bluuebunny/crossref_metadata_2025 huggingface dataset:
Pre-contact Diets of Indigenous Subarctic Peoples of North America
Authors: Szathmáry Emőke J. E.
Published: September 2016

This chapter focuses on the diets of indigenous peoples of the North American Subarctic before European contact, reconstructing the dietary past using several lines of evidence. These include the climate and environment of the North American Subarctic Culture Area, its animal and plant resources, the prehistory of its indigenous inhabitants, and information on food resources obtained during the contact-traditional phase of their history. For hunting-gathering peoples the maintenance of dietary adequacy requires the consumption of balanced diets. That balance depends on the existence of diversity in the plant and animal species on which people depend, and which must be available in sufficient quantities to meet their needs. Accordingly, the chapter focuses on the wild foods that were likely to have been consumed aboriginally, describes the composition of pre-contact diets, and comments on the nutrition and health of Subarctic peoples as perceived at the time of contact.
Dietary Change in Populations of the North American Subarctic
Authors: Szathmáry Emőke J. E.
Published: September 2016

This chapter considers the consequences of change, from a largely flesh based diet to one that includes flour and sugar, among North American Subarctic populations. It notes the problems associated with assessing dietary change among the indigenous inhabitants of this area, and what is known about their foods. It reviews frequently used methods of dietary intake assessment. Survey findings on total energy intakes and the macronutrient composition of indigenous diets are presented. Lastly, evidence regarding the impact of dietary change on the health of Subarctic peoples is summarized. Special consideration is given to chronic diseases, especially type 2 diabetes, and future health risks, given the rapidity of dietary acculturation in the Subarctic. It has proven difficult to demonstrate that dietary change has a direct causal role in the onset of chronic diseases, even though the transition from pre-contact to modern diets is recent, in some instances just a few decades ago.
Alban Berg’s “Guilt” by Association
Authors: Hall Patricia
Published: September 2016

This chapter examines how Alban Berg plotted to survive as a composer during the Third Reich. Berg’s opera Wozzeck premiered in Berlin on December 14, 1925, and achieved undisputed success eight years later. When Adolf Hitler became the leader of Nazi Germany, the works of many atonal composers, whether Aryan or not, were banned from performance in the country. Drawing on Berg’s personal documents held in the Austrian National Library, including musical sketches and drafts of letters, this chapter considers how Berg repackaged Wozzeck and his other opera Lulu in order to survive as a composer amid the harsh political environment during Hitler’s reign. It also comments on Berg’s desperation as a result of the Nazi government’s censorship of performances of Wozzeck. Finally, it considers Berg’s anti-Semitic tone in his opera, as well as his self-promotion to the point of aligning himself with Nazi Germany.
Substance-Impaired Driving in Adolescence
Authors: McCarty Kayleigh N. , McCarthy Denis M.
Published: September 2016

Driving while impaired by alcohol and other substances is a substantial problem for adolescents. This chapter provides an overview of the current state of the literature on adolescent substance-impaired driving (SID), including trends in the rate of engagement by gender, race, and ethnicity, and the effect of specific policies in reducing these rates. Factors that affect adolescent risk for SID are also discussed, including social and parental influences, personality traits, and cognitive factors. Interventions and prevention methods for reducing SID in adolescents are reviewed. The chapter concludes by highlighting future directions for research on this topic, including an increased focus on marijuana-impaired driving; the development of adolescent-specific theoretical models; and the examination of proximal, event-level influences on SID.
Targeted Prevention Approaches
Authors: Wagner Eric F. , Lewis Nehama
Published: September 2016

This chapter reviews the current literature on targeted prevention approaches for adolescent alcohol and other drug (AOD) use. We open the chapter by examining both the historical and current use of the term “targeted prevention” in regard to teen AOD use. We then provide a review of existing targeted prevention work from a health communication perspective and offer recommendations for future areas for research on targeting in health campaigns. This is followed by a review of existing targeted prevention work from a clinical intervention perspective, with attention to both selective and indicated prevention strategies. This includes recommendations for future areas for research on targeting in early intervention programs. We conclude the chapter with a brief recapitulation of its contents.
The Origins and Development of Arctic Maritime Adaptations in the Subarctic and Arctic Pacific
Authors: Fitzhugh Ben
Published: September 2016

This chapter explores the antiquity and evolution of Subarctic maritime traditions in the Beringian North Pacific—precursors of maritime cultures that ultimately pushed north and east across the Canadian and Greenlandic Arctic. Boat-based, maritime economies and settlement show up by the Pleistocene-Holocene transition in the relatively warm Subarctic Northeast Pacific (Gulf of Alaska and Aleutians) but appear delayed by 5,000 or more years in the Northwest Pacific and Bering and Chukchi seas. Potential biases of preservation and research histories are examined and dismissed, and two environmental models are proposed to explain the delay (or disruption) of maritime settlement in the seasonally frozen Okhotsk, Bering, and Chukchi seas. Late Holocene maritime traditions intensify and converge in all regions of the Subarctic and Arctic Pacific over the past 2,000–3,000 years, forging a common ecological, economic, technological, and social orientation, where none had previously existed.
Thule Origins in the Old Bering Sea Culture
Authors: Mason Owen
Published: September 2016

The Thule culture is the most widespread Arctic whaling culture; its distribution commonly associated by researchers with climatic warming. Its origins between A.D. 900 and 1200, and development in the Birnirk and Punuk cultures are contested between Siberia and Alaska, out of a base of Old Bering Sea cultures. Although reliant on whaling, the degree of social complexity in Thule remains uncertain, as the trade in iron decreases as does aesthetic elaboration. The last incarnation of a “Northern maritime tradition” and the predecessor of modern Iñupiat and Inuit, the considerable and renowned Thule whaling prowess lends their origin a political cast in modern communities.
Inuit-European Interactions in Greenland
Authors: Gulløv Hans-Christian
Published: September 2016

In every century since the Middle Ages there have been Europeans in Greenland. Medieval Norse farmers settled in the southwestern part of the country and met with Native Greenlanders from the twelfth to the fifteenth centuries. From the sixteenth century onward, English and Danish explorers, followed by primarily Dutch whalers, met the Inuit on the west coast of Greenland. In 1721, Greenland was colonized from the double monarchy Denmark-Norway. During the eighteenth century, permanent settlements were established throughout west Greenland, and in the nineteenth century contacts were established with the Inuit on the east coast and in the Thule area.
Modernization Theory
Authors: Cheibub José Antonio , Vreeland James Raymond
Published: September 2016

This article examines the link between economic development and democracy. Drawing on modernization theory, it considers whether democracy is more likely to emerge in a country that modernizes economically. After discussing various criticisms against modernization theory, the article reviews statistical evidence to determine whether economic modernization gives rise to democracy. It argues that the correlation between economic development and democracy stems from the survival of democracy and that a poor authoritarian regime is not likely to turn into a democracy even if it receives economic assistance, either in the form of foreign aid or access to markets through trade. The article highlights the correlation between economic level and survival, rather than between economic growth and survival, noting that economic growth can be helpful only if it is sustained.
The Politics of the Resource Curse
Authors: Ross Michael L.
Published: September 2016

This article considers the debate over the “resource curse” (i.e., whether too much natural-resource wealth is harmful for developing countries) along with the debate about the mechanisms and conditions that likely generate the reported problems. After reviewing the literature on the resource curse, this article discusses the ways that scholars define “natural resources.” It then analyzes research on how resource wealth affects democracy, the quality of government institutions, and the incidence of violent conflict. It cites evidence showing that petroleum wealth, in particular, seems to have at least three harmful effects: to make authoritarian regimes more durable, to increase certain types of corruption, and to foster the onset of violent conflict in low- and middle-income countries, particularly when this form of mineral wealth is found in the territory of marginalized ethnic groups.
Minority Influence
Authors: Butera Fabrizio , Falomir-Pichastor Juan Manuel , Mugny Gabriel , Quiamzade Alain
Published: September 2016

The aim of the present chapter is to explain the processes through which minority points of view may, or may not, diffuse in society at large. The first section presents the rise in the 1970s of a new stream of research, that of minority influence, and summarizes early conceptions and the initial experimental works that allowed differentiating minority from majority influence. The second part reviews the subsequent criticism to early minority influence research, in particular as regards its differences from majority influence. The third section examines the various models that attempted to reconcile previous controversies, and it organizes the great diversity in results observed over the years in studies on majority and minority influence. The final section points to the liveliness of this area of investigation by reviewing some recent extensions and applications of minority influence research.
Fearing the Disorder of Things
Authors: Meierhenrich Jens
Published: September 2016

This chapter offers a longitudinal analysis of Carl Schmitt’s institutional theory. It provides a detailed road map for the period under investigation, examining critical junctures and theoretical turns along the way. Two principal arguments are advanced. First, the chapter departs from conventional analyses according to which Schmitt only embarked on an “institutional turn” in the early 1930s. Instead of conceiving of Schmitt’s institutionalism as an intellectual stage of his thought, the chapter posits that it constituted—as his predominant theoretical approach—its essence. Second, the chapter argues and demonstrates that Schmitt’s institutional theory underwent a gradual transformation, from pragmatist institutionalism to extremist institutionalism. Taking a leaf from the late Hans Mommsen, the chapter argues that the development of Schmitt’s institutional theory was subject to a cumulative radicalization.
Burden and Social Cost of Fetal Alcohol Spectrum Disorders
Authors: Popova Svetlana , Lange Shannon , Burd Larry , Rehm Jürgen
Published: September 2016

Damage to the central nervous system is a unifying concept for nearly all of the diagnoses that fall under the Fetal Alcohol Spectrum Disorders (FASD) umbrella. Thus, FASD are an important public health and social problem worldwide that consumes a large amount of resources, both economic and societal by imparting a large burden on society through such sectors as the healthcare system, mental health and substance abuse treatment services, foster care, the criminal justice system, and the long-term care of individuals with intellectual and physical disabilities. Existing estimates of the economic impact of FASD demonstrate significant cost implications on the individual, the family and society. Many of the costs associated with FASD can be reduced with the implementation of effective social policies and intervention programs.
Colonization, Decolonization, and Power: Ruptures and Critical Junctures Out of Dominance
Authors: Liu James H. , Pratto Felicia
Published: September 2016

Colonization and decolonization are theorized at the intersection of Critical Junctures Theory and Power Basis Theory. This framework allows human agency to be conceptualized at micro-, meso-, and macro-levels, where individuals act on behalf of collectives. Their actions decide whether critical junctures in history (moments of potential for substantive change) result in continuity (no change), anchoring (continuity amid change with new elements), or rupture. We apply this framework to European colonization of the world, which is the temporal scene for contemporary social justice. Several critical junctures in New Zealand history are analyzed as part of its historical trajectory and narrated through changes in its symbology (system of meaning) and technology of state, as well as the identity space it encompasses (indigenous Māori and British colonizers). The impact of this historical trajectory on the social structure of New Zealand, including its national identity and government, is considered and connected to the overarching theoretical framework.
Social Justice in Multicultural Europe: A Social Psychological Perspective
Authors: Chryssochoou Xenia
Published: September 2016

Informed by Social Representations and Social Identity theories, this chapter argues that investigation of justice issues in multicultural Europe requires focusing on the ideological context in which justice is pursued or obstructed. Following Touraine (2005), it argues that two social representations of societal organization coexist in Europe with different implications for status, values, and justice attribution: one that organizes society and builds hierarchies in terms of merit; and another that organizes society according to cultural differences and to group membership. The use of each representation implies different criteria for distributive and procedural justice and emphasizes conflicts based on different memberships. A representation of society following a cultural order might hide the class membership of migrants and obstruct their individual mobility. Unable to fight in terms of class, migrants’ sole opportunity for seeking justice and equal treatment is to fight collectively by adopting an ethno-cultural or religious identity.
Social Justice Theory and Practice: Fostering Inclusion in Exclusionary Contexts
Authors: Opotow Susan
Published: September 2016

This chapter, focused on the meaning and dynamics of social justice and injustice, describes theory and the lived experience of injustice. Its first section defines social justice, social injustice, and three psychological justice models—distributive, procedural, and exclusionary/inclusionary. The second section applies these models to environmental injustice, a complex, pressing social issue in which acute and chronic exposure to toxic pollution has become concentrated in marginalized communities. This example clarifies that the scope of justice, however wide or narrow, is a defining framework that is then operationalized by distributive and procedural justice in societal structures and in everyday life. The final section discusses collaborative efforts to widen the scope of justice and the difficulties of fostering social justice in contexts characterized by power inequalities and a culture of moral exclusion.
Of “Takers” and “Makers”: A Social Psychological Analysis of Class and Classism
Authors: Bullock Heather E. , Reppond Harmony A.
Published: September 2016

During the 2012 United States presidential campaign, the Republican presidential and vice presidential candidates drew a stark line between “takers” and “makers,” claiming that too many Americans are “takers” because they receive more from the government and society than they contribute. In this chapter, we employ a critical social psychological framework to understand and deconstruct the political discourse surrounding “makers” versus “takers” and to illuminate the social psychology of social class and classism. This chapter focuses on attitudes and beliefs about social class that legitimize economic inequality and class disparities and the relationship of these beliefs to interclass relations and social and economic policy. In doing so, this chapter identifies the important role of social psychological research and justice-oriented frameworks in alleviating class-based disparities and classism.
The Multiple Faces of Reentry
Authors: Turner Susan
Published: September 2016

In recent years, prisoner reentry programs have been developed to promote the successful reintegration of offenders back into communities upon release from prison and jail. Specifically, these programs often involve a comprehensive case management approach to assist offenders in the acquisition of prosocial life skills. A variety of programs are currently used to facilitate the reentry process, including prerelease programs, drug rehabilitation, vocational training, and work programs. In addition, reentry courts have been established in several jurisdictions in an attempt to offer a more focused approach to community reintegration. This essay reviews the challenges associated with postrelease supervision and service delivery, including the potentially deleterious effects of long prison sentences and certain prison environments, as well as the development, implementation, and evaluation of prisoner reentry programs.
Phenomenology and Course of Mood Disorders
Authors: Strunk Daniel R. , Sasso Katherine
Published: September 2016

In this chapter, we provide an overview of the phenomenology of the mood disorders, including attention to both symptoms and functional impairment. Our overview emphasizes the heterogeneity among those with these disorders, as well as the most influential approaches to describing this variability across and within bipolar and depressive disorders. We discuss the degree of overlap between bipolar and depressive disorders, paying special attention to the clinical significance of low levels of manic symptoms. We also review several influential symptom-based specifiers, including those that refer to melancholic, atypical, anxious, and psychotic features. Having considered variability in the symptoms of these disorders, we then consider the course of these disorders. We survey the remarkable variability in course as well as current approaches to characterizing these differences. We conclude with a discussion of future directions.
The Commodification of Women’s Reproductive Tissue and Services
Authors: Dickenson Donna
Published: September 2016

Although the term “commodification” is sometimes criticized as imprecise or overused, in fact it has a complex philosophical ancestry and can never be used too much because the phenomena that it describes are still gaining ground. The issues that commodification raises in relation to reproductive technologies include whether it is wrong to commodify human tissues generally and gametes particularly, and whether the person as subject and the person as object can be distinguished in modern biomedicine. This chapter examines three areas in which commodification is a serious concern for important reproductive technologies: the sale of eggs for in vitro fertilization and research, the banking of umbilical cord blood, and the use of gestational surrogates both domestically and internationally. In each example, the commodification of women’s reproductive labor is masked by the manner in which “the lady vanishes” under a gift model, ignoring the true economic value of their labor and opening up the possibility of exploitation by commercial interests.
Freedom, Regulation, and Public Policy
Authors: Pennington Mark
Published: September 2016

This chapter explores the relationship between freedom, regulation, and public policy. Adopting a “non-ideal” approach, it argues that there is no necessary connection between different conceptions of liberty and any particular sort of regulatory/public policy framework. Both negative and positive conceptions of freedom require a role for “regulation,” but whether this “regulation” arises from public policy or is best left to emerge through private agency in a competitive environment is a matter that can only be resolved by theoretical speculation and empirical inquiry. Many disputes about the freedom-enhancing capacities of regulatory regimes ought to be addressed within a framework that combines social scientific theory and evidence to understand the “compliance problems” arising under alternative institutional arrangements.
Effects of Consecutive Streptomycin and Kasugamycin Applications on Epiphytic Bacteria in the Apple Phyllosphere
Authors: Tancos K. A. , Cox K. D.
Published: September 2016

Antibiotic applications are essential for fire blight management in the eastern United States. Recently, streptomycin-resistant Erwinia amylovora strains were found in New York. There are growing concerns that streptomycin resistance may develop from postbloom streptomycin applications in local orchards. Our goal was to investigate the impacts of increasing streptomycin and kasugamycin applications on bacterial epiphyte community composition and antibiotic resistance in the phyllosphere of ‘Idared’ apple plantings in 2014 and 2015. Rinsate samples from leaves treated with 0, 3, 5, and 10 applications of streptomycin and kasugamycin were collected to isolate, enumerate, and identify epiphytic bacterial species. The majority of isolated epiphytic bacteria were identified as Pantoea agglomerans and fluorescent Pseudomonas spp., whereas E. amylovora was rarely found. Overall, postbloom streptomycin use did not result in an increased recovery of streptomycin-resistant E. amylovora. However, other streptomycin-resistant epiphytes (P. agglomerans and Pseudomonas spp.) did increase with increasing streptomycin applications. Increasing kasugamycin applications reduced the overall number and percentage of streptomycin-resistant epiphytes in the phyllosphere, which has important implications regarding the use of kasugamycin in orchards where streptomycin resistance is a concern.
Integrated Management for the Reduction of Calonectria Infections in Ornamental Nurseries
Authors: Cinquerrui Alessandro , Polizzi Giancarlo , Aiello Dalia , Vitale Alessandro
Published: September 2016

Chemical control represents the main effective strategy for managing Calonectria diseases in ornamental nurseries. The occurrence of fungicide-resistant strains and the European Directive on “Sustainable Use of Pesticides” has forced ornamental plant growers to establish effective integrated pest management strategies to control Calonectria infections. Here, three nursery experiments were performed to detect the best combinations of fungicides and biological control agents (BCA) to control both leaf spot, caused by six Calonectria spp. on bottlebrush and metrosideros, and stem rot, caused by Calonectria morganii on Dodonaea plants. Overall, the cyprodinil + fludioxonil mixture alone or combined with bioformulates containing Bacillus, Trichoderma, and Streptomyces spp. provided the best performance in reducing leaf spot and stem rot caused by Calonectria spp., followed by the mixture of boscalid + pyraclostrobin. Although BCA alone provided disease suppression significantly lower than the controls in most cases, these treatments were, on average, the least effective in controlling Calonectria infections. Otherwise, there were no significant increases in efficacy with fungicides plus BCA over fungicides alone. Thus, the application of boscalid + pyraclostrobin and cyprodinil + fludioxonil mixtures may also be used in large-scale applications to reduce Calonectria diseases because they effectively managed leaf and stem infections. Our comprehensive research applied previously acquired information on Calonectria disease management in nurseries, resulting in important data that affects integrated plans to fight these pathogens in accordance with European legislation.
Comparative Reliability of Screening Parameters for Anthracnose Resistance in Water Yam (Dioscorea alata)
Authors: Nwadili Christian O. , Augusto Joao , Bhattacharjee Ranjana , Atehnkeng Joseph , Lopez-Montes Antonio , Onyeka T. Joseph , Kumar P. Lava , Asiedu Robert , Bandyopadhyay Ranajit
Published: September 2016

Anthracnose, caused by Colletotrichum gloeosporioides, is one of the major constraints limiting water yam (Dioscorea alata) production in the tropics. In this region, yam anthracnose control is mostly achieved by the deployment of moderately resistant yam genotypes. Therefore, screening for new sources of anthracnose resistance is an important aspect of yam research in the tropics. The reliability and applicability of different yam anthracnose rating parameters has not been fully examined. Disease severity on detached leaves in the laboratory and leaf severity, lesion size, and spore production on whole plants in the greenhouse were used to screen an F1 yam population and correlate screening results with field evaluations. Anthracnose lesion size had the smallest predicted residual means but whole-plant severity and detached-leaf severity had the best variance homogeneity and relatively small predicted residual means. The concordance correlation coefficient (rc) and κ statistic were used to determine the agreement between anthracnose rating parameters and field evaluations. Detached-leaf (rc = 0.95, κ = 0.81) and whole-plant (rc = 0.96, κ = 0.86) evaluations had high positive agreement with field evaluation but spore production (κ = 0.69) and lesion size (κ = 0.57) had moderate positive agreement. These results suggest that all the evaluated rating parameters can be used to successfully screen yam germplasm for anthracnose resistance but lesion size and spore production data may need to be transformed.
A Model for the Departmental Quality Management Infrastructure Within an Academic Health System
Authors: Mathews Simon C. , Demski Renee , Hooper Jody E. , Biddison Lee Daugherty , Berry Stephen A. , Petty Brent G. , Chen Allen R. , Hill Peter M. , Miller Marlene R. , Witter Frank R. , Allen Lisa , Wick Elizabeth C. , Stierer Tracey S. , Paine Lori , Puttgen Hans A. , Tamargo Rafael J. , Pronovost Peter J.
Published: September 2016

As quality improvement and patient safety come to play a larger role in health care, academic medical centers and health systems are poised to take a leadership role in addressing these issues. Academic medical centers can leverage their large integrated footprint and have the ability to innovate in this field. However, a robust quality management infrastructure is needed to support these efforts. In this context, quality and safety are often described at the executive level and at the unit level. Yet, the role of individual departments, which are often the dominant functional unit within a hospital, in realizing health system quality and safety goals has not been addressed. Developing a departmental quality management infrastructure is challenging because departments are diverse in composition, size, resources, and needs.

In this article, the authors describe the model of departmental quality management infrastructure that has been implemented at the Johns Hopkins Hospital. This model leverages the fractal approach, linking departments horizontally to support peer and organizational learning and connecting departments vertically to support accountability to the hospital, health system, and board of trustees. This model also provides both structure and flexibility to meet individual departmental needs, recognizing that independence and interdependence are needed for large academic medical centers. The authors describe the structure, function, and support system for this model as well as the practical and essential steps for its implementation. They also provide examples of its early success.
Improving the Medical Student Performance Evaluation to Facilitate Resident Selection
Authors: Andolsek Kathryn M.
Published: September 2016

The Medical Student Performance Evaluation (MSPE) was introduced as a refinement of the prior “dean’s letter” to provide residency program directors with a standardized comprehensive assessment of a medical student’s performance throughout medical school. The author argues that, although the MSPE was created with good intentions, many have questioned its efficacy in predicting performance during residency. The author asserts that, despite decades of use and some acknowledged improvement, the MSPE remains a suboptimal tool for informing program directors’ decisions about which applicants to interview and rank. In the current approach to MSPEs, there may even be some inherent conflicts of interest that cannot be overcome. In January 2015, an MSPE Task Force was created to review the MSPE over three years and recommend changes to its next iteration. The author believes, however, that expanding this collaborative effort between undergraduate and graduate medical education and other stakeholders could optimize the MSPE’s standardization and transparency. The author offers six recommendations for achieving this goal: developing a truly standardized MSPE template; improving faculty accountability in student assessment; enhancing transparency in the MSPE; reconsidering the authorship responsibility of the MSPE; including assessment of compliance with administrative tasks and peer assessments in student evaluations; and embracing milestones for evaluation of medical student performance.
The Importance of the Premedical Experience in Diversifying the Health Care Workforce
Authors: Morgan Helen K. , Haggins Adrianne , Lypson Monica L. , Ross Paula
Published: September 2016

In light of national calls for increased diversity in medicine, it is critical for academic medicine to remain actively engaged in the conversation about the value of diversity in higher education, specifically for students from underrepresented backgrounds. Too often, the undergraduate premedical experience is excluded from conversations about diversity in medicine. The undergraduate premedical experience, however, is a critical junction for many students from backgrounds underrepresented in medicine, especially for those who enter college underprepared for the academic rigor of the premedical experience.

In this Commentary, the authors describe the data that currently exist about the premedical experience for underrepresented students. They posit that academic medicine needs to be involved in promoting success for undergraduate students from underrepresented backgrounds, especially given the known societal and educational benefits of a diverse physician workforce. The authors reference the University of Michigan Health Sciences Scholars Program (HSSP) as an example of a partnership between the medical school and the undergraduate campus. HSSP uses higher education best practices known to promote success for underprepared college students. Innovative collaborations between academic medicine and higher education such as HSSP have the potential to increase the diversity of students who are able to matriculate into the health professions. Finally, the authors review issues related to the programming needed to support success for these students.
Spontaneous Twin Pregnancy After Oophoropexy and Pelvic Radiation for Rectal Cancer
Authors: Wald Kaitlyn , Easterling Tom , Swisher Elizabeth M.
Published: September 2016

BACKGROUND:

Pregnancy after adulthood pelvic radiation is rare. There is a paucity of literature to guide preconception counseling and pregnancy management for these patients.

CASE:

A 36-year-old woman, gravida 2 para 1001, was referred at 28 weeks of gestation with spontaneous twins, preterm premature rupture of membranes, and a history of rectal cancer that had been treated 3 years previously with oophoropexy, chemoradiation, and abdominal perineal resection. Delivery was complicated by difficult fetal extraction and resulted in the demise of twin A.

CONCLUSION:

Pregnancy after adulthood pelvic radiation is a potentially morbid event. Patients should be counseled about the potential delivery complications as well as the need for contraception after oophoropexy with intact fallopian tubes.
Maternal Death Due to Clostridium novyi in an Injection Drug User
Authors: Herrera Christina , Meehan Ryan , Podduturi Varsha , Eastman Alexander L. , Nelson David B.
Published: September 2016

BACKGROUND:

Soft-tissue infections in women with subcutaneous injection drug use are often polymicrobial.

CASE:

A 21-year-old nulliparous woman presented at 14–15 weeks of gestation with several gluteal abscesses related to subcutaneous injection of heroin. She was well appearing, afebrile, and without findings of systemic illness. After empiric broad-spectrum intravenous antibiotics, same-day incision and drainage was performed. Immediately after the procedure, she developed refractory hypotension, severe tachycardia, pulmonary edema, and leukemoid reaction (white blood cell count 80×109/L). Cardiac arrest ensued, and she died within 4 hours of onset of sepsis and within 24 hours of presentation. Wound cultures identified Clostridium novyi.

CONCLUSION:

Local, soft-tissue infections that includes C novyi can result in rapidly fatal, toxin-mediated septic shock in pregnant women with high-risk social behavior.
Timing of and Reasons for Unplanned 30-Day Readmission After Hysterectomy for Benign Disease
Authors: Penn Courtney A. , Morgan Daniel M. , Rice Laurel W. , Harris John A. , Rauh-Hain J. Alejandro , Uppal Shitanshu
Published: September 2016

OBJECTIVE:

To characterize timing and reasons associated with unplanned 30-day readmissions after hysterectomy for benign indications.

METHODS:

We performed a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Project database files from 2012 to 2013. We identified patterns of 30-day readmission after benign hysterectomy for all surgical approaches (abdominal, laparoscopic, vaginal). Readmission timing was determined from discharge date and readmission diagnoses were tabulated. Statistical analyses included χ2 tests and multivariable logistic regression.

RESULTS:

The 30-day readmission rate was 2.8% (1,118/40,580 hysterectomies). Readmissions complicated 3.7% (361/9,869) of abdominal, 2.6% (576/22,266) of laparoscopic, and 2.1% (181/8,445) of vaginal hysterectomies. Readmissions were more likely when hysterectomy was performed abdominally (adjusted odds ratio [OR] 1.45, 95% confidence interval [CI] 1.2–1.76) but not laparoscopically (adjusted OR 1.1, 95% CI 0.9–1.4) compared with a vaginal approach. Eighty-two percent of readmissions occurred within 15 days of discharge. The shortest median time to readmission was associated with pain (3 days), and the longest was associated with noninfectious wound complications (10 days). Surgical site infection was the most common diagnosis (abdominal 36.6%, laparoscopic 28.3%, vaginal 32.6%). Surgical site infections, surgical injuries, and wound complications combined accounted for 51.5% of abdominal, 51.9% of laparoscopic, and 50.8% of vaginal hysterectomy readmissions. Medical complications such as cardiovascular events and venous thromboembolism were responsible for 5.8% of abdominal, 6.9% of laparoscopic, and 8.8% of vaginal hysterectomy readmissions. Surgical injuries were responsible for more readmissions after laparoscopic (unadjusted OR 2.3, 95% CI 1.48–3.65) and vaginal hysterectomies (unadjusted OR 2.3, 95% CI 1.29–3.97) than abdominal cases.

CONCLUSION:

Readmissions after hysterectomy tend to occur shortly after discharge. Most readmissions are related to surgical issues, most commonly surgical site infection. Medical complications, including venous thromboembolism, account for less than 10% of readmissions. Readmission reduction efforts should focus on early postdischarge follow-up, preventing infectious complications, and determining preventability of surgical-related reasons for readmission.
Perinatal Outcomes in Cephalic Compared With Noncephalic Singleton Presentation in the Setting of Preterm Premature Rupture of Membranes Before 32 Weeks of Gestation
Authors: Yee Lynn M. , Grobman William A.
Published: September 2016

OBJECTIVE:

To investigate the relationship between fetal presentation at the time of admission for preterm premature rupture of membranes (PROM) and perinatal outcomes, including gestational latency, among women in a large and well-characterized population with preterm PROM at less than 32 weeks of gestation.

METHODS:

This was a secondary analysis of data from women randomized to receive magnesium sulfate compared with placebo in the previously reported Maternal-Fetal Medicine Units Network Beneficial Effects of Antenatal Magnesium Sulfate (1997–2004) trial. Women with a singleton gestation and preterm PROM were included. Fetal presentation at the time of randomization was recorded. Associations of fetal position (cephalic compared with noncephalic) with perinatal outcomes were compared using χ2, Fisher exact, and Wilcoxon rank-sum tests. Perinatal outcomes included gestational latency, abruption, and neonatal morbidity and mortality. Multivariable regression (logistic, linear, and Cox) analyses were used to adjust for potential confounding factors.

RESULTS:

Of the 1,767 eligible women, 439 (24.5%) had a noncephalic presentation. Noncephalic presentation was associated with an earlier median gestational age at the time of preterm PROM (26.6 compared with 28.4 weeks of gestation, P<.001), but no difference in gestational latency (7.5 compared with 7.7 days, P=.7, adjusted hazard ratio 1.09, 95% confidence interval [CI] 0.97–1.23). There were no differences in odds of abruption or neonatal morbidity in multivariable analyses. However, even after controlling for potential confounding factors including gestational age at delivery and mode of delivery, odds of neonatal death before discharge was greater for noncephalic gestations (11.5% compared with 3.4%, P<.001; adjusted odds ratio 2.24, 95% CI 1.12–4.48).

CONCLUSION:

Even after controlling for gestational age and route of delivery, noncephalic fetuses in the setting of preterm PROM are at greater risk of neonatal death.
Levonorgestrel Intrauterine Device as an Endometrial Cancer Prevention Strategy in Obese Women
Authors: Dottino Joseph A. , Hasselblad Vic , Secord Angeles Alvarez , Myers Evan R. , Chino Junzo , Havrilesky Laura J.
Published: September 2016

OBJECTIVE:

To estimate the cost-effectiveness of the levonorgestrel intrauterine device (IUD) as an endometrial cancer prevention strategy in obese women.

METHODS:

A modified Markov model was used to compare IUD placement at age 50 with usual care among women with a body mass index (BMI, kg/m2) 40 or greater or BMI 30 or greater. The effects of obesity on incidence and survival were incorporated. The IUD was assumed to confer a 50% reduction in cancer incidence over 5 years. Costs of IUD and cancer care were included. Clinical outcomes were cancer diagnosis and deaths from cancer. Incremental cost-effectiveness ratios were calculated in 2015 U.S. dollars per year of life saved. One-way and two-way sensitivity analyses and Monte Carlo probabilistic analyses were performed.

RESULTS:

For a 50 year old with BMI 40 or greater, the IUD strategy is costlier and more effective than usual care with an incremental cost-effectiveness ratio of $74,707 per year of life saved. If the protective effect of the levonorgestrel IUD is assumed to be 10 years, the incremental cost-effectiveness ratio decreases to $37,858 per year of life saved. In sensitivity analysis, a levonorgestrel IUD that reduces cancer incidence by at least 68% in women with BMIs of 40 or greater or costs less than $500 is potentially cost-effective. For BMI 30 or greater, the incremental cost-effectiveness ratio of IUD strategy is $137,223 per year of life saved compared with usual care. In Monte Carlo analysis, IUD placement for BMI 40 or greater is cost-effective in 50% of simulations at a willingness-to-pay threshold of $100,000 per year of life saved.

CONCLUSION:

The levonorgestrel IUD is a potentially cost-effective strategy for prevention of deaths from endometrial cancer in obese women.
17-α Hydroxyprogesterone Caproate for the Prevention of Recurrent Preterm Birth
Authors: Heyborne Kent D.
Published: September 2016

Spontaneous preterm birth is a syndrome with many causes and thus unresponsive to a single intervention. It logically follows that patients with a prior spontaneous preterm birth are a heterogeneous group unlikely to respond equally to a single preventive intervention such as 17-α hydroxyprogesterone caproate. Further confounding this issue is our fundamental lack of knowledge about the mechanism(s) by which 17-α hydroxyprogesterone caproate reduces preterm birth. Recently, studies demonstrating that responders and nonresponders can be identified based on obstetric history, genotype, physical characteristics, and behavioral factors have begun to provide clues into both 17-α hydroxyprogesterone caproate's mechanism and the pathophysiology of recurrent preterm birth and may allow for more targeted therapy. These studies lend support to speculation that inflammation or nitric oxide metabolism may be common threads between 17-α hydroxyprogesterone caproate's mechanism and preterm birth prevention. It will remain critically important to avoid the temptation to regard prior spontaneous preterm birth as a single disease entity amenable to a single treatment.
Sexual Health in Women Affected by Cancer
Authors: Coady Deborah , Kennedy Vanessa
Published: September 2016

As cancer therapies improve, the number of women surviving or living long lives with cancer continues to increase. Treatment modalities, including surgery, chemotherapy, radiotherapy, and hormonal therapy, affect sexual function and may cause sexual pain through a variety of mechanisms, depending on treatment type. Adverse sexual effects resulting from ovarian damage, anatomic alterations, and neurologic, myofascial, or pelvic organ injury may affect more than half of women affected by cancer. Despite the fact that no specialty is better qualified to render care for this consequence of cancer treatments, many obstetrician–gynecologists (ob-gyns) feel uncomfortable or ill-equipped to address sexual pain in women affected by cancer. Asking about sexual pain and dyspareunia and performing a thorough physical examination are essential steps to guide management, which must be tailored to individual patient goals. Understanding the cancer treatment-related pathophysiology of sexual pain aids in providing this care. Effective mechanism-based treatments for sexual pain and dyspareunia are available, and by using them, knowledgeable ob-gyns can enhance the quality of life of potentially millions of women affected by cancer.
Evolving Paradigms in Research and Care in Ovarian Cancers
Authors: Karlan Beth Y. , Alvarez Ronald D. , Strauss Jerome F.
Published: September 2016

The National Academies of Sciences, Engineering, and Medicine convened an expert committee to examine and summarize the state of the science in ovarian cancer research. An Executive Summary of the recently released report describing the key findings and specific recommendations to reduce the incidence of and morbidity and mortality from ovarian cancers is presented. Highlights include the recognition that ovarian cancer is not just one disease, but rather a constellation of distinct cancer types, some of which originate outside of the ovary. Furthermore, it was noted that our incomplete understanding of the basic biology of each subtype of ovarian cancer is an impediment to advances in prevention, screening, early detection, diagnosis, treatment, and supportive care.
Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy
Authors: Raymond Elizabeth G. , Weaver Mark A. , Louie Karmen S. , Tan Yi-Ling , Bousiéguez Manuel , Aranguré-Peraza Ana Gabriela , Lugo-Hernández Elba M. , Sanhueza Patricio , Goldberg Alisa B. , Culwell Kelly R. , Kaplan Clair , Memmel Lisa , Sonalkar Sarita , Jamshidi Roxanne , Winikoff Beverly
Published: September 2016

OBJECTIVE:

To evaluate the effects of timing of depot medroxyprogesterone acetate injection on medical abortion outcome and risk of repeat pregnancy within the subsequent 6 months.

METHODS:

In a multinational randomized trial, we assigned women undergoing medical abortion who wanted depot medroxyprogesterone acetate to administration either with mifepristone (Quickstart group) or after the abortion (Afterstart group). We ascertained abortion outcome, pregnancies, and contraception use over 7 months.

RESULTS:

From August 2013 to March 2015, we enrolled 461 participants with pregnancy durations of 75 days or less. Of participants included in the abortion outcome analyses, 14 of 220 (6.4%) and 12 of 226 (5.3%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the upper 90% confidence limit on this difference was 4.9%, within our prestipulated 5% noninferiority margin. Ongoing pregnancy after initial abortion treatment was significantly more common in the Quickstart group (8/220 [3.6%]) than in the Afterstart group (2/226 [0.9%]); the difference was 2.7% (90% confidence interval 0.4–5.6%). By 6 months, 5 of 213 (2.3%) and 7 of 217 (3.2%) in the Quickstart and Afterstart groups, respectively, became pregnant (exact log-rank test, P=.64). Use of highly effective contraceptives was significantly more common in the Quickstart group at 31 days (P<.001), but no difference was apparent at 6 months. The Quickstart group was significantly more satisfied with group assignment.

CONCLUSION:

Depot medroxyprogesterone acetate administration with mifepristone did not appreciably increase the risk of surgery after medical abortion but did increase the risk of ongoing pregnancy. It enhanced patient satisfaction, but we found no evidence that it decreased 6-month risk of repeat pregnancy.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, https://clinicaltrials.gov, NCT01902485.
Differences in Mortality Between Pregnant and Nonpregnant Women After Cardiopulmonary Resuscitation
Authors: Mogos Mulubrhan F. , Salemi Jason L. , Spooner Kiara K. , McFarlin Barbara L. , Salihu Hamisu M.
Published: September 2016

OBJECTIVE:

To examine the association between pregnancy status and in-hospital mortality after cardiopulmonary resuscitation (CPR) in an inpatient setting.

METHODS:

We conducted a population-based cross-sectional study using the Nationwide Inpatient Sample databases (2002–2011). International Classification of Diseases, 9th Revision, Clinical Modification codes were used to define cases, comorbidities, and clinical outcomes. Rates of CPR among study groups were calculated by patient and hospital characteristics. Survey logistic regression was used to estimate adjusted odds ratios (ORs) that represent the association between pregnancy status and mortality after CPR. Joinpoint regression was used to describe temporal trends in CPR and mortality rates.

RESULTS:

During the study period, 5,923 women (13–49 years) received inpatient CPR annually. Cardiopulmonary resuscitation rates increased significantly from 2002 to 2011, by 6.4% and 3.8% annually, for pregnant and nonpregnant women, respectively. In-hospital mortality rates after CPR were lower among pregnant women 49.4% (45.4–53.4) than nonpregnant women 71.1% (70.1–72.2), even after adjusting for confounders (adjusted OR 0.46, 95% confidence interval 0.39–0.56).

CONCLUSION:

Cardiopulmonary resuscitation in an inpatient pregnant woman is associated with improved survival compared with this procedure in nonpregnant women. Elucidating reasons behind this association could help to improve CPR outcomes in both pregnant and nonpregnant women.