and efficacy of D2 dissection in a high-volume North American center. MethodsA prospectively entered database of all patients undergoing gastrectomy for cancer at a North American referral center from 2005 to 2016 was reviewed. Wedge resections, thoracoabdominal approach, emergency surgery, palliative operations, and non-adenocarcinoma cases were excluded. ResultsOf 366 non-bariatric gastrectomies over this period, 175 met the inclusion criteria. Median age was 73 years and 69% were male. One hundred forty-one patients (80%) underwent D2 dissection, the rest having D1. There was no difference in postoperative complications (D1 = 44%: D2 = 42%), anastomotic leaks (D1 = 6%: D2 = 5%), and same-admission or 30-day mortality (D1 = 6%: D2 = 2%). D2 dissection was associated with higher pathological stage (72% > stage 1 vs 38% > stage 1; p < 0.05) and median lymph node yield (30 vs 14; p < 0.05), with no difference in complete resection (R0) rate (D1 = 98% vs D2 = 92%). Laparoscopic approach was employed in 34% (45/141) of D2 cases, resulting in shorter median length of stay (6 days vs 9; p < 0.05) and equivalent oncologic outcomes compared to open D2. ConclusionThis study supports the use of D2 lymphadenectomy, by either open or laparoscopic approach, in high-volume North American centers as a safe and effective oncologic procedure for gastric cancer, with equivalent complication rates and superior lymph node yield to traditional D1 dissection.

Electoral Pluralism, Social Division and the 2016 Parliamentary Elections in Jordan

AbstractRepresenting one of the most stable regimes in the Middle East, Jordan has been undergoing a process of political liberalization since 1989. Due to the so‐called East Bank‐West Bank cleavage that followed by the influx of Palestinian migrants to Jordan, the country has also come to epitomize a divided society. Within this context, this paper aims to analyze the ongoing prospects for democratization in Jordan through an examination of four persistent debates shaping its electoral pluralism: those over social/identity division, electoral law as a regime‐survival mechanism, the role of the Ikhwan and the IAF's electoral boycotts, and electoral apathy. Finally, the impact of the Arab upheavals/revolts on restructuring the process of political reform — as well as opposition in the kingdom in the post‐2011 era — will be explored with reference to the changing dynamics of Islamist opposition.

Spatially and Sequentially Heterogeneous Discounts of Distressed Property Values in Cuyahoga County, Ohio

One of the most persistent public policy debates is over the aftermath of the foreclosure crisis and its continuing impact on housing markets. Distressed properties – including foreclosure and real estate-owned properties – tend to be sold at much lower prices than nearby comparable properties, often pulling down both surrounding property values and neighborhood morale. Recent findings show that these discounts for distressed properties are associated with various factors, but three important dimensions of these discounts remain relatively unexplored. First among these is the degree of variation in these discounts, even within the same regional market. Second is how discounts vary through the typical sequence of the distressed property transaction cycle. The final factor is the nature by which discounts vary according to the market participants – are the buyers/sellers individuals or institutions? This study examines these major factors affecting discounts, and estimates the spatially and sequentially heterogeneous discounts for distressed properties in the housing submarkets of Cuyahoga County, Ohio. Findings indicate that the discounts of distressed properties in the strong and weak submarkets substantially vary based on all three of these previously overlooked factors, yielding a more complex and nuanced housing context for practitioners and policymakers to consider.

Adult ADHD: Questioning Diagnosis and Treatment in a Patient with Multiple Psychiatric Comorbidities

Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is a contentious diagnostic issue, which has been increasing in prevalence in recent years, and is often comorbid with other psychiatric disorders. This report presents a detailed account of a clinical case involving a middle-aged man with a history of recurrent depressive episodes and an unsubstantiated diagnosis of ADHD, treated with stimulants. There is persistent debate around the use of psychostimulants both in adult ADHD and in the treatment of depression. Despite promising activating properties, psychostimulants carry significant risks of misuse and substance use disorder. In this report, we consider the potential benefits and adverse effects of stimulants in the treatment of adult ADHD and mood disorders and review the learning points of this complicated, but not uncommon, clinical case.