bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges from the Future of Human Enhancement
Authors: Agar Nicholas
Published: January 2017

This chapter explores some challenges that arise in respect of the regulation of human enhancement. It opens by advocating a definitional pluralism that acknowledges the existence of many concepts of human enhancement. These highlight different moral concerns about the application of genetic and cybernetic technologies to human brains and bodies. I identify one concept that is particularly effective at expressing the upsides of human enhancement. Another concept serves better to reveal enhancement’s downsides. I describe a further concept that reveals moral issues connected with great degrees of human enhancement. The chapter concludes with a discussion of attempts to regulate enhancement in elite sport. I defend the efforts of the World Anti-Doping Agency (WADA) to keep artificial means of enhancement out of sport.
From Improvement Towards Enhancement
Authors: Somsen Han
Published: January 2017

This chapter discusses a host of what mostly are still isolated ad hoc technology-driven initiatives, usually in support of human (rights) imperatives, which effectively endeavour to engineer and re-engineer living and non-living environments in ways that have no natural, legal, or historical precedent. The umbrella term I propose to capture such initiatives is ‘environmental enhancement’. Potential examples that fit this definition include genetic modification of disease-transmitting mosquitoes to protect human health, solar radiation-management initiatives and other forms of climate engineering to sustain human life on earth, the creation of new life forms to secure food supplies and absorb population growth, and de-extinction efforts that help restore the integrity of ecosystems. The question this paper asks, in the words of Brownsword, is whether conventional environmental law ‘connects’ with environmental enhancement, focusing on EU environmental law, and whether states may be duty-bound to enhance environments in pursuit of human rights imperatives.
Isotope Analysis
Authors: Wiegand Bettina
Published: January 2017

Lithogenic isotopes of strontium (Sr), neodymium (Nd), and lead (Pb) are a powerful tool for the study of the composition and origin of pre-historic ceramics and their raw materials. Despite their use in classical geochronology and isotope-geochemical provenance studies of rocks and minerals, Sr, Nd, and Pb isotope ratios have so far scarcely been used in archaeological provenance studies of ceramics and glazes. The following chapter provides an overview of the basics for application of lithogenic isotopes to ceramic provenance research specifically focusing on chemical preparation of samples, mass spectrometric analysis techniques, and interpretation of analytical results. Examples of currently available research results are discussed with respect to the respective isotope systems.
X-Radiography of Archaeological Ceramics
Authors: Berg Ina , Ambers Janet
Published: January 2017

This chapter summarizes the history, theory and methodology of ceramic X-radiography. Particular emphasis is placed upon the two most common uses of ceramic X-radiography, namely the identification of forming techniques and the characterization of clay fabrics. Practical considerations are offered for the choice of X-ray set-ups, exposure parameters, digitization, image enhancement, analysis and interpretation of the resulting X-ray. The chapter concludes with three case studies that demonstrate the great value of this technique and its potential to help illuminate many socio-cultural dimensions of ancient pottery production. The authors emphasize that deep understanding of the theoretical and practical dimensions of this technique are an essential foundation for subsequent interpretation.
Assessing Vessel Function by Organic Residue Analysis
Authors: Barnard Hans , Eerkens Jelmer W.
Published: January 2017

Organic residues can be defined as the carbon-based remains of plants, animals or humans, either in their original or a decomposed state. Biomolecules that can indicate the source of such residues include lipids (such as fatty acids, sterols, mono-, di-, and triglycerides, di-, and triterpenoids), alkaloids (such as caffeine, capsaicin, cocaine, ephedrine, nicotine, theobromine), carbohydrates (such as polysaccharides and starches), proteins (such as albumin, casein, collagen, gliadin, hemaglobin, hordein, myoglobin) and DNA. Archaeological organic residues have been identified in stains on teeth, deposits on stone tools, stains in soil, smoking pipes, and material adhering to pot sherds. A comprehensive overview of such an overwhelming number of compounds and range of methods is beyond the scope of this chapter. Instead, we present an overview for identifying and interpreting organic residues in ceramic vessels, followed by a brief discussion of issues related to archaeological organic residue analysis in general.
Direct Dating Methods
Authors: Blain Sophie , Hall Christopher
Published: January 2017

Many important anthropological questions require the researcher to determine the date of the artifacts and features under consideration. Archaeological ceramics are often used to date contexts and strata, relying upon stylistic changes over time (typology). These relative dates can often be anchored in real time by radiocarbon dating of organic material believed to be contemporaneous. However, these dates are still relative or approximates. The two techniques discussed in this chapter, luminescence and rehydroxylation dating, are able to directly date the ceramics themselves using mineralogical/structural changes. Rehydroxylation dating is at present a research method not fully validated.
The Organization of Pottery Production
Authors: Duistermaat Kim
Published: January 2017

A brief discussion of two traditional approaches in the study of pottery production organization, ceramic ecology and typologies of production, identifies several key problems. In order to move forward and develop new strategies, it is proposed to adopt a symmetrical perspective, integrating methods and concepts from a variety of theoretical origins, including chaîne opératoire, object biography, relevant user groups or cadena, and entanglement. A brief case study outlining a proposed strategy for a relational approach to the study of ceramic production organization concludes the chapter.
Sleeping Princesses and Beauties
Authors: Gupta Maureen
Published: January 2017

This article demonstrates that in his production of Sleeping Beauty for the American Ballet Theatre, Alexei Ratmansky proposes a softer style of ballet and reintegrates pantomime into the fabric of the ballet. His use of a choreographic text raises questions of “authenticity” and the intentions of Petipa, and how a notational text may collide with nontextual Sleeping Beauty traditions developed since the ballet’s premiere in 1890. This production also draws from Bakst’s gorgeous designs for the Ballets Russes London production of 1921–1922. By incorporating choreographic and design elements from the ballet’s history into his own creation, Ratmansky shows not only homage to past traditions, but also his own contemporary aesthetic. The article asserts that what emerges is an affirmation of the living tradition of this ballet that continues to instruct us even as we are challenged to consider new meaning in the older practices of this foundational ballet.
Archaic Shell Mounds in the American Southeast
Authors: Saunders Rebecca
Published: January 2017

Freshwater and estuarine shellfish began to be exploited in the southeastern United States between 9000 and 7000 b.p. Shortly thereafter, shell mounds appeared in the mid-South Shell Mound Archaic, along the St. Johns River in peninsular Florida, and, somewhat later, in the Stallings Island area along the middle Savannah River. On the lower Atlantic and Gulf Coasts, shell rings arose. Until recently, all these mounds were considered middens—the accumulations of the remains of simple meals of mobile peoples who visited the same areas for hundreds or thousands of years. More recent scholarship indicates that these mounds were deliberate constructions—some of the first sculpted landscapes created by Archaic peoples to memorialize the past, celebrate the present, and provide for the future. In this chapter, recent research on shell sites in these four areas is discussed. The emphasis is on changing perspectives about the peoples who built them.
Identifying (with) the Secular
Authors: Quack Johannes
Published: January 2017

This chapter discusses two academic strands with respect to scholarly attempts to identify the secular. Based on a review of criticism brought forward against the classical secularization thesis, it outlines, on one hand, what consequences have been drawn by descriptive and explanatory social scientists and how they apply notions such as secularity, secularism, and secularization today, and, on the other, examines the conceptual histories as well as distinct genealogical studies of “the secular” to explore the ways in which attempts to identify the secular may also imply an identification with or against the secular. Here, recent arguments concerning the importance of researching how worldview secularism and political secularism are both to be differentiated as well as historically intertwined are taken up. Finally, the chapter attempts to determine whether and how both academic strands can be brought together in research on the heterogeneity of religious–secular entanglements in the contemporary world.
Secularism, Race, and Political Affiliation in America
Authors: Navarro-Rivera Juhem , Trejo Yazmín García
Published: January 2017

This chapter introduces readers to a relatively unknown aspect of American secularism: its growing racial diversity. It discusses the importance of racial and ethnic minorities in the growth in the number of people with no religious affiliation (nones) in the United States since 1990. Furthermore, it argues and demonstrates that this growing racial diversity is a major source of the exodus of secular Americans away from the Republican Party and, to a lesser extent, toward the Democratic Party. The chapter concludes with the implications of this diversity and political affiliations for the future cohesion of the secular community in the United States and how it will be able to leverage these to gain political power in the future.
Secular Living
Authors: Smith Jesse M.
Published: January 2017

This chapter discusses the definitions, experiences, and sociocultural construction of secularity. How do people make meaning out of, and in relation to, the secular? The chapter focuses on those individuals and groups who either reject or are uninterested in religion and who hold no theistic beliefs. This is different task from an academic conversation about historical secularism, the functions of secular states or governments, or the historical processes and expressions of secularization. Ideas of the secular, secularism, and secularity are not easy and straightforward concepts. Their meaning(s) and implications are more varied, flexible, and contested than is often assumed: the secular itself involves many paths and meanings and is expressed and experienced in different ways. It is important to go beyond a simplistic “religious life” versus “secular life” distinction and recognize the variability and versatility of secularity, as that variety is becoming increasingly clear in the contemporary landscape.
Secular Spirituality
Authors: Fuller Robert C.
Published: January 2017

This chapter pursues some questions about religiosity’s intersections with contemporary secularity. Traditional religiosity persists in economically advanced nations, such as the United States. The nones, those who have abandoned religious affiliations, continue to hold various kinds of religious belief. In addition, forms of contemporary religiosity often embrace most of secularism’s basic premises. Eight central attributes of secular spirituality can be identified: eclecticism, self-growth, relevance to life, self-direction, openness to wonder, authenticity beyond churches, metaphysical explanations, and communal and ecological morality. The persistence of both traditional and nontraditional forms of religiosity and spirituality should adjust the current popular views of secularism.
Nonreligious People in Religious Societies
Authors: Gervais Will M. , Najle Maxine
Published: January 2017

Although secularism is on the rise, with fewer people identifying with a specific religion, atheists still face a significant degree of prejudice. This chapter discusses that social phenomenon and research efforts to reveal its causes and potential ways to reduce antipathy toward atheists. Social psychology can inquire into causes for prejudice and discrimination against the nonreligious, covering related matters such as origins of unbelief, how others respond to it, and how nonreligious people cope with these and other issues. This chapter also considers specific social movements within and around religious disbelief and offers some speculation on the impact of vocal atheist movements on the current state of interfaith (and nonfaith) relations.
Ethics, Secular and Religious
Authors: Teehan John
Published: January 2017

Morality from an evolutionary perspective is a code of conduct that regulates behavior within a group in order to promote social cohesion and stability. Both religion and secularism are grounded in the same moral psychology. How should the distinction between secular and religious ethics be assessed? Religious morality is a late-comer to the natural history of morality, reinforcing much of morality with a worldview about unnatural powers that humans’ brains are prone to projecting onto reality. However, the natural history of morality reveals that religious moral traditions do not originate moral rules but instead reinforce ancient moral intuitions. Secularism as a worldview works within an immanent frame, compared to the transcendent frame of religious worldviews. This distinction is helpful in understanding the relationship between religious violence and secular-ideological driven violence.
The Imagined War between Secularism and Religion
Authors: Juergensmeyer Mark
Published: January 2017

The case of the 2015 attack on the offices of the Charlie Hebdo satirical magazine in Paris illustrates the imagined war between secularism and religion that is in the background of many incidents of violence at the turn of the twenty-first century. The Enlightenment idea that there are two different worldviews—two distinctly different spheres of understanding about reality, one of them secular and the other religious—is inherently problematic. This dichotomy creates an arena of discord that is easily exploited by people who feel isolated and marginalized for whatever reason and look for someone to blame and some battle to join. It is a false conflict that extremists on both sides, religious and secular, have exacerbated.
Political Secularism and Democracy in Theory and Practice
Authors: Fox Jonathan
Published: January 2017

An overwhelming majority of democracies, no matter how the concept of democracy is defined, restrict the religious practices and institutions of minority religions, substantially support religion, and give de jure and de facto preferences to a single religion or a few religions. Since so few democracies meet any standard of political secularism, political secularism is either not essential to liberal democracy or these countries’ status as liberal democracies must be questionable. Political secularism as an ideology is not as influential in the practical politics of democratic states as many believe. An important question is whether political secularism is the best model for democracy or whether the best models are those that integrate state support for religion with checks and balances that protect religious freedom.
Joan Littlewood
Authors: Macpherson Ben
Published: January 2017

This chapter reassesses the work of Joan Littlewood and Theatre Workshop from the 1950s to the 1970s. It finds that, in many instances, Littlewood’s visionary approach to collaborative devising and her innovative borrowing from a breadth of theatrical traditions broadened the scope of the British musical as a vehicle for social engagement, with a legacy that is both tangible and vital as part of the history of twentieth-century musical theatre. Yet, the chapter argues that in many ways, at the root of Littlewood’s approach was an often contradictory world view: at once critical of the Establishment and simultaneously embedded within it. The chapter concludes by arguing that this paradoxical approach is what makes Littlewood’s work so innovative and, ultimately, so typically British.
Tim Rice
Authors: Jubin Olaf
Published: January 2017

Although his major passion has always been pop music, Tim Rice is in certain respects the most successful British lyricist in musical theatre history. But what exactly is a ‘Tim Rice musical’? It turns out that the lyricist with a unique voice is most prominently at work in those musicals which he conceived himself and which investigate themes such as the plight of individuals who stand out from the crowd because of their talent and the way they are treated by the people that admire them—or tear them down. This ‘pop star scenario’ also addresses such aspects as the unpredictable behaviour of the crowd, the discrepancy between public and private image, the danger that the latter will be consumed by the former, personal ambition and its price, as well as the dissatisfaction and potential downfall that follows after early success.
Cameron Mackintosh
Authors: Lundskaer-Nielsen Miranda
Published: January 2017

The biggest British musical theatre star to emerge in the 1980s and 1990s was arguably not a performer, director, or writer but a producer. Cameron Mackintosh is a unique figure within the contemporary theatre. In a commercial musical theatre environment that has increasingly moved towards producing by committee—with investors often taking a producer title and even having a creative voice—Mackintosh’s early financial success with Cats and Les Misérables has enabled him to exercise an unusual level of control over the projects that he produces. Drawing on published interviews, existing scholarship, and original personal interviews with his creative collaborators, this article explores Cameron Mackintosh’s creative and business influences and assesses his lasting impact on the global musical theatre scene.
Attracting the Family Market
Authors: Warner Rebecca
Published: January 2017

The musical aimed at the family market is an important part of the landscape of the British musical. This paper seeks to explore some of the key characteristics that can make a musical appeal to a hybrid, cross-generational audience. By employing Tony Graham’s five-step gauge for considering the suitability of particular works for capturing a child’s interest as a framework, the essay explores the musicals Honk!, Mary Poppins, Matilda, and Charlie and the Chocolate Factory as case studies. Special attention is paid to ideas of imagination, transcendence, and the use of a universal topic to appeal to the family market.
West End Royalty
Authors: Nicholls Stewart
Published: January 2017

Ivor Novello represents the stylistic bridge between Edwardian operetta and post-Second World War British musical comedy. This essay charts the development of British operetta, which was dominated by Novello, in the context of changing public attitudes, artistic influences, and world events. Consideration will be given to how Novello and his contemporaries were obliged to adapt their style to compete with the changes in British musical theatre in the late 1940s, what kind of legacy their works have left, why the pieces are seldom performed today, and why much of British musical theatre of this period has been forgotten. Whilst some of the contemporary neglect of English operetta may be attributed to the loss of some of the original material (such as libretti, sheet music, and orchestrations) and the lack of adequate recordings, the question will be considered whether the work of Novello and his fellow writers is actually worth reviving.
Pain Interference, Psychopathology, and General Medical Conditions Among Black and White Adults in the US General Population
Authors: Barry Declan T. , Glenn Corey Pilver , Hoff Rani A. , Potenza Marc N.
Published: January 2017

Objectives:

To assess how race might moderate relationships between pain interference and psychopathology, and general medical conditions among a nationally representative sample of black and white adults.

Methods:

Chi-square tests and multivariable logistic regression analyses were performed on data from the National Epidemiologic Survey on Alcohol and Related Conditions on 32,474 adult respondents (25% black, 75% white), who were categorized according to 1 of 3 levels of pain interference (ie, no/low, moderate, or severe).

Results:

Pain interference was associated with race in bivariate analyses (P < .001); relative to white respondents, black respondents had lower rates of no/low pain interference (78.9% vs 80.3%), lower rates of moderate pain interference (6.8% vs 7.8%), and higher rates of severe pain interference (14.3% vs 11.9%). Pain interference was associated with past-year axis I psychiatric disorders in both black and white respondents (P < 0.001) with the largest odds typically observed in association with moderate or severe pain interference. A stronger relationship was observed in black as compared with white respondents between severe pain interference and any axis I disorder (odds ratio [OR] 1.28, P < 0.05) and alcohol abuse or dependence (OR 1.90, P < 0.05), and between moderate pain interference and tachycardia (OR 1.69, P < 0.05). In contrast, a weaker relationship was observed in black as compared with white respondents between moderate pain interference and any general medical condition (OR 0.70, P < 0.05).

Conclusions:

These findings underscore the complexity of race-related disparities in health and suggest the importance of further study of the possible mechanisms underlying the apparent differences between black and white groups in the relationships between pain interference, psychopathology, and general medical conditions.
Association of Hospital Volume With Racial and Ethnic Disparities in Locally Advanced Cervical Cancer Treatment
Authors: Uppal Shitanshu , Chapman Christina , Spencer Ryan J. , Jolly Shruti , Maturen Kate , Rauh-Hain J. Alejandro , delCarmen Marcela G. , Rice Laurel W.
Published: January 2017

OBJECTIVE:

To evaluate racial–ethnic disparities in guideline-based care in locally advanced cervical cancer and their relationship to hospital case volume.

METHODS:

Using the National Cancer Database, we performed a retrospective cohort study of women diagnosed between 2004 and 2012 with locally advanced squamous or adenocarcinoma of the cervix undergoing definitive primary radiation therapy. The primary outcome was the race–ethnicity-based rates of adherence to the National Comprehensive Cancer Network guideline–based care. The secondary outcome was the effect of guideline-based care on overall survival. Multivariable models and propensity matching were used to compare the hospital risk-adjusted rates of guideline-based adherence and overall survival based on hospital case volume.

RESULTS:

The final cohort consisted of 16,195 patients. The rate of guideline-based care was 58.4% (95% confidence interval [CI] 57.4–59.4%) for non-Hispanic white, 53% (95% CI 51.4–54.9%) for non-Hispanic black, and 51.5% (95% CI 49.4–53.7%) for Hispanic women (P<.001). From 2004 to 2012, the rate of guideline-based care increased from 49.5% (95% CI 47.1–51.9%) to 59.1% (95% CI 56.9–61.2%) (P
trend<.001). Based on a propensity score-matched analysis, patients receiving guideline-based care had a lower risk of mortality (adjusted hazard ratio 0.65, 95% CI 0.62–0.68). Compared with low-volume hospitals, the increase in adherence to guideline-based care in high-volume hospitals was 48–63% for non-Hispanic white, 47–53% for non-Hispanic black, and 41–54% for Hispanic women.

CONCLUSION:

Racial and ethnic disparities in the delivery of guideline-based care are the highest in high-volume hospitals. Guideline-based care in locally advanced cervical cancer is associated with improved survival.
A Statewide Progestogen Promotion Program in Ohio
Authors: Iams Jay D. , Applegate Mary S. , Marcotte Michael P. , Rome Martha , Krew Michael A. , Bailit Jennifer L. , Kaplan Heather C. , Poteet Jessi , Nance Melissa , McKenna David S. , Walker Hetty C. , Nobbe Jennifer , Prasad Lakshmi , Macaluso Maurizio , Lannon Carole
Published: January 2017

OBJECTIVE:

To promote use of progestogen therapy to reduce premature births in Ohio by 10%.

METHODS:

The Ohio Perinatal Quality Collaborative initiated a quality improvement project in 2014 working with clinics at 20 large maternity hospitals, Ohio Medicaid, Medicaid insurers, and service agencies to use quality improvement methods to identify eligible women and remove treatment barriers. The number of women eligible for prophylaxis, the percent prescribed a progestogen before 20 and 24 weeks of gestation, and barriers encountered were reported monthly. Clinics were asked to adopt protocols to identify candidates and initiate treatment promptly. System-level changes were made to expand Medicaid eligibility, maintain Medicaid coverage during pregnancy, improve communication, and adopt uniform data collection and efficient treatment protocols. Rates of singleton births before 32 and 37 weeks of gestation in Ohio hospitals were primary outcomes. We used statistical process control methods to analyze change and generalized linear mixed models to estimate program effects accounting for known risk factors.

RESULTS:

Participating sites tracked 2,562 women eligible for treatment between January 1, 2014, and November 30, 2015. Late entry to care, variable interpretation of treatment guidelines, maintenance of Medicaid coverage, and inefficient communication among health care providers and insurers were identified as treatment barriers. Births before 32 weeks of gestation decreased in all hospitals by 6.6% and in participating hospitals by 8.0%. Births before 32 weeks of gestation to women with prior preterm birth decreased by 20.5% in all hospitals, by 20.3% in African American women, and by 17.1% in women on Medicaid. Births before 37 weeks of gestation were minimally affected. Adjusting for risk factors and birth clustering by hospital confirmed a program-associated 13% (95% confidence interval 0.3–24%) reduction in births before 32 weeks of gestation to women with prior preterm birth.

CONCLUSION:

The Ohio progestogen project was associated with a sustained reduction in singleton births before 32 weeks of gestation in Ohio.
Pathologically Diagnosed Placenta Accreta and Hemorrhagic Morbidity in a Subsequent Pregnancy
Authors: Roeca Cassandra , Little Sarah E. , Carusi Daniela A.
Published: January 2017

OBJECTIVE:

To identify the relationship between pathologically diagnosed placenta accreta and risk of major morbidity in a subsequent pregnancy.

METHODS:

We conducted a retrospective cohort study of patients with pathologically diagnosed placenta accreta in an index pregnancy who returned with a subsequent pregnancy at our academic center from 2007 to 2015. Subsequent delivery outcomes included minor, major, or no morbidity. Minor morbidity included estimated blood loss 500–1,500 cc for vaginal and 1,000–1,500 cc for cesarean delivery, transfusion of one to three units of red cells, and minor surgical procedures. Major morbidity included estimated blood loss greater than 1,500 cc, transfusion of greater than three units of red cells, uterine artery embolization, unplanned laparotomy, or hysterectomy.

RESULTS:

Three hundred thirty-nine patients with pathologically diagnosed accreta did not undergo hysterectomy, and 39 (11.5%) of these returned for subsequent delivery. Of these, 14 (36%) had accretas that had been identified clinically in the index pregnancy. Twenty-one (54%) experienced morbidity in the index pregnancy, 16 of these (76%) minor and five (24%) major. Of patients without morbidity in the first pregnancy, none experienced major morbidity in a subsequent pregnancy, whereas 6 of 21 (29%) with any index morbidity had a subsequent major morbid outcome (P=.02). Of those with a morbid index delivery, 25% had either a clinical or pathologic accreta diagnosis at follow-up compared with none of those who index accreta was nonmorbid (P=.05).

CONCLUSION:

Risk for major hemorrhagic morbidity after a prior pathologically diagnosed accreta depends on the clinical context. Preparation for major blood loss is indicated after any prior pregnancy complicated by hemorrhage or treatment of retained placenta with a pathologic accreta.
Subspecialty Influence on Scientific Peer Review for an Obstetrics and Gynecology Journal With a High Impact Factor
Authors: Parikh Laura I. , Benner Rebecca S. , Riggs Thomas W. , Hazen Nicholas , Chescheir Nancy C.
Published: January 2017

OBJECTIVE:

To evaluate whether quality of peer review and reviewer recommendation differ based on reviewer subspecialty in obstetrics and gynecology and to determine the role of experience on reviewer recommendation.

METHODS:

We performed a retrospective cohort study of reviews submitted to Obstetrics & Gynecology between January 2010 and December 2014. Subspecialties were determined based on classification terms selected by each reviewer and included all major obstetrics and gynecology subspecialties, general obstetrics and gynecology, and nonobstetrics and gynecology categories. Review quality (graded on a 5-point Likert scale by the journal's editors) and reviewer recommendation of “reject” were compared across subspecialties using χ2, analysis of variance, and multivariate logistic regression.

RESULTS:

There were 20,027 reviews from 1,889 individual reviewers. Reviewers with family planning subspecialty provided higher-quality peer reviews compared with reviewers with gynecology only, reproductive endocrinology and infertility, gynecologic oncology, and general obstetrics and gynecology specialties (3.61±0.75 compared with 3.44±0.78, 3.42±0.72, 3.35±0.75, and 3.32±0.81, respectively, P<.05). Reviewers with gynecology-only subspecialty recommended rejection more often compared with reviewers with a nonobstetrics and gynecology subspecialty (57.7% compared with 38.7%, P<.05). Editorial Board members recommended rejection more often than new reviewers (68.0% compared with 41.5%, P<.05). Increased adjusted odds of manuscript rejection recommendation were associated with reproductive endocrinology, female pelvic medicine and reconstructive surgery, and gynecology-only reviewer subspecialty (adjusted odds ratio [OR] 1.23 [1.07–1.41], 1.21 [1.05–1.39], and 1.11 [1.02–1.20]). Manuscript rejection recommendation rate was also increased for reviewers who had completed the highest quintile of peer reviews (greater than 195) compared with the lowest quintile (one to seven) (adjusted OR 2.85 [2.60–3.12]).

CONCLUSION:

Peer review quality differs based on obstetrics and gynecology subspecialty. Obstetrics and gynecology subspecialty and reviewer experience have implications for manuscript rejection recommendation. Reviewer assignment is pivotal to maintaining a rigorous manuscript selection process.
Osteoporosis: fracture epidemiology update 2016
Authors: Cauley Jane A.
Published: January 2017

Purpose of review

The purpose of this review is to provide an update on osteoporosis epidemiology. The focus is on fractures because fractures are the most important clinical consequence of osteoporosis. Studies published over the past 18 months are identified and reviewed. Finally, the clinical impact of these new findings is discussed.

Recent findings

Important research in 2015–2016 include analyses of screening and rescreening in younger women and older men, risk factors for hip fractures in older men, obesity and weight loss/gain, and risk of fracture. Several dietary factors, including adherence to a Mediterranean diet and a diet rich in protein, fruits, and vegetables and maintenance of physical function with increasing age represent modifiable nonpharmacologic risk factors that improve bone health. Sarcopenia may have a more important role in fracture in men than women. Important biomarkers for fracture include low 25-hydroxyvitamin D and hemoglobin A1c.

Updated literature on fracture epidemiology have identified important risk factors for fracture.
SURGICAL OUTCOMES AND COMPLICATIONS OF RHEGMATOGENOUS RETINAL DETACHMENT IN EYES WITH CHORIORETINAL COLOBOMA
Authors: Abouammoh Marwan A. , Alsulaiman Sulaiman M. , Gupta Vishali S. , Younis Afnan , Chhablani Jay , Hussein Abdullah , Casella Antonio M. , Banker Alay S. , Arevalo J. Fernando ,   for the King Khaled Eye Specialist Hospital (KKESH) International Collaborative Retina Study Group
Published: January 2017

Purpose:

To study the outcomes of management of rhegmatogenous retinal detachment in eyes with chorioretinal colobomas.

Methods:

A retrospective review of 119 patients (119 eyes) with chorioretinal colobomas who underwent surgical repair for rhegmatogenous retinal detachment was performed. Data were collected on the site of the retinal break, type of surgery, anatomical success, and complications.

Results:

The most common location of the primary retinal break was the intercalary membrane in 58.8% of eyes. The most common surgical intervention was vitrectomy with endolaser and silicone oil tamponade (77.3% of eyes). Final anatomical success was achieved in 87.4% of eyes. Anatomical success was significantly higher in eyes that received long-acting tamponade (P = 0.006). Cryotherapy was significantly associated with failure of primary vitrectomy (P = 0.028). Placement of an encircling band did not affect anatomical outcomes (P = 0.75). Most of the eyes (60%) with recurrent retinal detachment after primary vitrectomy had a primary break within the normal retina.

Conclusion:

The optimal option for managing retinal detachment in eyes with chorioretinal colobomas is pars plana vitrectomy with long-acting tamponade (silicone oil or octafluoropropane) and retinopexy to the edge of the coloboma and the primary breaks. Cryotherapy is associated with poor anatomical outcomes. An encircling band does not seem to affect the final anatomical outcome.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY CHANGES IN EARLY TYPE 3 NEOVASCULARIZATION AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT
Authors: Miere Alexandra , Querques Giuseppe , Semoun Oudy , Amoroso Francesca , Zambrowski Olivia , Chapron Thibaut , Capuano Vittorio , Souied Eric H.
Published: January 2017

Purpose:

To investigate the morphologic changes on optical coherence tomography angiography (OCTA) of treatment-naive Type 3 neovascularization secondary to exudative age-related macular degeneration after 1 year of anti–vascular endothelial growth factor therapy.

Methods:

Consecutive patients diagnosed with treatment-naive early-stage Type 3 neovascularization were enrolled in this retrospective study. All patients underwent color fundus photographs/MultiColor (Heidelberg Engineering) imaging, fluorescein angiography, indocyanine green angiography, structural spectral domain OCT, and OCTA Optovue RTVue XR Avanti (Optovue) at baseline, and repeated OCTA and structural spectral domain OCT at Month 12. Qualitative analysis of the 3 × 3 OCTA examinations at baseline and Month 12 was then compared, to assess changes after anti–vascular endothelial growth factor therapy.

Results:

A total of 15 treatment-naive eyes of 15 consecutive patients were included in the analysis. At 12-month follow-up after pro-re-data anti–vascular endothelial growth factor therapy (5.75 ± 1.48 injections of ranibizumab, and injections of 6.33 ± 1.21 of aflibercept), OCTA demonstrated persistence of the deep capillary plexus abnormalities in 13/15 eyes. In the outer retina and choriocapillaris, the initial lesion became undetectable in 7/15 cases, accompanied by choriocapillaris atrophy. The abnormal vascular complex persisted in the form of a tuft-shaped lesion in the outer retinal segmentation in 9/15 eyes, which in the choriocapillaris segmentation was associated with sub–retinal pigment epithelium neovascularization in 8 cases.

Conclusion:

Optical coherence tomography angiography showed that the tuft-shaped abnormal outer retinal lesion, frequently associated with a small clew-like flow signal in the choriocapillaris, after 1 year of anti–vascular endothelial growth factor therapy, either becomes undetectable or develops sub–retinal pigment epithelium neovascularization.
Dyserythropoiesis of myelodysplastic syndromes
Authors: Lefèvre Carine , Bondu Sabrina , Le Goff Salomé , Kosmider Olivier , Fontenay Michaela
Published: January 2017

Purpose of review

Myelodysplastic syndromes (MDS) are heterogeneous diseases of the hematopoietic stem cell in the elderly. Anemia is the main symptom that mostly correlates with dysplastic erythropoiesis in the bone marrow. We will review the recent advances in understanding the diverse mechanisms of dyserythropoiesis.

Recent findings

Dyserythropoiesis defined as 10% dysplastic erythroid cells in the bone marrow is found in more than 80% of early MDS. Immature erythroblasts accumulate at the expense of mature erythroblasts due to differentiation arrest and apoptosis. In early MDS with dyserythropoiesis, caspase-dependent cleavage of the erythroid transcription factor GATA-1 occurring in basophilic erythroblasts accounts for impairment of final maturation. Depending on initiating genetic alteration, specific mechanisms contribute to erythroid defect. In MDS with 5q deletion, the haploinsufficiency of ribosomal protein gene, RPS14, opposes the transition of immature to mature erythroblasts by inducing a p53-dependent ribosome stress, cell cycle arrest and apoptosis. Recent work identifies the activation of a p53-S100A8/9 innate immune pathway that both intrinsically and extrinsically contributes to defective erythropoiesis. In MDS with ring sideroblasts, a paradigm of dyserythropoiesis, a unique mutation in SF3B1 splicing factor gene induces a multiplicity of alterations at RNA level that deeply modifies the patterns of gene expression.

Insights in the pathophysiology of MDS with dyserythropoiesis may guide the choice of the appropriate therapy, for instance lenalidomide in MDS with del(5q). A better understanding of the mechanisms of dyserthropoiesis is required to treat anemia in non-del(5q) MDS, especially in case of resistance to first-line therapy by erythropoiesis-stimulating agents.
Feasibility of Using HIV Care-Continuum Outcomes to Identify Geographic Areas for Targeted HIV Testing
Authors: Castel Amanda D. , Kuo Irene , Mikre Meriam , Young Toni , Haddix Meredith , Das Suparna , Maugham Geoffrey , Reisen Carol
Published: January 2017

Background:

Improved detection and linkage to care of previously undiagnosed HIV infections require innovative approaches to testing. We sought to determine the feasibility of targeted HIV testing in geographic areas, defined by continuum of care parameters, to identify HIV-infected persons needing linkage or engagement in care.

Methods:

Using HIV surveillance data from Washington, DC, we identified census tracts that had an HIV prevalence >1% and were either above (higher risk areas—HRAs) or below (lower risk areas—LRAs) the median for 3 indicators: monitored viral load, proportion of persons out of care (OOC), and never in care. Community-based HIV rapid testing and participant surveys were conducted in the 20 census tracts meeting the criteria. Areas were mapped using ArcGIS, and descriptive and univariate analyses were conducted comparing the areas and participants.

Results:

Among 1471 persons tested, 28 (1.9%) tested HIV positive; 2.1% in HRAs vs. 1.7% in LRAs (P = 0.57). Higher proportions of men (63.7% vs. 56.7%, P = 0.007) and fewer blacks (91.0% vs. 94.6%, P = 0.008) were tested in LRAs vs. HRAs; no differences were observed in risk behaviors between the areas. Among HIV-positive participants, 54% were new diagnoses (n = 9) or OOC (n = 6), all were Black, 64% were men with a median age of 51 years.

Conclusions:

Although significant differences in HIV seropositivity were not observed between testing areas, our approach proved feasible and enabled identification of new diagnoses and OOC HIV–infected persons. This testing paradigm could be adapted in other locales to identify areas for targeted HIV testing and other reengagement efforts.
Comparative Perioperative Pain and Recovery in Women Undergoing Vaginal Reconstruction Versus Robotic Sacrocolpopexy
Authors: Westermann Lauren B. , Crisp Catrina C. , Mazloomdoost Donna , Kleeman Steven D. , Pauls Rachel N.
Published: January 2017

Background

In this study of patients undergoing vaginal hysterectomy with either robotic or vaginal prolapse repair, there was no difference in quality of life in the weeks following surgery; however, less narcotics were used, less pain was documented by nurses and Surgical Pain Scale (SPS), and better performance on voiding trials was noted in those undergoing robotic sacrocolpopexy.

Objectives

Minimally invasive surgery for pelvic organ prolapse is the preferred surgical route for optimal recovery. However, information regarding patient-centered outcomes among various techniques is lacking. We sought to describe pain and quality of life in patients undergoing vaginal hysterectomy with uterosacral ligament suspension (USLS) compared with robotic-assisted sacrocolpopexy (RSC).

Methods

This institutional review board–approved prospective cohort study enrolled consecutive patients undergoing vaginal hysterectomy with USLS or with RSC. The primary outcome was pain on postoperative day 1 using the SPS. Nursing verbal pain scores, narcotic usage, surgical data, and Short-Form Health Survey 12 at baseline and 2 and 6 weeks after surgery were collected. A sample size calculation revealed 37 subjects per group would be required.

Results

Seventy-eight women were enrolled (USLS, n = 39; RSC, n = 39). There were no significant differences in scores on the SPS between groups. Subjects undergoing RSC had lower nursing verbal pain scores (P = 0.04), less narcotic consumption (P = 0.02), and lower estimated blood loss (P = 0.01) and were less likely to fail voiding trials (P < 0.001); however, surgery duration was longer (P < 0.001). After controlling for age, regression analysis revealed SPS “worst pain” was lower in the robotic arm (P = 0.01), but not in other scales of the SPS. At 2 and 6 weeks postoperatively, Short-Form Health Survey 12 scores were not different between cohorts.

Conclusions

Both USLS and RSC are minimally invasive, with similar quality-of-life scores after surgery. However, the robotic approach may be associated with less pain, less narcotic use, and better performance in voiding trials. Surgeons should consider these findings when counseling patients regarding treatment options.
Readmission and Reoperation After Surgery for Pelvic Organ Prolapse
Authors: Hokenstad Erik D. , Glasgow Amy E. , Habermann Elizabeth B. , Occhino John A.
Published: January 2017

Objectives

We aimed to determine the rates of readmission and reoperation for patients undergoing surgery for pelvic organ prolapse (POP).

Methods

The American College of Surgeons National Surgical Quality Improvement Program Participant User File was used to select all surgeries performed for POP from 2012 through 2014. The cohort was then reviewed for unplanned readmissions and unplanned reoperations within 30 days of POP surgery. Patient and procedural factors associated with readmission or reoperation were compared using χ2 analyses and Student t test. Multivariable logistic regression determined independent risk factors for both readmission and reoperation.

Results

A total of 23,419 patients underwent surgery for POP. Of these, there were 435 (1.9%) readmissions and 341 (1.5%) reoperations within 30 days. Median numbers of days from index procedure to readmission or reoperation were 9 and 8 days, respectively. Those who were readmitted had higher American Society of Anesthesia (ASA) scores, longer operative times, and longer lengths of stay than those who were not readmitted (all P < 0.001). Patients who underwent unplanned reoperation also had higher ASA scores, longer operative times, and longer lengths of stay than those who did not undergo reoperation (all P < 0.01). The most common reasons for readmission were surgical site infection (SSI) (19.3%) and non-SSI (15.9%). The most common reason for reoperation was urologic (27.6%) such as cystoscopy or stent placement.

Conclusions

Readmission and reoperation rates are relatively low for patients undergoing surgery for POP. Infection, both SSI and non-SSI, accounted for 35.2% of readmissions. Identification of ASA score of 3 or higher, longer total operating time, and increased length of stay is associated with unplanned readmission and reoperation.
Levator Ani Muscle Defects in Patients With Surgical Failure
Authors: Wyman Allison M. , Greene Kristie A. , Bassaly Renee , Hahn Lindsey , Patton Simon , Miladinovic Branko , Hoyte Lennox
Published: January 2017

Introduction

The objective of the study was to use a well-described system of measuring levator ani (LA) muscle defects from magnetic resonance images to evaluate whether major defects are correlated to an increased risk of surgical failure.

Methods

A retrospective cohort study performed on patients who underwent laparoscopic uterosacral ligament suspension from 2010 to 2012. Surgical failure was defined as a composite score of anatomic bulge beyond the hymen with sensation of bulge or repeat treatment of prolapse via pessary or surgery by 1-year follow-up. Levator ani muscle defects were graded by a score of 0 (no defect), 1 (<50% muscle bulk missing), 2 (>50% muscle bulk missing), or 3 (complete loss of muscle). Total score is the sum from both graded sides, with 0 classified as having no defect, 1 to 3 classified as having minor defects, and 4 to 6 classified as having major defects. Dichotomous values of LA major defects were compared against dichotomous values of surgical outcomes via a contingency table. Fisher exact test was then performed to correlate major defects to surgical success/failure. P value of less than 0.05 was considered statistically significant.

Results

Sixty-six women met the inclusion criteria. Thirteen (19.6%) patients met the criteria for surgical failure at 1 year. Of the 13, 54% (7) had a major defect, and 46% (6) had a minor or no defect (odds ratio, 1.31; 95% confidence interval, 0.39–4.41; P = 0.762).

Conclusions

We did not find a statistical correlation to surgical failure after a laparoscopic uterosacral ligament suspension with LA muscle defects on preoperative magnetic resonance images within this specific patient population.