Long-Term Results after DMEK (Descemet’s Membrane Endothelial Keratoplasty)

Ziel der Arbeit: Evaluation der langfristigen Ergebnisse sowie der Komplikationsrate nach Descemet’s Membran Endothelialen Keratoplastik (DMEK) Methoden: Eine cross-sectional, Fall-Serien Studie. Insgesamt wurden 230 Augen von 142 Patienten, die zwischen 2010 und 2014 eine DMEK an der Universitäts-Augenklinik Marburg bekommen haben, untersucht. Die best-korrigierte Sehschärfe (BCVA), die Refraktion, die zentrale Hornhautdicke, das Hornhautvolumen sowie die Endothelialzelldichte wurden als Parameter herangezogen und mit den präoperativen Befunden verglichen. Die Transplantat-Überlebensrate sowie die postoperativen Komplikationen wurden ebenfalls betrachtet. Ergebnisse: Die Nachbeobachtungszeit betrug 47 ± 13.3 Monate. Bei den Patienten die keine anderen okuläre Erkrankungen hatten hat sich die BCVA von 0.60 ± 0.32 logMAR präoperativ auf bis zu 0.10 ± 0.22 logMAR verbessert (201 Augen). 71.1% dieser Patienten hatten eine BCVA von 0.11 logMAR oder besser (≥ 0.8 dezimal), wobei 49.2% dieser Patienten eine volle BCVA von 0.00 logMAR oder besser erreicht haben. Die zentrale Hornhautdicke hat von 675 ± 112µm präoperativ auf 547 ± 52 µm in der letzten Follow-up Untersuchung abgenommen, und das Hornhautvolumen hat von 65.2 ± 8.4 mm2 präoperativ auf 61.9 ± 5.4 mm2 abgenommen. Der Endothelzellverlust lag bei 1392 ± 455 Zellen/mm², was einem durchschnittlichen Verlust von 54.7% der Transplantatzellen entspricht. Die Transplantat-Überlebensrate lag bei 92% mit einer durchschnittlichen Überlebenszeit von 76.6 ± 1.3 Monaten. Schlussfolgerung: DMEK bietet hohe visuelle Ergebnisse und sehr gute klinische Befunde, die mehrere Jahre nach der Operation stabil bleiben können. Durch die hohe Transplantat-Überlebensrate und die niedrige postoperative Komplikationsrate wird DMEK derzeit als erste Wahl zur Behandlung von Endothelzellerkrankungen eingesetzt

The wrongs of racist beliefs

We care not only about how people treat us, but also what they believe of us. If I believe that you’re a bad tipper given your race, I’ve wronged you. But, what if you are a bad tipper? It is commonly argued that the way racist beliefs wrong is that the racist believer either misrepresents reality, organizes facts in a misleading way that distorts the truth, or engages in fallacious reasoning. In this paper, I present a case that challenges this orthodoxy: the case of the supposedly rational racist. We live in a world that has been, and continues to be, structured by racist attitudes and institutions. As a result, the evidence might be stacked in favour of racist beliefs. But, if there are racist beliefs that reflect reality and are rationally justified, what could be wrong with them? Moreover, how do I wrong you by believing what I epistemically ought believe given the evidence? To address this challenge, we must recognize that there are not only epistemic norms governing belief, but moral ones as well. This view, however, is at odds with the assumption that moral obligation requires a kind of voluntary control that we lack with regard to our beliefs. This background assumption motivates many philosophers to try to explain away the appearance that beliefs can wrong by locating the wrong elsewhere, e.g., in an agent’s actions. Further, even accounts that accept the thesis that racist beliefs can wrong restrict the class of beliefs that wrong to beliefs that are either false or the result of hot irrationality, e.g., the racist belief is a result of ill-will. In this paper I argue that although the these accounts will capture many of the wrongs associated with racist beliefs, they will be only partial explanations because they cannot explain the wrong committed by the supposedly rational racist. The challenge posed by the supposedly rational racist concerns our epistemic practices in a non-ideal world. The world is an unjust place, and there may be many morally objectionable beliefs it justifies. To address this challenge, we must seriously consider the thesis people wrong others in virtue of what they believe about them, and not just in virtue of what they do

What We Epistemically Owe To Each Other

This paper is about an overlooked aspect—the cognitive or epistemic aspect—of the moral demand we place on one another to be treated well. We care not only how people act towards us and what they say of us, but also what they believe of us. That we can feel hurt by what others believe of us suggests both that beliefs can wrong and that there is something we epistemically owe to each other. This proposal, however, surprises many theorists who claim it lacks both intuitive and theoretical support. This paper argues that the proposal has intuitive support and is not at odds with much contemporary theorizing about what we owe to each other

Reassessing the Citizens Protection Act: A Good Thing It Passed, and a Good Thing It Failed

The Citizens Protection Act (CPA) of 1998 has always been a lightening rod for criticism, and it remains so today. This article reassesses the CPA’s perceived inadequacies in light of how it has actually affected (or, not affected) federal prosecutors’ involvement in criminal investigations. The article takes issue with the critics and demonstrates that the CPA succeeded where it should have, failed where it should have, and left us—however inadvertently—with a remarkably coherent and consistent approach to regulating federal prosecutors’ involvement in criminal investigations regardless of whether a suspect retains counsel early in the proceedings. The CPA requires federal prosecutors to follow state rules of professional conduct “to the same extent and in the same manner” as all other lawyers. The CPA was intended to—and did—nullify a U.S. Department of Justice (DOJ) declaration that unilaterally exempted federal prosecutors from much of the “no-contact” rule, which prohibits a lawyer in a matter from communicating with the client of another lawyer in the matter. The CPA was also intended to—but did not—require federal prosecutors to comply with various state interpretations of the no-contact rule that might have restricted their ability to participate in both covert and overt communications with represented criminal suspects. It is a good thing the CPA passed because DOJ’s assertion of authority over the no-contact rule for its own lawyers would inevitably have undermined public confidence in federal prosecutors’ commitment to fair and ethical investigatory processes. By the same token, it is a good thing that the CPA failed because broadly depriving DOJ of federal prosecutors’ involvement in communications with represented suspects would have substantially hindered criminal investigations for no good reason

Can Beliefs Wrong?

We care what people think of us. The thesis that beliefs wrong, although compelling, can sound ridiculous. The norms that properly govern belief are plausibly epistemic norms such as truth, accuracy, and evidence. Moral and prudential norms seem to play no role in settling the question of whether to believe p, and they are irrelevant to answering the question of what you should believe. This leaves us with the question: can we wrong one another by virtue of what we believe about each other? Can beliefs wrong? In this introduction, I present a brief summary of the articles that make up this special issue. The aim is to direct readers to open avenues for future research by highlighting questions and challenges that are far from being settled. These papers shouldn’t be taken as the last word on the subject. Rather, they mark the beginning of a serious exploration into a set of questions that concern the morality of belief, i.e., doxastic morality

The Specter of Normative Conflict: Does Fairness Require Inaccuracy?

A challenge we face in a world that has been shaped by, and continues to be shaped by, racist attitudes and institutions is that the evidence is often stacked in favor of racist beliefs. As a result, we may find ourselves facing the following conflict: what if the evidence we have supports something we morally shouldn’t believe? For example, it is morally wrong to assume, solely on the basis of someone’s skin color, that they’re a staff member. But, what if you’re in a context where, because of historical patterns of discrimination, someone’s skin color is a very good indicator that they’re a staff member? When this sort of normative conflict looms, a conflict between moral considerations on the one hand and what you epistemically ought to believe given the evidence on the other, what should we do? It might be unfair to assume that they’re a staff member, but to ignore the evidence would mean risking inaccurate beliefs. Some, notably Tamar Gendler (2011), have suggested that we simply face a tragic irresolvable dilemma. In this chapter, I consider how these cases of conflict arise and I canvass the viability of suggested resolutions of the conflict. In the end, I argue that there’s actually no conflict here. Moral considerations can change how we epistemically should respond to the evidence

Radical moral encroachment: The moral stakes of racist beliefs

Historical patterns of discrimination seem to present us with conflicts between what morality requires and what we epistemically ought to believe. I will argue that these cases lend support to the following nagging suspicion: that the epistemic standards governing belief are not independent of moral considerations. We can resolve these seeming conflicts by adopting a framework wherein standards of evidence for our beliefs to count as justified can shift according to the moral stakes. On this account, believing a paradigmatically racist belief reflects a failure to not only attend to the epistemic risk of being wrong, but also a failure to attend to the distinctively moral risk of wronging others given what we believe

Molecular epidemiology of waterborne zoonoses in the North Island of New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Veterinary Science (Epidemiology and Public Health) at Institute of Veterinary, Animal and Biomedical Sciences (IVABS), Massey University, Palmerston North, New Zealand

Campylobacter, Cryptosporidium and Giardia species are three important waterborne zoonotic pathogens of global public health concern. This PhD opens with an interpretive overview of the literature on Campylobacter, Cryptosporidium and Giardia spp. in ruminants and their presence in surface water (Chapter 1), followed by five epidemiological studies of Campylobacter, Cryptosporidium and Giardia spp. in cattle, sheep and aquatic environment in New Zealand (Chapters 2-6). The second chapter investigated four years of retrospective data on Campylobacter spp. (n=507) to infer the source, population structure and zoonotic potential of Campylobacter jejuni from six high-use recreational rivers in the Wanganui- Manawatu region of New Zealand through the generalised additive model, generalised linear/logistic regression model, and minimum spanning trees. This study highlights the ubiquitous presence of Campylobacter spp. in both low and high river flows, and during winter months. It also shows the presence of C. jejuni in 21% of samples containing highly diverse strains, the majority of which were associated with wild birds only. These wild birds-associated C. jejuni have not been detected in human, suggesting they may not be infectious to human. However, the presence of some poultry and ruminant-associated strains that are potentially zoonotic suggested the possibility of waterborne transmission of C. jejuni to the public. Good biosecurity measures and water treatment plants may be helpful in reducing the risk of waterborne Campylobacter transmission In the third study, a repeated cross-sectional study was conducted every month for four months to investigate the source of drinking source-water contamination. A total of 499 ruminant faecal samples and 24 river/stream water samples were collected from two rural town water catchments (Dannevirke and Shannon) in the Manawatu- Wanganui region of New Zealand, and molecular analysis of those samples was performed to determine the occurrence of Campylobacter, Cryptosporidium, and Giardia spp. and their zoonotic potential. The major pathogens found in faecal samples were Campylobacter (n=225 from 7/8 farms), followed by Giardia (n=151 from 8/8 farms), whereas Giardia cysts were found in many water samples (n=18), followed by Campylobacter (n=4). On the contrary, Cryptosporidium oocysts were only detected in a few faecal (n=18) and water (n=3) samples. Cryptosporidium and Giardia spp. were detected in a higher number of faecal samples from young animals (≤ 3 months) than juvenile and adult animals, whereas Campylobacter spp. were highly isolated in the faecal samples from juvenile and adult ruminants. PCRsequencing of the detected pathogens indicated the presence of potentially zoonotic C. jejuni and C. coli, Cryptosporidium parvum (gp60 allelic types IIA18G3R1 and IIA19G4R1) and Giardia duodenalis (assemblages AII, BII, BIII, and BIV) in cattle and sheep. In addition, potentially zoonotic C. jejuni and Giardia duodenalis assemblages AII, BI, BII, and BIV were also determined in water samples. These findings indicate that these three pathogens of public health significance are present in ruminant faecal samples of farms and in water, and may represent a possible source of human infection in New Zealand. In the fourth study, PCR-sequencing of Cryptosporidium spp. isolates obtained from the faeces of 6-week- old dairy calves (n=15) in the third study were investigated at multiple loci (18S SSU rDNA, HSP70, Actin and gp60) to determine the presence of mixed Cryptosporidium spp. infections. Cryptosporidium parvum (15/15), C. bovis (3/15) and C. andersoni (1/15), and two new genetic variants were determined along with molecular evidence of mixed infections in five specimens. Three main Cryptosporidium species of cattle, C. parvum, C. bovis and C. andersoni, were detected together in one specimen. Genetic evidence of the presence of C. Anderson and two new Cryptosporidium genetic variants are provided here for the first time in New Zealand. These findings provided additional evidence that describes Cryptosporidium parasites as genetically heterogeneous populations and highlighted the need for iterative genotyping at multiple loci to explore the genetic makeup of the isolates. The C. jejuni and C. coli isolates (n=96) obtained from cattle, sheep and water in the third study were subtyped to determine their genetic diversity and zoonotic potential using a modified, novel multi-locus sequence typing method (“massMLST”; Chapter 5). Primers were developed and optimised, PCR-based target-MLST alleles’ amplification were performed, followed by next generation sequencing on an Illumina MiSeq machine. A bioinformatics pipeline of the sequencing data was developed to define C. jejuni and C. coli multi-locus sequence types. This study demonstrated the utility and potential of this novel typing method, massMLST, as a strain typing method. In addition to identifying the possible C. jejuni/coli clonal complexes or sequence types of 68/96 isolates from ruminant faeces and water samples, this study reported three new C. jejuni strains in cattle in New Zealand, along with many strains, such as CC-61, CC-828 and CC-21, that have also been found in humans, indicating the public health significance of these isolates circulating on the farms in the two water catchment areas. Automation of the massMLST method and may allow a cost-effective high-resolution typing method in the near future for multilocus sequence typing of large collections of Campylobacter strains. In the final study (Chapter 6), a pilot metagenomic study was carried out to obtain a snapshot of the microbial ecology of surface water used in the two rural towns of New Zealand for drinking purposes, and to identify the zoonotic pathogens related to waterborne diseases. Fresh samples collected in 2011 and 2012, samples from the same time that were frozen, and samples that were kept in the preservative RNAlater were sequenced using whole-genome shotgun sequencing on an Illumina MiSeq machine. Proteobacteria was detected in all the samples characterised, although there were differences in the genus and species between the samples. The microbial diversity reported varied between the grab and stomacher methods, between samples collected in the year 2011 and 2012, and among the fresh, frozen and RNAlater preserved samples. This study also determined the presence of DNA of potentially zoonotic pathogens such as Cryptosporidium, Campylobacter and Mycobacterium spp. in water. Use of metagenomics could potentially be used to monitor the ecology of drinking water sources so that effective water treatment plans can be formulated, and for reducing the risk of waterborne zoonosis. As a whole, this PhD project provides new data on G. duodenalis assemblages in cattle, sheep and surface water, new information on mixed Cryptosporidium infections in calves, a novel “massMLST” method to subtype Campylobacter species, and shows the utility of shotgun metagenomic sequencing for drinking water monitoring. Results indicate that ruminants (cattle and sheep) in New Zealand shed potentially zoonotic pathogens in the environment and may contribute to the contamination of surface water. A better understanding of waterborne zoonotic transmission would help in devising appropriate control strategies, which could reduce the shedding of Campylobacter, Cryptosporidium, and Giardia spp. in the environment and thereby reduce waterborne transmission

KIDS COUNT Indicator Brief: Preventing Low Birthweight

Outlines trends in low birthweight and preterm births and offers prevention strategies such as expanding access to comprehensive health care, ensuring good nutrition for pregnant women, and addressing demographic, social, and environmental risk factors