An Empirical Argument for Presentism

According to orthodoxy, our best physical theories strongly support Eternalism over Presentism. Our goal is to argue against this consensus, by arguing that a certain overlooked aspect of our best physical theories strongly supports Presentism over Eternalism

Experience and Time: A Metaphysical Approach

What is the temporal structure of conscious experience? While it is popular to think that our most basic conscious experiences are temporally extended, we will be arguing against this view, on the grounds that it makes our conscious experiences depend on the future in an implausible way. We then defend an alternative view of the temporal structure of experience from a variety of different objections. Along the way, we hope to illustrate the wider philosophical ramifications of the relationship between experience and time. What one thinks about the temporal structure of experience is, we believe, deeply interconnected with issues concerning whether consciousness is vague or precise, whether conscious states can be reduced to physical states, whether phenomenal properties are intrinsic properties, and whether phenomenal consciousness can “overflow” access consciousness. As we will see, even seemingly unrelated metaphysical questions, such as the debate between Humean and Non-Humean accounts of natural necessity, bear on questions about the relationship between experience and time

Intralobar Pulmonary Sequestration and Increased Serum CA 19-9

Intralobar pulmonary sequestration is an uncommon congenital lung anomaly which consists of a mass of normal lung tissue not connected to the normal tracheobronchial tree and supplied by an anomalous systemic artery. Carbohydrate antigen 19-9 (CA 19-9) is widely accepted as a tumour marker for biliary, pancreatic and gastrointestinal cancer. However, CA 19-9 may also be increased in patients with benign disease. We describe the case of a 56-year-old woman with intralobar pulmonary sequestration who underwent unnecessary and extensive diagnostic abdominal examinations because of an increase in CA 19-9 serum levels

Endorotor-Based Endoscopic Necrosectomy as a Rescue or Primary Treatment of Complicated Walled-off Pancreatic Necrosis. A Case Series.

Direct endoscopic necrosectomy (DEN) is a cumbersome, time-consuming procedure that can be necessary in cases of infected pancreatic walled-off necrosis (WON) not responding to endoscopic ultrasound (EUS)- guided drainage only. Until now, DEN has been performed with non-dedicated devices, thus requiring multiple, long-lasting sessions to achieve adequate clearance of necrotic content. These results in prolonged hospital stay, increased costs and have potential consequences for patients who must undergo multiple endoscopic interventions under sedation. We report four cases of DEN performed in patients with WON after EUS-guided drainage with the Endorotor system, a new morcellator device specifically designed to perform the procedure

Incidence of bloodstream infections, length of hospital stay and survival in patients with recurrent Clostridioides difficile infection treated with fecal microbiota transplantation or antibiotics: a prospective cohort study

Background: Clostridioides difficile infection (CDI) is a risk factor for bloodstream infections (BSI). Fecal microbiota transplantation (FMT) is more effective than antibiotics in treating recurrent CDI, but its efficacy in preventing CDI-related BSI is uncertain. Objective: To assess incidence of primary BSI in patients with recurrent CDI treated with FMT compared with patients treated with antibiotics. Design: Prospective cohort study. FMT and antibiotic treated patients were matched using propensity score. Setting: Single academic medical center. Patients: 290 inpatients with recurrent CDI; 57 patients per treatment in matched cohort. Interventions: FMT or antibiotics. Measurements: Our primary outcome was the development of primary BSI within a 90-day follow-up. Secondary outcomes were length of hospitalization, and overall survival (OS) at 90 days. Results: 109 patients were treated with FMT, and 181 received antibiotics. Five patients in the FMT group and 40 in the antibiotic group developed BSI. Due to differences in the patients treated with FMT and antibiotics in a number of baseline characteristics including the number of recurrences and CDI severity, comparative analyses were limited to the matched cohort. Subjects in the FMT group experienced a 23% lower risk of developing BSI (95% confidence interval 10-35%), 14 fewer days of hospitalization (95% confidence interval 9-20 days), and a 32% increase in OS (95% confidence interval 16-47%) compared with the antibiotic group. Limitations: Non-randomized study with potential for unmeasured/residual confounding. Limited generalizability of the propensity score-matched cohort. Conclusion: In a propensity score-matched cohort, patients with recurrent CDI treated with FMT were less likely to develop primary BSI

Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR)

Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps' vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula

Small nonfunctional pancreatic neuroendocrine neoplasms. Time for a step-up treatment approach?

Surgery has been regarded as the only curative treatment for patients with small nonfunctional pancreatic neuroendocrine neoplasms (NF-PNENs) less than 2 cm. Due to the significant adverse event rates of surgery, the European Neuroendocrine Tumor Society issued guidelines favoring surveillance for those patients lacking criteria suggestive of an aggressive disease. Despite the above recommendations, a significant proportion of small NF-PNEN patients still undergo surgery. Recently, several studies have reported the safety and effectiveness of EUS-guided radiofrequency ablation (RFA) for the treatment of small NF-PNENs. The experience with EUS-RFA is, however, limited, but published results indicate a potential role as a minimally invasive alternative treatment for these patients, in particular in those in whom further progression is more probable, before they reach the absolute need for surgery. A step-up approach with EUS-RFA followed by surgery for the failure cases can become a valid option to be validated in clinical studies

Systematic assessment of data-driven approaches for wall heat transfer modelling for LES in IC engines using DNS data

Data-driven (DD) methods offer a promising pathway towards novel modelling solutions in fluid flow and heat transfer. In this study, we investigate the application of DD neural network (NN) methods on wall heat transfer modelling in the context of wall-modelled large-eddy simulation (WMLES) in engines, focusing on the systematic evaluation of criteria for the successful DD model generation. High-fidelity input data for model training and testing is generated by spatial filtering of DNS and wall-resolved LES fields in several engine and engine-like configurations. The NN-based models are constructed using different input data and wall-adjacent cell schemes, while cell size and network complexity are also varied. The evaluated NN-based models demonstrate improved performance with respect to classical wall functions, indicating promising potential for engineering applications. In particular, better modelling results were obtained with the inclusions of a wall-normal cell Reynolds number and of data from the second wall-normal cell. Such a two-cell input format appears to offer a good compromise between performance and complexity. Both the present NN models and literature reference approaches generally perform better in unburned regions than in burned ones. In near-wall regions with flame fronts, we present an analysis dividing samples into “unburned”, “burned”, and “flame boundary” zones exposing different characteristics and a varying degree of modelling difficulty.ISSN:0017-9310ISSN:1879-218

Direct endoscopic necrosectomy with the newly developed 6-mm powered rotating resection catheter: When size matters

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