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Abstract Background An acute abdomen is an emergency that requires accurate diagnosis and prompt treatment. In pregnancy, the process is even more challenging and sometimes the radiological findings are unclear. Moreover, endometriosis- related complications are rare, especially in previously unknown endometriosis. Case presentation We report on a case of acute endometriosis-related sigmoid perforation during pregnancy (34 weeks of gestation) due to a previously unknown deep intestinal infiltrating endometriosis with focal ulceration of the affected colonic mucosa. Conclusions Despite the low relative risk, clinicians should be aware of possible endometriosis-associated complications in pregnancy with potentially life-threatening events, even in previously unknown endometriosis. Further studies should evaluate intestinal complications during pregnancy in relation to previous treatment of intestinal endometriosis (conservative vs. surgical).

Distant water fishing occurs worldwide as foreign fleets fish in the exclusive economic zones (EEZs) of other states. We test the hypothesis that host state governance performance is an explanatory factor in observed distant water fishing effort using Global Fishing Watch's fishing effort data obtained from vessels' automatic identification system (AIS). We examine the explanatory power of the World Governance Indicators (WGI), Gross Domestic Product (GDP) per capita, and biophysical fisheries productivity indicators (temperature, oxygen, salinity, nutrients, and primary productivity) on fishing effort from foreign fleets across the four most common gear types (fixed gear, longliners, trawlers, and tuna purse seiners). Our models include both host EEZ fishery productivity indicators and governance indicators with R2 values of 0.97 for longlining, 0.95 trawling, 0.95 for fixed gear and 0.82 for tuna purse seiners. Although a lack of good governance may enable illegal, unreported and unregulated fishing, the United Nations Convention of the Law of the Sea (UNCLOS) has enabled the legal establishment of foreign fishing contracts. However, it is unlikely that fishing contracts are decoupled from economic and political negotiations on other issues. We argue that it is worthwhile to consider the term "fish grabbing", meaning wealthier and politically more powerful states consciously seek to profit from fishing in the waters of often weaker states through developing legal fishing contracts.

Introduction: Anterior stand-alone fusion (ASAF) devices have been developed in an attempt to reduce adjacent segment degenerative changes observed with posterior instrumented fusion techniques. Research question: The purpose of this study was to assess mid- to long-term clinical and radiological results following ASAF at the lumbosacral junction with special emphasis on the assessment of adjacent level pathologies.Materials & Methods: Clinical outcome scores and radiological data were acquired within an ongoing single-center prospective cohort study. Progression of adjacent level degeneration was evaluated based on MRI scans according to the Pfirrmann and Weishaupt classification system by two independent radiologists. Results: The results from 37 patients (FU ​≥ ​5 years) demonstrated high satisfaction rates and significant improvements in VAS and ODI scores. N ​= ​8 patients (21.6%) had to undergo subsequent surgery at the cranially adjacent level. The incidence of adjacent level disc degeneration and adjacent facet joint degeneration was 24.3% and 35.1%, respectively. More pronounced degenerative changes of the adjacent level discs (p ​= ​0.005) and facet joints (p ​= ​0.042) prior to surgery and a lower segmental lordosis reconstruction at the lumbosacral junction (p ​= ​0.0084) were identified as potential risk factors for the development of subsequent adjacent level pathologies. Discussion & Conclusion: The study revealed satisfactory clinical results at a mid-to long-term FU of ≥5 years. The incidence of adjacent level degeneration was higher than initially expected. Patients with preexisting radiographic signs of degenerative adjacent level changes have a higher risk for subsequent deterioration necessitating reoperation at the adjacent segment at later stages. Furthermore, adequate intraoperative segmental lordosis reconstruction at the index segment is paramount as the present data reveal this to be a key protective factor for adjacent segment preservation.

A 54-year-old patient presented with progressive pain for one month in the second finger of the right hand with an emphasis on the proximal interphalangeal (PIP) joint. Subsequent magnetic resonance imaging (MRI) showed a diffuse intraosseous lesion at the base of the middle phalanx with destruction of the cortical bone and extraosseous soft tissue. An expansively growing chondromatous bone tumor, e.g., a chondrosarcoma, was suspected. After incisional biopsy, the pathologic findings finally revealed, surprisingly, a metastasis of a poorly differentiated non-small cell adenocarcinoma of the lung. This case illustrates a rare but important differential diagnosis for painful finger lesions.

This study aims to understand tourists' willingness to pay a price premium for a local green hotel certification, and is one of only a few in the literature for small-island tourism destinations in emerging economies with their unique and pressing sustainability challenges. In a survey of 535 tourists visiting Gili Trawangan, Indonesia, facing numerous waste management and coral reef conservation issues, the willingness to pay extra for sustainable hotel services was elicited. There were five discrete pricing levels across the surveys that ranged from $0.75 USD to $7.50 USD extra per night. We examined the relationship of the respondents' payment choice to their socio-demographic attributes and attitudes regarding environmental issues such as climate change. The main findings and practical implications of the study are: (1) to demonstrate the broad willingness to pay for sustainable hotel services. Findings indicate at all price levels (between $0.75 USD and $7.50 USD), more than 50% of tourists are willing to pay. (2) To estimate a lower bound mean willingness to pay per night for a local green hotel certificate of $1.55USD and 1.34€ EUR, and (3) To identify individual attributes that influence willingness to pay. Findings indicate environmental knowledge and preferences play a role. These results can be used generally to incorporate evidence-based practices into the development of a green hotel marketing strategy, and to help define the target market for small-scale green hotel certification. Additionally, we propose a finance strategy for funding local and sustainable initiatives that support the hotel industry and the island's infrastructure through the premiums collected from the 'Gili Green Award' certificate.

Empirical studies have demonstrated that students who are taught in a group of students with higher average achievement benefit in terms of their achievement. However, there is also evidence showing that being surrounded by high-achieving students has a negative effect on students' academic self-concept, also known as the big-fish--little-pond effect. In view of the reciprocal relationship between achievement and academic self-concept, the present study aims to scrutinize how the average achievement of a class affects students' achievement and academic self-concept, and how that, in turn, affects subsequent achievement and academic self-concept. Using a sample of 6,463 seventh-graders from 285 classes in Germany, multilevel path models showed that the class-average achievement at the beginning of the school year positively affected individual achievement in the middle and at the end of the school year, and negative effects on academic self-concept occurred only at the beginning of Grade 7, but not later in the school year. In addition, mediation analyses revealed that the effects of class-average achievement on students' achievement and academic self-concept at the end of the school year were mediated by midterm achievement, but not by midterm academic self-concept. This pattern was found for mathematics, biology, physics, and English as a foreign language. The results of our study indicate that the consequences for students of belonging to a group of high-achieving students should be analyzed with respect to both academic self-concept and achievement.

Ziel dieser Studie war, Tiergesundheitsparameter bei Mastschweinen unter möglichst naturnahen Bedingungen während einer Mastperiode im Wald und bei der anschließenden Schlachtung zu erheben und zu dokumentieren. Gleichzeitig wurde die Schlachtkörperqualität überprüft. Die tägliche Zunahme der Tiere und der Kraftfutteraufwand prokg erzeugtem Fleisch wurden ermittelt. Dafür wurden zwei Gruppen mit jeweils 20 Schweinen (Schwäbisch-Hällisch*Pietrain) mit einem durchschnittlichen Gewicht von ca. 25kg in zwei Waldflächen im bayerischen Alpenvorland eingestallt und dort bis zur Schlachtung gehalten. Sie erhielten ad libitum Kraftfutter (KF) und Grundfutter (GF) (Kleegras). Die Tiere wurden in 4-wöchigem Rhythmus sowie vor der Schlachtung gewogen und hinsichtlich Verletzungen, Parasitenbefall und allgemeinem Gesundheitszustand bonitiert. Am Schlachthof wurden Schlachtgewicht, Muskelfleischanteil (MfA) sowie der Zustand der Schlachtorgane und Klauen erhoben. Intramuskulärer Fettgehalt (IMF) und Radiocäsiumbelastung wurden durch Fleischproben bestimmt. Die Waldmastschweine wiesen bei den Lebendbonituren kaum Verletzungen auf, 99,7% der untersuchten Tiere erhielten Note 0 (Benotung in Anlehnung an Welfare Quality® Assessment Protocol for Pigs 2009). Auch der Organzustand am Schlachthof war überwiegend ohne Befund (Verdauungstrakt bei 100% der Schweine, Herz und Niere bei 97,4%, Lunge bei 81,6%, Leber bei 55,3% ohne besonderen Befund). Die durchschnittlichen täglichen Zunahmen bis 130kg Lebendgewicht (LM) lagen bei 792 g bzw. 796 g pro Tag. Der durchschnittliche MfA bei der Schlachtung mit >150kg LM lag bei 55,2% und der durchschnittliche IMF bei 2,5%. Die Werte für eine Radiocäsiumbelastung lagen deutlich unter dem Grenzwert.

Scientific agenda setting is critical at all levels of research, but can be strongly influenced by structural path dependencies of the science system itself. In this article we examine how knowledge production is shaped by interconnected path dependencies using the field of tropical marine sciences as a global case study. We use scientometric analysis methods on an original data set of 1328 peer-reviewed journal publications to examine publication trends including a co-authorship network analysis, links between author origin and research locations as well as a quantitative analysis of terminology use over space (i.e., region) and time. Scientometric findings are analytically discussed through a conceptual framework premised on theories of path dependency. Findings and critical analysis highlight how tropical marine science provides a prominent global example of how North American, European and Australian science programs predominantly shape knowledge production of the global science system, generating critical reflection on the path dependencies these create on current and likely future knowledge production and science agendas. Similar dependencies face other fields of science, and thus this study provides broadly relevant quantitative observational empirical findings supplemented with a critical social science analysis of how a transcultural Science and Technology Studies lens is useful for unpacking the webs of path dependencies driving, inhibiting and/ or shaping global knowledge production, placing meaning and context over observed empirical trends.

Abstract Background The PTEN-hamartoma-tumor-syndrome (PHTS) is caused by germline mutations in Phosphatase and Tensin homolog (PTEN) and predisposes to the development of several typical malignancies. Whereas PTEN mutations have been implicated in the occurrence of malignant mesotheliomas, the genetic landscape of verrucous carcinomas (VC) is largely uncharted. Both VC and malignant peritoneal mesotheliomas (MPM) are exceedingly rare and a potential link between these malignancies and PHTS has never been reported. Case presentation We here describe the clinical course of a PHTS patient who, in addition to a typical thyroid carcinoma at the age of 36 years, developed a highly-differentiated oral VC and an epithelioid MPM six years later. The patient with a history of occupational asbestos exposure underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for MPM. The clinical diagnosis of PHTS was consequently corroborated by a germline PTEN deletion. Sequencing of tumor tissue revealed a second hit in PTEN in the thyroid carcinoma and VC, confirmed by a PTEN loss and activation of the PI3K/AKT pathway in immunohistochemistry. Furthermore, additional somatic mutations in the thyroid carcinoma as well as in the VC were detected, whereas the genetics of MPM remained unrevealing. Discussion and conclusions We here report the very unusual clinical course of a patient with rare tumors that have a germline mutation first hit in PTEN in common. Since this patient was exposed to asbestos and current evidence suggests molecular mechanisms that might render PHTS patients particularly susceptible to mesothelioma, we strongly recommend PHTS patients to avoid even minimal exposure.