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Abstract Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient’s values and target the best outcome possible given the patient’s desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes.

Abstract Background Transcultural nursing recognises the significance of cultural backgrounds in providing patients with quality care. This study investigates the opinions of master’s students in nursing and midwifery regarding the attitudes of Jehovah’s Witnesses towards refusing blood transfusions. Methods 349 master’s students in nursing and midwifery participated in a quantitative study and were surveyed via the Web to evaluate their awareness of the stance of Jehovah’s Witnesses on blood transfusions and the ethical and legal dilemmas associated with caring for Jehovah’s Witness (JW) patients. Results The study yielded three significant findings. It unequivocally demonstrates that nursing and midwifery students possess inadequate knowledge regarding Jehovah’s Witnesses’ stance on blood transfusions and their acceptance of specific blood products and medical procedures. Despite being cognisant of the ethical and legal dilemmas of caring for JW patients, students lack an understanding of patients’ autonomy to reject blood transfusions and their need for bloodless medicine. Students also articulated educational needs regarding cultural competencies regarding the Jehovah’s Witnesses’ beliefs on blood transfusions and non-blood management techniques. Conclusions Healthcare professionals need the knowledge and skills necessary to provide holistic, patient-centred and culturally sensitive care. This study emphasises the urgent need for university curricula and nursing postgraduate training to include modules on transcultural nursing and strategies for minimising blood loss.

Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient's values and target the best outcome possible given the patient's desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes. [ABSTRACT FROM AUTHOR]

In the histories of both colonial and postcolonial Malawi, there have been cases of religious-related violence, both in its physical and non-physical forms. Such cases have led to the deaths of the "perpetrators" of violence and 'innocent' believers, destruction of property, prison detentions, and even the forced removal of citizens from the country. This paper analyzes two case studies, one in which private citizens perpetrated the violence, led by a preacher called John Chilembwe, of the Providence Industrial Mission (PIM), challenging British colonial authorities during the second decade of the twentieth century. In the second case, the focus is on the independent Malawi government, which used violence against members of the Jehovah's Witness (JW) religious sect from the early 1960s to the early 1990s, owing to the Witnesses' disassociation from the demands of the secular state. Using data primarily drawn from various archives and other published studies, this paper argues that the use of 'religious-based violence' is not just a domain 'reserved' for those experiencing oppression, exclusion, and marginalization. Rather, authoritarian governments, like the one that emerged in postcolonial Malawi and other parts of Africa, also resorted to using 'religious-based violence' to serve as a tool for eliminating 'non-conforming' religious sects and organizations. In doing so, this paper contributes to the various fields of scholarship, including the relationship between religion and violence in modern Africa and the dynamics and operations of the state in both colonial and postcolonial Africa. [ABSTRACT FROM AUTHOR]

Background: Transcultural nursing recognises the significance of cultural backgrounds in providing patients with quality care. This study investigates the opinions of master's students in nursing and midwifery regarding the attitudes of Jehovah's Witnesses towards refusing blood transfusions. Methods: 349 master's students in nursing and midwifery participated in a quantitative study and were surveyed via the Web to evaluate their awareness of the stance of Jehovah's Witnesses on blood transfusions and the ethical and legal dilemmas associated with caring for Jehovah's Witness (JW) patients. Results: The study yielded three significant findings. It unequivocally demonstrates that nursing and midwifery students possess inadequate knowledge regarding Jehovah's Witnesses' stance on blood transfusions and their acceptance of specific blood products and medical procedures. Despite being cognisant of the ethical and legal dilemmas of caring for JW patients, students lack an understanding of patients' autonomy to reject blood transfusions and their need for bloodless medicine. Students also articulated educational needs regarding cultural competencies regarding the Jehovah's Witnesses' beliefs on blood transfusions and non-blood management techniques. Conclusions: Healthcare professionals need the knowledge and skills necessary to provide holistic, patient-centred and culturally sensitive care. This study emphasises the urgent need for university curricula and nursing postgraduate training to include modules on transcultural nursing and strategies for minimising blood loss. [ABSTRACT FROM AUTHOR]

This article explores the spiritual journey of Eldridge Cleaver, a former Black Panther and author, who became a member of the Church of Jesus Christ of Latter-day Saints (LDS) in 1983. Cleaver's interest in Mormonism began in the late 1970s, and he eventually met with LDS missionaries and prominent members of the Church. Despite initial obstacles, Cleaver was baptized into the LDS Church in 1983 but became less active over time. The article discusses the challenges Cleaver faced, including feeling estranged in predominantly white wards, struggles in his political career, financial difficulties, and addiction to crack cocaine. Cleaver expressed admiration for the social practices of the LDS Church and desired a more equitable role for women. The article highlights the complexities of religious conversion and the unfulfilled potential of Cleaver's spiritual journey. [Extracted from the article]

Present day Jehovah's Witness (JW) religion accounts for 8.5 million followers. A tenant feature of the JW faith is religious objection to transfusions of blood and blood products. Interpatient variability, as it pertains to blood and blood products may occur; hence, a confidential interview will determine which products individual may consent to (Marsh and Bevan, 2002). This belief and practice place great restrictions on treating medical professionals in scenarios of life‐threatening anaemia and active haemorrhage. The review to follow explores the physiological and pathophysiological consequences of severe anaemia. Non‐blood transfusion practices are explored, many of which are potentially lifesaving. Particular attention is drawn to the evolving science involving artificial oxygen carriers and their use in emergency situations. A greater safety profile ensures its future use amongst religious objectors to be greatly beneficial. Intravenous iron supplementation has enjoyed a lively debate within the critical care community. A review of recent systematic and meta‐analysis supports its use in the ICU; however, more investigation is needed into the complementary use of hepcidin. [ABSTRACT FROM AUTHOR]

This paper builds upon and extends Christian and legal scholarship on the civil rights movement by illuminating a climate of religious freedom that served as a catalyst for and was integral to the success of the spirited activism of the civil rights movement. To date, scholars have not extensively considered how the expansion of religious freedom in church and state jurisprudence both directly and indirectly created a climate that contributed to the success of the CRM, and how advancements in civil rights impacted the broader revolution occurring in constitutional rights. The climate of religious freedom included court support for evangelizing in residentially exclusive areas, exemptions for conscientious opposers from participating in oath swearing and other ceremonies, and exemptions from other general laws that unduly inhibited the free exercise of religious rights. [ABSTRACT FROM AUTHOR]

Surgical myectomy is recommended for symptomatic hypertrophic obstructive cardiomyopathy (HOCM) after optimal pharmacological therapy. Percutaneous transluminal septal myocardial ablation (PTSMA) is reserved for high-risk adults. Symptomatic patients below 25 years underwent either surgery or PTSMA after heart-team discussion and informed consent. Echocardiography assessed gradients in surgical group. PTSMA group underwent invasive transseptal hemodynamic assessment, selective coronary angiography and super-selective cannulation of septal perforators using microcatheters. Contrast echocardiography through the microcatheter identified the myocardial target for PTSMA. Hemodynamic and electrocardiographic monitoring guided alcohol injection. Both groups were continued on beta-blockers. Symptoms, echocardiographic gradients and Brain natriuretic peptide (NTproBNP) measurements were assessed on follow-up. Twelve patients aged 5–23 years (11–98 kg) formed the study group. Indications for PTSMA in 8 patients included abnormal mitral valve anatomy warranting replacement (n = 3), Jehovah's witness (n = 2), severe neurodevelopmental and growth retardation (n = 1) and refusal of surgery (n = 2). PTSMA targeted first perforator (n = 5), second perforator (n = 2) and anomalous septal artery from left main trunk (n = 1). Outflow gradient reduced from 92.5 ± 19.7 to 33.1 ± 13.5 mmHg. At a median follow-up of 38 months (range 3–120 weeks), the peak instantaneous echocardiographic gradient was 32 ± 16.5 mmHg. Gradient reduced in four surgical patients from 86.5 ± 16.3 mmHg to 42 ± 14.7 mm Hg. All patients were in NYHA class I/II on follow-up. The mean NTproBNP in PTSMA group reduced from 6084 ± 3628 pg/ml to 3081 ± 2019 pg/ml; it was 1396 and 1795 pg/ml in surgery. PTSMA may be considered in medically refractory high-risk young patients. It relieves symptoms and reduces gradient. Though surgery is preferred in young patients, PTSMA may have a role in selected patients. [ABSTRACT FROM AUTHOR]

Following their ban in 2017, the state targeted Jehovah’s Witnesses as harmful sectarians in the context of a ‘conservative twist’ in Russian politics grounded in late-Soviet anti-sectarian models and narratives. The active use of religious instruments in the political setup has led to a growing securitization of religion in Russia, where ‘non-traditional’ religiosity and religious non-conformism have been criminalised and blended with terrorism and extremism. The article focuses on forensic expertise in religion used in trials against believers and discusses how the forensic analysis of religious teachings for criminal evidence (criminotheology) have construed Jehovah’s Witnesses as dangerous extremists.

Çalışmanın konusu kıyamet beklentisi üzerine kurulan, köktenci ve lider eksenli bir grup olan Yehova Şahitleri hareketinin günümüzde internet ortamında sürdürdüğü misyonerlik faaliyetlerinin değerlendirilmesidir. Şahitler, Armageddon (kıyamet savaşı) sonrasında hayatta kalacak olanların sayısını artırmak için vaazlarını yoğunlaştırma ve çeşitli araçları bu amaç doğrultusunda kullanma çabasındadırlar. Bu bağlamda çalışmanın amacı bir yandan Yehova Şahitleri’nin misyonerlik faaliyetleriyle ilgili bilgi sunmak diğer yandan başta web tabanlı dijital mecralarda olmak üzere kendileri tarafından üretilen ve akıllı cihazlara yüklenebilen aplikasyonlar aracılığıyla hareketin üye kazanma stratejilerini değerlendirmektir. Burada hedef, Yehova Şahitleri özelinde dinî grupların yoğun enformasyon ve teknoloji çağında misyonerlik faaliyetlerini yürütme şekilleri üzerine bir bakış açısı sunmaktır. Bu amaç ve hedefler çerçevesinde çalışmada karşılaştırma, betimleme, metin analizi ve yorum geliştirme gibi yöntem ve tekniklerden yararlanılmaktadır. Mesih beklentisi içerisinde olan ve kendilerini onun gelişine hazırlayan bir grup olarak Yehova Şahitleri, özellikle son dönemlerde dijital ortamda yürüttükleri üye kazanma yöntemleriyle hedeflerine ulaşma çabasındadırlar.

Objectives: The aim of the study is to assess obstetric and fetal outcomes of Jehovah's Witnesses (JWs) mothers in an inner city teaching hospital, as well as to examine the acceptance rates of various blood fractions and blood transfusion alternatives. Methods: Case series to evaluate the maternal and fetal outcomes of JWs over a nine period between 2013 and 2021. Results: There were 146 pregnancies extracted from our database, of which 10 were early pregnancy losses. Data from 136 deliveries > 24 weeks' gestation were assessed, with a mean maternal age and gestational age of 30.26 (± 5.4) years and 38.7 (± 5.3) weeks, respectively. 57% had normal vaginal deliveries, 8% had instrumental births and 35% had caesarean births. Mean estimated blood loss at caesarean was 575 (± 305.6) mls, while the overall mean estimated loss was 427.8 (± 299.8) mls. Cell salvage was performed in all caesarean sections but autologous transfusion was only necessary for 26%. Consultant presence was documented in 62% of caesarean births. The mean birthweight and 5-min Apgar scores were 3.31 (± 0.05) kg and 9.1 (± 0.09), respectively. There were no maternal deaths or admissions to the adult intensive care unit and the most serious complication was a uterine rupture following a trial of scar, after which the baby required cooling for hypoxic ischaemic encephalopathy. Conclusions: Pregnant JWs received obstetric care led by senior clinicians, with optimisation of haematinics, minimizing of blood loss at delivery and access to technology such as cell salvage. [ABSTRACT FROM AUTHOR]

This research explores qualitatively the experiences of individuals shunned by the Jehovah's Witnesses community. Four key themes emerge from the 21 semistructured videoconferencing interviews which form the research data analysed using reflexive thematic analysis (Braun et al., 2019). These themes, namely Reasons for Being Shunned, the Judicial Committee, and Consequences of Religious Shunning and Reinstatement, shed light on the events and behaviour which led to the public announcement of the participants' formal shunning and on the controlling environment the religious community has created by endorsing a culture based on fear, guilt, and shame. Although research conducted to explore the experiences of religious shunning is not abundant, the findings of the current study are in line with previous research, highlighting that the individual's journey from being a member to leaving the community is a multifaceted experience, influenced by several factors, which has a detrimental impact on their well-being. [ABSTRACT FROM AUTHOR]

Jehovah's Witnesses – Disfellowshipping and shunning in the perspective of the rule of law: Jehovah's Witnesses (JW) are sometimes criticised for 'shunning' former congregants. This article focuses on the reproach of shunning and has a twofold purpose. Firstly: what is disfellowshipping and shunning about? For an adequate assessment, an analysis of the religious context and the policies JW applied therein is essential. Hereby sociological factors are taken into account as well. Secondly a legal study follows, in which voluntarily or involuntarily leaving the religious community of Jehovah's Witnesses is viewed in the broader constitutional legal framework in which religious communities and individual believers each have their own legal position, both in their mutual relationship to each other and in relation to the society they are in. [ABSTRACT FROM AUTHOR]

In this case study, I consider Mr. A, a Jehovah's Witness with chronic vertebral osteomyelitis in need of surgical debridement. Prior to proceeding to the OR, he was unwilling either to explicitly consent to or refuse blood transfusion, while indicating he was open to transfusion intraoperatively, if the team judged it necessary. Ethics was consulted to determine if it would be morally justifiable for the team to proceed with blood transfusion during the course of surgery without Mr. A's documented consent to being transfused. I argue that in this case, what might be termed indirect consent—namely, delegating decision-making regarding some possible course of action without explicitly consenting to the course of action itself—may be sufficient for discharging the clinician's ethical obligation to obtain consent. Identifying information has been changed or omitted to protect patient confidentiality. [ABSTRACT FROM AUTHOR]

Total hip arthroplasties aim to improve quality of life and reduce pain in patients suffering from late-stage hip osteoarthritis. On the other hand, it may represent a risky surgical procedure in people who refuse blood products because of religious beliefs, such as Jehovah's Witnesses (JW). Preoperative optimisation protocols of these patients allow medical professionals to perform arthroplasties in a safer manner, avoiding allogeneic blood transfusion. In our retrospective study, two groups of patients were evaluated. Group 1 included JW patients who underwent a preoperative Hb optimisation program; Group 2 included non-JW patients authorizing transfusion in case of necessity. Differences in Hb levels were as follows: before surgery (JW 14.24 ± 1.10 vs. non-JW 12.48 ± 1.00, p-value ≤ 0.05), and after surgery (day 1 Hb: JW 12.88 ± 0.90 vs. non-JW 10.04 ± 1.30, p-value ≤ 0.05; day 3 Hb: JW 14.65 ± 0.80 vs. non-JW 9.10 ± 0.90 p-value ≤ 0.05). Moreover, cost-effectiveness strategies were evaluated in both groups. Our findings support that patient blood management programs are a safe and good strategy in hip prosthetic surgery, decreasing risks and transfusion overuse. [ABSTRACT FROM AUTHOR]

Total hip arthroplasties aim to improve quality of life and reduce pain in patients suffering from late-stage hip osteoarthritis. On the other hand, it may represent a risky surgical procedure in people who refuse blood products because of religious beliefs, such as Jehovah’s Witnesses (JW). Preoperative optimisation protocols of these patients allow medical professionals to perform arthroplasties in a safer manner, avoiding allogeneic blood transfusion. In our retrospective study, two groups of patients were evaluated. Group 1 included JW patients who underwent a preoperative Hb optimisation program; Group 2 included non-JW patients authorizing transfusion in case of necessity. Differences in Hb levels were as follows: before surgery (JW 14.24 ± 1.10 vs. non-JW 12.48 ± 1.00, p-value ≤ 0.05), and after surgery (day 1 Hb: JW 12.88 ± 0.90 vs. non-JW 10.04 ± 1.30, p-value ≤ 0.05; day 3 Hb: JW 14.65 ± 0.80 vs. non-JW 9.10 ± 0.90 p-value ≤ 0.05). Moreover, cost-effectiveness strategies were evaluated in both groups. Our findings support that patient blood management programs are a safe and good strategy in hip prosthetic surgery, decreasing risks and transfusion overuse.

Polytrauma involving traumatic brain injury poses serious threats like hemorrhagic shock and consumption coagulopathy. Blood and blood components are a necessity for maintenance of homeostasis in these patients. Elizabeth Topley and R. Clarke, in their study, demonstrated a considerable drop in red cell volume following a major trauma, nearly 11% in the next 14 days. Use of extensive perioperative blood salvage techniques, recombinant erythropoietin, iron complex injections, and antifibrinolytic agents cannot replace the benefits of blood and blood component transfusion. The real challenge of blood transfusion arises in Jehovah's Witness (JW) patients where a licensed medical practitioner (LMP) is caught in the loop of protecting the sanctity of faith over saving a patient's life. This case report highlights the successful management of a 19-year-old JW patient without transfusion of blood or blood products despite an absolute indication for transfusion. We also discuss the legal and ethical perspectives necessary for a legal medical practitioner, when treating patients of JW faith. [ABSTRACT FROM AUTHOR]

In the histories of both colonial and postcolonial Malawi, there have been cases of religious-related violence, both in its physical and non-physical forms. Such cases have led to the deaths of the “perpetrators” of violence and ‘innocent’ believers, destruction of property, prison detentions, and even the forced removal of citizens from the country. This paper analyzes two case studies, one in which private citizens perpetrated the violence, led by a preacher called John Chilembwe, of the Providence Industrial Mission (PIM), challenging British colonial authorities during the second decade of the twentieth century. In the second case, the focus is on the independent Malawi government, which used violence against members of the Jehovah’s Witness (JW) religious sect from the early 1960s to the early 1990s, owing to the Witnesses’ disassociation from the demands of the secular state. Using data primarily drawn from various archives and other published studies, this paper argues that the use of ‘religious-based violence’ is not just a domain ‘reserved’ for those experiencing oppression, exclusion, and marginalization. Rather, authoritarian governments, like the one that emerged in postcolonial Malawi and other parts of Africa, also resorted to using ‘religious-based violence’ to serve as a tool for eliminating ‘non-conforming’ religious sects and organizations. In doing so, this paper contributes to the various fields of scholarship, including the relationship between religion and violence in modern Africa and the dynamics and operations of the state in both colonial and postcolonial Africa.

Using the example of the Jehovah's Witnesses (JW) religious organization, the authors analyze the situation for representatives of religious minorities in Ukraine in connection with the Russia-Ukraine’s war. Being institutions that, even in peacetime, occupying a non-dominant position in the structure of the religious life of Ukraine, religious minorities suffer the most from the war and its consequences compared to the majority religions. The purpose of the article is to clarify the scale of resource losses (human, material, moral), the nature of the religious minorities representatives’ activities (in this case, the JW) and the possibilities of preserving and revitalizing the activities of their communities. As a result of the study, the authors came to conclusions that can be considered a certain novelty: the war accelerated the processes of civil and national identification, strengthened people in their faith, and intensified socially useful and humanitarian assistance to the needy from religious minorities. The vast majority of communities took a distinctly patriotic position, contributing in various ways to the victory of Ukraine in the war and the establishment of a stable and just peace. At the same time, the authors predict that Ukraine after the war may be threatened with a decrease in religious pluralism due to the impossibility of reviving the activities of some small religious groups, which will not be able to return to their pre-war usual life, even if the conditions of latitude and state guarantees of human rights are preserved in the religious sphere and their communities.

Jehovah's Witnesses are one of the few western religious communities of Western origin that has been able to exhibit steady growth in Turkey and around the world with its unique understanding of worships and interpretations of Christianity. The witnesses first arose around Protestant religious movements in the United States under the name "Bible Students". Although they were initially seen as a sect of Christian origin, but over time, due to peculiar doctrines they display they began to be considered as a new world religion. In the first part of this study, the demographic profile and patterns of religious recruitment of Istanbul Kurtulus congregation will be analysed together with data from previous studies on congregations in other countries, and ways and forms of recruitment in Türkiye for ordinary Jehovah's Witnesses to the new religion will be discussed extensively. The data pool which our study is based was obtained from field notes of the services we have attended for three years, data from informants of the congregation and semi structured interviews with 21 members. The first and key finding of our research is that religious conversion patterns in our sample are much more closely in aligned with social network theory than in the cases of other countries. Additionally, gender is identified as an important factor of mediation for conversion, with networks of kinship playing an active role. In the second part of this study, based on these insights, we will offer two basic types of recruitment orientation which we call as "Accomodation" and "Pioneering". These two orientations seem to correspond to two different social motives and needs in our sample. In the last part of this study, conversion experiences of two interviewees will be elaborated as representing these two motives. [ABSTRACT FROM AUTHOR]

The experience of World War I made popular the concept of medical geography (geomedicine in English, geomedizine in German), which became part of Nazism's philosophy of national welfare, safety, and solidarity. The Nazis used it to create propaganda to show some groups as rats, vermin, and Untermenschen (subhumans). In this way, more than 10 million people were killed under the Nazi regime: 6 million Jews, plus more than 5 million Gypsies, Jehovah's Witnesses, and other individuals who were not part of the German theory of "master race." The Germans' fear of typhus that spread in the Wehrmacht was so immense that during the occupation, Polish doctors used this phobia to organize a resistance movement. Contemporarily, the scope of geographic medicine encompasses the following research areas: spatial differentiation of disease incidents and the process of disease diffusion, geographic inequalities in the population's health level, and morbidity determinants among the inhabitants of developing countries. In the first half of the 19th century, it played an essential role in the activities aimed against epidemics of infectious diseases, including louse-borne typhus (epidemic typhus), cholera, and typhoid, linking these diseases to cultural determinants. Under the influence of this idea, the concept of doctor-hygienist emerged, and social medicine began to evolve. [ABSTRACT FROM AUTHOR]

Objective: Management of emergency care. Background: Surgical management in patients who undergo traumatic blood loss but who refuse blood transfusion can be challenging, but physicians and surgeons must comply with the wishes and beliefs of their patients. This report describes the management of severe anemia, with hemoglobin level of 2.5 g/dL, in a 71-year-old male Korean trauma patient who declined blood transfusion. Case Report: A 71-year-old man was admitted to hospital with severe blood loss following trauma. He declined blood transfusion due to his religious belief as a Jehovah's Witness. On day 4, the patient's hemoglobin level dropped from 7.7 to 3.9 g/dL. Despite the need for blood transfusion, the patient refused. Hence, therapeutic strategies, including crystalloid fluid resuscitation, bleeding control, vasopressor support, erythropoietin administration, supplementation with iron, folic acid, and vitamin B12, coagulopathy correction, oxygen consumption reduction, and mechanical ventilation were implemented. Following 16 days of supportive management, the hemoglobin reached 7.4 g/dL. However, it suddenly decreased on day 41 (2.5 g/dL) due to episodes of melena secondary to an actively bleeding gastric ulcer, which was successfully managed with endoscopic hemostasis. Despite increased vasopressor dosage and addition of vasopressin and hydrocortisone, the patient became unresponsive with persistent hypotension. Methylene blue was used as the final therapeutic agent. The patient responded well and subsequently recovered without blood transfusion. Conclusions: This report has presented the clinical challenges of managing the case of a patient who requires but declines blood transfusion and has highlighted the approach to clinical care while respecting the wishes of the patient. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Radical gynecology oncology surgeries are feasible in patients refusing blood transfusion, when performed with careful preoperative (with hemoglobin optimization and patients' counseling), intraoperative (with hemostasis and stepwise devascularization, hemodilution, and autologous cell salvage) and postoperative (considering iron infusion or erythropoietin) planning with a multidisciplinary team involvement. We describe the case of a female Jehovah's Witness patient in her 60s undergoing pelvic exenteration, focusing on the preoperative, intraoperative, and postoperative measures that allowed an uncomplicated surgery without blood transfusion. Blood transfusions are common in the surgical management of gynecology oncology patients, up to 93% of patients undergoing pelvic exenteration may require blood products. However, increasingly more patients are cautious in receiving blood products, either for fear of potential risks or for religious believes. It is therefore vital to optimize the management of these patients in order to avoid blood transfusions. In this case, we summarize the management of a lady in her 60s who underwent laparotomy, pelvic exenteration, Bricker colicureterostomy, and end colostomy formation for recurrent endometrial carcinoma, despite previous total abdominal hysterectomy and bilateral salpingo‐oophorectomy followed by brachytherapy, chemotherapy, and external beam radiotherapy for high‐grade serous carcinoma. Preoperatively, an advance decision to refuse blood products was discussed to ascertain all the options that were suitable. As her preoperative hemoglobin was acceptable (127 g/L), no further intervention was required. Intraoperatively, blood loss was effectively minimized with meticulous hemostasis, stepwise pelvic devascularization, intraoperative hemodilution, and cell salvage. Despite these interventions, total blood loss was 1030 mL and postoperative hemoglobin was 113 g/L. Postoperative measures therefore included intravenous iron infusion, minimization of phlebotomy, and optimization of cardiopulmonary status. Erythropoietin was also considered, but was not necessary as patient responded to the previous measures well and was successfully discharged after an uncomplicated recovery. Only few cases of total pelvic exenteration have been described in the literature for Jehovah's Witness patients. However, our case shows that laparotomy and pelvic exenteration is feasible in patients refusing blood products, if performed under a multidisciplinary team and with careful preoperative, intraoperative, and postoperative planning, also in the setting of previous radical hysterectomy and co‐adjuvant therapy. [ABSTRACT FROM AUTHOR]

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Parenchymal-sparing hepatectomy (PSH), though technically challenging, is emerging as a choice of treatment for colorectal liver metastases (CRLM). PSH in Jehovah’s witness (JW) patients, for whom transfusion is not an option, involves complex surgical and medicolegal issues. A 52-year-old JW male with synchronous, multiple, bilobar liver metastases from a rectal adenocarcinoma was referred following neoadjuvant chemotherapy. At surgery, 10 metastatic deposits were observed and confirmed by intraoperative ultrasonography. Parenchymal-sparing non-anatomical resections were performed using a cavitron ultrasonic aspirator with the application of intermittent Pringle maneuvres. Histology confirmed multiple CRLMs with tumor-free resection margins. PSH is increasingly employed for CRLMs to preserve residual liver volume and minimize morbidity without compromising oncological outcomes. It is technically challenging, especially in the presence of bilobar, multi-segmental disease. This case illustrates the feasibility of performing complex hepatic surgery in special patient groups by meticulous planning and preparation involving multiple specialties and the patient.

This paper builds upon and extends Christian and legal scholarship on the civil rights movement by illuminating a climate of religious freedom that served as a catalyst for and was integral to the success of the spirited activism of the civil rights movement. To date, scholars have not extensively considered how the expansion of religious freedom in church and state jurisprudence both directly and indirectly created a climate that contributed to the success of the CRM, and how advancements in civil rights impacted the broader revolution occurring in constitutional rights. The climate of religious freedom included court support for evangelizing in residentially exclusive areas, exemptions for conscientious opposers from participating in oath swearing and other ceremonies, and exemptions from other general laws that unduly inhibited the free exercise of religious rights.

Background and Objectives: Jehovah's Witnesses (JW) reject the transfusion of blood components based on their religious beliefs, even if they are in danger of harm or death. In cardiac surgery, this significantly reduces the margin of safety and leads to ethical conflicts. Informed consent should be carefully documented and the patient's family should be involved. This study aims to compare the postoperative course of JW who underwent major cardiac surgery with a similar population of non-Witnesses (NW). Patients and Methods: Demographic, procedural, and postoperative data of all consecutive JW who underwent cardiac surgery at our institution were obtained from the records. They were compared with a propensity-score-matched group of NW. Anemic JW were treated with erythropoietin and/or iron as needed. Cardiac surgery was performed by experienced surgeons using median sternotomy and cardiopulmonary bypass. Common blood-sparing techniques were routinely used. Periprocedural morbidity and mortality were statistically evaluated for both groups. Results: A total of 32 JW and 64 NW were part of the matched dataset, showing no demographic or procedural differences. EPO was used preoperatively in 34.4% and postoperatively in 15.6% of JW but not in NW. Preoperative hemoglobin levels were similar (JW, 8.09 ± 0.99 mmol/L; NW, 8.18 ± 1.06; p = 0.683). JW did not receive any transfusions except for one who revoked, while NW transfusion rates were 2.5 ± 3.1 units for red cells (p < 0.001) and 0.3 ± 0.8 for platelets (p = 0.018). Postoperative levels differed significantly for hemoglobin (JW, 6.05 ± 1.00 mmol/L; NW, 6.88 ± 0.87; p < 0.001), and hematocrit (JW, 0.29 ± 0.04; NW, 0.33 ± 0.04; p < 0.001) but not for creatinine. Early mortality was similar (JW, 6.3%; NW, 4.7%; p = 0.745). There were more pacemakers and pneumonias in JW, while all other postoperative conditions were not different. Conclusions: Real-world data indicate that Jehovah's Witnesses can safely undergo cardiac surgery provided that patients are preconditioned and treated by experienced surgeons who use blood-saving strategies. Postoperative anemia is observed but does not translate into a worse clinical outcome. This is consistent with other studies. Finally, the results of this study suggest that all patients should benefit from optimal pretreatment and blood-sparing strategies in cardiac surgery, not just Jehovah's Witnesses. [ABSTRACT FROM AUTHOR]

Perioperative management of patients declining transfusions of blood products can be challenging both ethically and clinically. Jehovah's Witnesses (JW) decline treatment with blood products and have published a list of interventions they might accept as substitutes. No detailed documentation of available substitute interventions at Danish hospitals exists. Likewise, no national guidelines exist on how to optimise patients who refuse to receive treatment with blood products. The primary aim was to investigate which treatments are currently available to healthcare professionals in Denmark when treating patients who refuse transfusion of blood components. Additionally, we wanted to investigate how many departments have local guidelines for treatment for this group of patients. Based on our findings we would suggest potential improvements in the treatment of patients declining transfusion of blood components. Consultants from Danish departments of anaesthesiology, abdominal surgery and obstetrics were invited to participate in a nationwide cross‐sectional online survey. The questionnaire explored available interventions offered perioperatively. Respondents were all on‐call consultants. The questionnaire underwent content, face and technical validation during pilot testing. Ninety‐six of 108 (89%) respondents from 55 departments completed the questionnaire. Thirty‐five (36%) respondents reported having a departmental guideline mostly dealing with judicial aspects regarding patients declining transfusions with blood, and 34 (35%) would in collaboration with other professionals make an interdisciplinary strategy for patients declining transfusions with blood. For patients declining treatment with blood products in anticoagulant treatment, and hence with a greater risk of bleeding, reverting treatment is essential. Depending on the type of anticoagulant, between 31 (32%) and 59 (60%) of respondents reported locally available guidelines for reverting anticoagulant treatments. We found a considerable variation and limited availability of interventions to minimise blood loss in patients declining transfusion of blood components. This scarcity of local guidelines together with the considerable variation of available treatment documented in our survey could possibly be enhanced by a lack of national guidelines. [ABSTRACT FROM AUTHOR]

Following their ban in 2017, the state targeted Jehovah's Witnesses as harmful sectarians in the context of a 'conservative twist' in Russian politics grounded in late-Soviet anti-sectarian models and narratives. The active use of religious instruments in the political setup has led to a growing securitization of religion in Russia, where 'non-traditional' religiosity and religious non-conformism have been criminalised and blended with terrorism and extremism. The article focuses on forensic expertise in religion used in trials against believers and discusses how the forensic analysis of religious teachings for criminal evidence (criminotheology) have construed Jehovah's Witnesses as dangerous extremists. [ABSTRACT FROM AUTHOR]

The research interest of this article is focused on determining the level of influence of Adventist ideas on the formation of the religious identity of the founder of the Bible Students (later Jehovah's Witnesses) and the Watch Tower Society, Charles Taze Russell. As a result of the analysis of the works of Russell and his associates, an attempt was made to explore the attitude of Russell and his supporters to Adventism as a whole. Also, in the opposite direction, the influence of Adventism on the formation of Russell's doctrinal system is determined. Selected aspects of the religious identity of Russell and the Bible Students are identified in the context of searching for answers to the question "Why did Russell deny any influence of Adventism on the formation of his personality?" In the context of scientific research, it has been established that in Russell's time, society treated with contempt the scattered descendants of the Millerites, who suffered a public failure on October 22, 1844. Accordingly, when Russell was asked why certain aspects of his beliefs were similar to Adventist ideas? He replied that his teaching had nothing in common with Adventism. However, in his autobiography, Russell acknowledged the fact that the influence of Adventists on his personal development occurred during his spiritual quest in his youth. Consequently, there are a number of Adventist positions with which Russell strongly disagrees. Namely, the events at the Second Coming of Christ, the method of the Savior's return to earth, and the method of saving the faithful and the unfaithful. There are also a number of provisions with which he agreed. For example, a look at the unconscious state of the dead, the expectation of the imminent return of Christ to earth, and an emphasis on the study of biblical prophecies of the books of Daniel according to two criteria. First is the emphasis on the second coming of Christ. Secondly, the fulfillment of biblical prophecies in the context of prophetic periods. At the same time, in his approving comments about these two aspects of Adventist teaching, he repeatedly emphasized that Adventists had stopped in their research. That is why we summarize that the religious identity of Russell and his supporters contains Adventist ideas (not to be identified with the modern Seventh-day Adventist Church), which Charles Taze Russell and the Bible Students have constantly denied. [ABSTRACT FROM AUTHOR]

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Methemoglobinemia is an acute medical emergency that requires prompt correction. Physicians should have a high degree of suspicion of methemoglobinemia in cases that present with hypoxemia that does not resolve with supplemental oxygenation, and they should confirm this suspicion with a positive methemoglobin concentration on arterial blood gas. There are multiple medications that can induce methemoglobinemia, such as local anesthetics, antimalarials, and dapsone. Phenazopyridine is an azo dye used over-the-counter as a urinary analgesic for women with urinary tract infections, and it has also been implicated in causing methemoglobinemia. The preferred treatment of methemoglobinemia is methylene blue, but its use is contraindicated for patients with glucose-6-phosphatase deficiency or those who take serotonergic drugs. Alternative treatments include high-dose ascorbic acid, exchange transfusion therapy, and hyperbaric oxygenation. The authors report a case of a 39-year-old female who took phenazopyridine for 2 weeks to treat dysuria from a urinary tract infection and subsequently developed methemoglobinemia. The patient had contraindications for the use of methylene blue and was therefore treated with high-dose ascorbic acid. The authors hope that this interesting case promotes further research into the utilization of high-dose ascorbic acid for managing methemoglobinemia in patients who are unable to receive methylene blue. [ABSTRACT FROM AUTHOR]

Although present in Aboriginal communities since the early 1930s, Jehovism among Indigenous peoples in Canada and the United States has not yet been the subject of any published ethnographic, sociological, or historical study. This article presents the result of the first ethnographic study with Jehovah's Witnesses among Aboriginal peoples in Canada. From an online field of research spanning over a period of 10 months with Anishinabe (Algonquin) Witnesses from Kitigan Zibi (Outaouais, Quebec), I explore the motivations behind the decision to become a Jehovah's Witness for the latter. I also show that the first conversions in Kitigan Zibi are mainly due to a dual historical context that created a fertile ground for conversion. Finally, I propose the concept of 'small-scale conversion' as another way to conceive the intergenerational transmission of religion. [ABSTRACT FROM AUTHOR]

The COVID-19 crisis truly challenged social interaction, the use of space and objects, as well as our sense of purpose and meaning in life. In this context, religious communities faced sudden interruption of their usual activities, lack of access to communal spaces and a global epidemic that summoned ancient "medieval plague" anxieties to work with. This article focuses on the vast repertoire of adaptations and reactions to the crisis that several religious communities developed in Spain. Our research is based on 40 conversations with members of Protestant and Evangelical denominations, Sunni Islam, Orthodox churches, Jehovah's Witnesses, Church of Jesus Christ of Latter-day Saints, Judaism, Hinduism, Buddhism, Sikhism, Church of Scientology, Baha'i, Seventh-day Adventist Church, Christian Science and Paganism, all of them minorities in the traditionally Catholic country. To analyze this repertoire of adaptations we focus on three aspects: the general context of changes and challenges, the ritual adaptations and the subjective experience of the adaptations. Grace Q. Zhang's theories on linguistic elasticity will be applied to understand the elasticity of ritual adaptations in COVID times. [ABSTRACT FROM AUTHOR]

Abstract Background The Hypotension Prediction Index (HPI) displays an innovative monitoring tool which predicts intraoperative hypotension before its onset. Case presentation We report the case of an 84-year-old Caucasian woman undergoing major spinal surgery with no possibility for the transfer of blood products given her status as a Jehovah’s Witness. The hemodynamic treatment algorithm we employed was based on HPI and resulted in a high degree of hemodynamic stability during the surgical procedure. Further, the patient was not at risk for either hypo- or hypervolemia, conditions which might have caused dilution anemia. By using HPI as a tool for patient blood management, it was possible to reduce the incidence of intraoperative hypotension to a minimum. Conclusions In sum, this HPI-based treatment algorithm represents a useful application for the treatment of complex anesthesia and perioperative patient blood management. It is a simple but powerful extension of standard monitoring for the prevention of intraoperative hypotension.

In the article, the author examines the gastronomic culture and its regulatory function, expressed in the regulation of eating behavior and food consumption by people through the existence of prohibitions and permits. In particular, it is indicated that such tools, as a rule, find their place in religious canons (codes of rules). Speaking about the religious regulation of consumption, the author examines Protestantism and its currents and trends. According to the results of the study, it was revealed that within the framework of Adventism, Lutheranism, Anglicanism, Mormonism, Jehovah’s Witnesses, etc., there are tools for regulating food consumption that have a characteristic similarity with those in Judaism, Islam and Catholicism. Of course, Protestantism, being a denomination of Christianity, along with Catholicism, can borrow some rules and features. Meanwhile, drawing an analogy with these religions and confessions, we can talk about the existence of prohibited and permitted food, while in some areas of Protestantism restrictions are not as strict as in others. Religion, acting as a regulator of eating behavior, designates products originating from “unclean” and “pure” animals and birds. At the same time, in the Bible, the signs that make it possible to differentiate food have a symbolic meaning – “unclean” food sources symbolize mundanity, the impossibility of turning to God, the sinfulness of man. As a result, a gastronomic cultural layer is formed, within which the nutrition of believers, that is, the products they use daily, also taking into account national characteristics, not only have an impact on health, but also have a symbolic meaning of commitment to God, enlightenment, etc. According to the results of the study, the author formulated the factors that are important in determining eating behavior and consumption: a) symbolizing; b) cleansing; c) providing and d) adapting (relevant to the current situation of globalization of the world space and the technologization of life spheres).