bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns of animal exploitation in western Turkey
Authors: Çakırlar Canan , Atici Levent
Published: April 2017

This chapter presents a first overview of zooarchaeological research in western Turkey, a vast region between the Anatolian Plateau and the Aegean Sea. The reason for this overview is twofold. First, although zooarchaeological research began early on within the history of archaeology in the region, almost all zooarchaeological studies have been site-based, masking their potential contribution to the cultural and environmental narrative of the region and beyond. Second, recent zooarchaeological research has shown that the region carries path-breaking potential for elucidating patterns of human–animal relationships in both prehistoric and historic periods. This chapter probes the zooarchaeological evidence from the Palaeolithic through historical times and highlights the results of zooarchaeological research on topics such as Epipalaeolithic foraging, Neolithic husbandry, urban animal economies, trade, and the symbolic role of animals.
Zooarchaeology in the twenty-first century
Authors: Albarella Umberto
Published: April 2017

After more than a century of growth, zooarchaeology has started fulfilling its full potential. The recognition of the centrality of zooarchaeological investigations in archaeology represents the most important, and hopefully enduring, development. Zooarchaeology remains, however, ultimately inter-disciplinary and cannot be pigeon-holed within either Science or Humanities. Zooarchaeologists use a multitude of approaches, and contribute to all aspects of investigations of past human life, ranging from social structure, to economy, diet, ecology, ideology, and religion. The discipline has developed a set of well-established methods, whose widespread use enhances data comparability. It is, however, important that the research strategies and approaches of zooarchaeologists remain dynamic and open to constant scrutiny. Zooarchaeology is today highly international, enjoying a healthy level of open communication. There is, however, the need to reach out to areas where the discipline is still underdeveloped, as those will generate new stimuli as well as research opportunities.
Colonialism and Development in Africa
Authors: Heldring Leander , Robinson James A.
Published: April 2017

In this article, we evaluate the impact of colonialism on development in sub-Saharan Africa. In the world context, colonialism had very heterogeneous effects, operating through many mechanisms—sometimes encouraging development, sometimes retarding it. In the African case, however, this heterogeneity is muted, making an assessment of the average effect more interesting. To draw conclusions, it is necessary to know not just what actually happened to development during the colonial period but also what might have happened without colonialism and its legacy. In light of plausible counterfactuals, colonialism probably had a uniformly negative effect on development in Africa. To develop this claim, we distinguish between three sorts of colonies, each with a distinct performance within the cultural period, different counterfactuals, and varied legacies.
The Dynamics of Poverty
Authors: Krishna Anirudh
Published: April 2017

This article examines the dynamics of poverty and explains why poverty dynamics studies are necessary: to estimate the risk of impoverishment and the probability of escaping poverty; to identify the reasons associated with poverty descents and escapes; to distinguish between transient and chronic poverty; and to elucidate the social mobility prospects of individuals in different economic situations. The article begins with an overview of three types of approaches used in investigating poverty dynamics: panel data studies, participatory poverty assessments and ethnographic studies, and mixed-method studies. This is followed by a discussion of key findings from poverty dynamics studies; one finding is that poverty creation and poverty reduction occur everywhere in tandem. The article concludes by outlining future directions for research into poverty dynamics.
Single and Cohabiting Parents and Poverty
Authors: Gibson-Davis Christina M.
Published: April 2017

This article examines the interrelationships among poverty rates, inequality, and nonmarital family structures, focusing on households with a never-married parent, usually the mother, or with cohabiting parents. It first considers marriage and fertility patterns around the world and how these patterns exhibit characteristics of the so-called second demographic transition in which marriage and fertility have become increasingly disconnected. It then discusses the reasons why nonmarital families tend to be poorer than marital families and also why the correlation between poverty and nonmarital family structures does not causally explain between- or within-country variation in poverty rates. It also describes some methods for addressing high poverty rates among nonmarital household structures, arguing that policies other than marriage promotion would be far more effective at reducing poverty for nonmarital households. The article concludes with an assessment of some implications of nonmarital fertility for economic inequality.
Employment and the Working Poor
Authors: Gautié Jérôme , Ponthieux Sophie
Published: April 2017

This article examines the phenomenon of working poverty and issues relating to employment and the working poor. It first provides an overview of the problems of definition and measurement regarding the working poor, along with the consequences of the diversity of definitions. In particular, it considers different current definitions of the statistical category “working poor” and how definitions affect the assessment of the in-work poverty phenomenon. It also provides a “statistical” portrait of the working poor and explores how the risk of working poverty has evolved in the 2000s. Finally, it discusses the causes of working poverty, including low income at the individual level and the role of welfare states, and outlines potential remedies in terms of public policies.
Great Escapes and Great Divergences
Authors: Wade Robert H.
Published: April 2017

This article highlights ambiguities and indeterminacies in our knowledge about growth, inequality, and poverty, stemming in particular from measurement difficulties and from differences in measures of what is ostensibly the same thing (“poverty,” “inequality”). It examines global income distribution, patterns of economic growth, the movement of countries in the global income hierarchy, trends in income distribution between countries and between individuals or households, and trends in the incidence of “extreme” and “ordinary” poverty. The article begins with a snapshop of world income and population distribution, followed by a discussion on growth and geographical distribution. It then considers income inequality within countries, along with income inequality between countries and all people. It shows that the global income distribution is still highly polarized and that the proportion of the world’s population living in the degree of poverty which kills—“extreme poverty”—has probably fallen over the past several decades.
Hunger and Food Insecurity
Authors: Barrett Christopher , Lentz Erin C.
Published: April 2017

This article examines hunger and food insecurity in relation to poverty. Evidence shows that food insecurity is overwhelmingly concentrated in developing countries, even as it also exists in wealthy countries. Today, food insecurity remains widespread in large measure because extreme poverty remains widespread, and vice versa. However, the relationship between poverty and food insecurity is complex and bidirectional. This article first reviews concepts and definitions related to food security before discussing the major approaches used to measure food insecurity. It then explains why measurement matters and why it remains so challenging and proceeds by providing a historical overview of hunger and food insecurity. It also analyzes the causes of hunger and food insecurity and interventions intended to reduce hunger and food insecurity. Finally, it suggests directions for future research.
Poverty and Crime
Authors: Sharkey Patrick , Besbris Max , Friedson Michael
Published: April 2017

This article examines theory and evidence on the association between poverty and crime at both the individual and community levels. It begins with a review of the literature on individual- or family-level poverty and crime, followed by a discussion at the level of the neighborhood or community. The research under consideration focuses on criminal activity and violent behavior, using self-reports or official records of violent offenses (homicide, assault, rape), property crime (burglary, theft, vandalism), and in some cases delinquency or victimization. The article concludes by highlighting three shifts of thinking about the relationship between poverty and crime, including a shift away from a focus on individual motivations and toward a focus on situations that make crime more or less likely.
Poverty and Informal Economies
Authors: Bonnet Francois , Venkatesh Sudhir
Published: April 2017

This article examines how the informal economy matters in the context of poverty and social inequality. It first presents a brief history of the concept and related theoretical perspectives and controversies before discussing the informal economic activities among the urban poor. In particular, it considers the informal economy between informal activities and the informal sector and describes three types of informal economies, along with their corresponding problems: the informal economy in the third world, to which corresponds a problem of development; the “second economy” in the Soviet Union, which complicates the question of the relationship between formal and informal; and the informal economy in contemporary Western societies. The article also explores what types of regulation emerge from informality and concludes with an assessment of methodological challenges and research priorities for the coming period of social science research on the urban poor.
Social Class, Poverty, and the Unequal Burden of Illness and Death
Authors: Angel Ronald J.
Published: April 2017

This article explores major themes related to the association among social factors that generate and maintain poverty and that determine health outcomes among different income groups. It first considers the social class factors that affect health and persistent socially based inequities in health before explaining the meaning and measurement of poverty. It then examines the effect of childhood poverty on adult outcomes, along with the phenomenon known as the “Hispanic paradox.” It also assesses the interrelationships among poverty, mental illness, and health care, the concept of “social capital,” the so-called “new morbidity,” and the health implications of health care reform for poor and minority Americans. Finally, it reflects on the potential role of nongovernmental and faith-based organizations in enhancing the health of disadvantaged individuals and communities.
Poverty Knowledge and the History of Poverty Research
Authors: O'Connor Alice
Published: April 2017

This article examines the history of poverty research and the evolution of the practice of gathering knowledge about the poor. It distinguishes between poverty research and poverty knowledge, suggesting that the convergence of the two was a historically specific development that first began to gain wide currency in the late nineteenth century in response to the vast and increasingly visible disparities of industrial capitalism in Western Europe and the United States. It also situates poverty research within the politics and social organization of knowledge and considers the influence of broader contextual factors, such as the creation, expansion, and subsequent restructuring of welfare states in Western industrial democracies; the geopolitical imperatives of empire, decolonization, and the Cold War; and the official declaration of the War on Poverty in the 1960s. Finally, it explores how poverty knowledge was reshaped by the economic, political, and ideological transformations associated with the rise of neoliberalism.
The Mirror, the Lamp, and Public Performances
Authors: Ghosh Shubha
Published: April 2017

How courts determine copyright infringement has been the subject of scholarly debate. Where courts fail is in adequately appreciating the richness of a creative work, often reducing the novel, the song, the work to its literal terms. While the need for contextualizing creative works is accepted, the approach is not. This article uses the aesthetic framework of literary critic M.H. Abrams to offer a conceptual framework to contextualizing a work within the legal method for assessing copyright infringement. This framework is applied to the problems of infringement by reproduction and unauthorized public performance. Abrams’ aesthetic categories provide a multivalent approach to copyright law. The article ends with a precatory discussion of the problems of conceptualism in law, whether in the application of economic models or of aesthetic theories.
Effectiveness of Written and Oral Specialty Certification Examinations to Predict Actions against the Medical Licenses of Anesthesiologists
Authors: Zhou Yan , Sun Huaping , Culley Deborah J. , Young Aaron , Harman Ann E. , Warner David O.
Published: April 2017

Background

The American Board of Anesthesiology administers written and oral examinations for its primary certification. This retrospective cohort study tested the hypothesis that the risk of a disciplinary action against a physician’s medical license is lower in those who pass both examinations than those who pass only the written examination.

Methods

Physicians who entered anesthesiology training from 1971 to 2011 were followed up to 2014. License actions were ascertained via the Disciplinary Action Notification Service of the Federation of State Medical Boards.

Results

The incidence rate of license actions was relatively stable over the study period, with approximately 2 to 3 new cases per 1,000 person-years. In multivariable models, the risk of license actions was higher in men (hazard ratio = 1.88 [95% CI, 1.66 to 2.13]) and lower in international medical graduates (hazard ratio = 0.73 [95% CI, 0.66 to 0.81]). Compared with those passing both examinations on the first attempt, those passing neither examination (hazard ratio = 3.60 [95% CI, 3.14 to 4.13]) and those passing only the written examination (hazard ratio = 3.51 [95% CI, 2.87 to 4.29]) had an increased risk of receiving an action from a state medical board. The risk was no different between the latter two groups (P = 0.81), showing that passing the oral but not the written primary certification examination is associated with a decreased risk of subsequent license actions. For those with residency performance information available, having at least one unsatisfactory training record independently increased the risk of license actions.

Conclusions

These findings support the concept that an oral examination assesses domains important to physician performance that are not fully captured in a written examination.
Laparoscopy Compared With Laparotomy for Debulking Ovarian Cancer After Neoadjuvant Chemotherapy
Authors: Melamed Alexander , Nitecki Roni , Boruta David M. , del Carmen Marcela G. , Clark Rachel M. , Growdon Whitfield B. , Goodman Annekathryn , Schorge John O. , Rauh-Hain J. Alejandro
Published: April 2017

OBJECTIVE:

To compare 3-year survival, length of hospitalization, perioperative mortality, risk of readmission, and residual disease associated with laparoscopic and laparotomic interval debulking surgery among women with epithelial ovarian cancer.

METHODS:

We used the National Cancer Database to identify a cohort of patients diagnosed with stage IIIC and IV epithelial ovarian cancer between 2010 and 2012 who underwent neoadjuvant chemotherapy and interval debulking surgery. We compared 3-year overall survival, duration of postoperative hospitalization, 90-day postoperative mortality, and residual disease status between women who underwent interval debulking by laparoscopy and by laparotomy. We used the Kaplan-Meier method and Cox regression models in survival analyses. At a significance of .05, this study had 80% power to detect an 8% difference in 3-year survival. The main analysis was intention to treat.

RESULTS:

We identified 3,071 women meeting inclusion criteria, of whom 450 (15%) underwent surgery initiated laparoscopically. There was no difference in 3-year survival between patients undergoing laparoscopy [47.5%; 95% confidence interval (CI) 41.4–53.5] and laparotomy (52.6%; 95% CI 50.3–55.0; P=.12). Survival did not differ after adjustment for demographic characteristics, facility type, presence of comorbidities, and stage (adjusted hazard ratio, 1.09; 95% CI 0.93–1.28; P=.26). Postoperative hospitalization was slightly shorter in the laparoscopy group (median 4 compared with 5 days, P<.001). Frequency of readmission (5.3% compared with 3.7%; P=.26), death within 90 days of surgery (2.8% compared with 2.9%, P=.93), and suboptimal debulking (20.6% compared with 22.6%, P=.29) did not differ between patients undergoing laparoscopy and laparotomy.

CONCLUSION:

Ovarian cancer patients selected for laparoscopic interval debulking surgery after neoadjuvant chemotherapy have 3-year survival rates similar to women who undergo interval debulking by laparotomy. Laparoscopy is associated with a modestly shorter postoperative hospitalization, whereas readmission rates and risk of perioperative death are similar for the surgeries.
Trends in Maternal Mortality by Sociodemographic Characteristics and Cause of Death in 27 States and the District of Columbia
Authors: MacDorman Marian F. , Declercq Eugene , Thoma Marie E.
Published: April 2017

OBJECTIVE:

To analyze recent trends in maternal mortality by sociodemographic characteristics and cause of death and to evaluate data quality.

METHODS:

This observational study compared data from 2008–2009 with 2013–2014 for 27 states and the District of Columbia that had comparable reporting of maternal mortality throughout the period. Maternal mortality rates were computed per 100,000 live births. Statistical significance of trends and differentials was evaluated using a two-proportion z-test.

RESULTS:

The study population included 1,687 maternal deaths and 7,369,966 live births. The maternal mortality rate increased by 23% from 20.6 maternal deaths per 100,000 live births in 2008–2009 to 25.4 in 2013–2014. However, most of the increase was among women aged 40 years or older and for nonspecific causes of death. From 2008–2009 to 2013–2014, maternal mortality rates increased by 90% for women 40 years of age or older but did not increase significantly for women younger than 40 years. The maternal mortality rate for nonspecific causes of death increased by 48%; however, the rate for specific causes of death did not increase significantly between 2008–2009 (13.5) and 2013–2014 (15.0).

CONCLUSION:

Despite the United Nations Millennium Development Goal and a 44% decline in maternal mortality worldwide from 1990 to 2015, maternal mortality has not improved in the United States and appears to be increasing. Maternal mortality rates for women 40 years or older and for nonspecific causes of death were implausibly high and increased rapidly, suggesting possible overreporting of maternal deaths, which may be increasing over time. Efforts to improve reporting for the pregnancy checkbox and to modify coding procedures to place less reliance on the checkbox are essential to improving vital statistics maternal mortality data, the official data source for maternal mortality statistics used to monitor trends, identify at-risk populations, and evaluate the success of prevention efforts.
Using a Patient Navigator to Improve Postpartum Care in an Urban Women's Health Clinic
Authors: Yee Lynn M. , Martinez Noelle G. , Nguyen Antoinette T. , Hajjar Nadia , Chen Melissa J. , Simon Melissa A.
Published: April 2017

OBJECTIVE:

To estimate whether postpartum visit attendance was improved in women exposed to a postpartum patient navigation program compared with those who received care immediately before the program's initiation and to assess whether other postpartum health behaviors improved during the intervention period.

METHODS:

This is a prospective observational study of women enrolled in a patient navigation program compared with women receiving care before the program. Navigating New Motherhood was a postpartum patient navigation program for adult, English-speaking women receiving prenatal care at a Medicaid-based university clinic. In 2015, Navigating New Motherhood introduced a clinic-level change in which a navigator was hired and assumed supportive and logistic responsibilities for enrolled patients between delivery and postpartum visit completion. We compared medical record data from women who enrolled in Navigating New Motherhood with those of women receiving care in the same clinic for 1 year immediately before Navigating New Motherhood. The primary outcome was postpartum visit attendance. Secondary outcomes included World Health Organization (WHO) Tier 1 or 2 contraception uptake and other health services measures. We conducted bivariable and multivariable analyses.

RESULTS:

Of the 225 women approached for Navigating New Motherhood participation after program initiation, 96.9% (n=218) enrolled; these women were compared with 256 women in the historical cohort. Most women in both groups were racial or ethnic minorities and all had Medicaid insurance. There were no important differences in demographic, clinical, or health service characteristics between groups, although women in Navigating New Motherhood were more likely to transfer into the clinic for prenatal care and to deliver neonates admitted to the neonatal intensive care unit. The primary outcome, return for postpartum care, was more common among women in Navigating New Motherhood (88.1% compared with 70.3%, P<.001), a difference that persisted after adjustment for potential confounding factors (adjusted odds ratio [OR] 3.57, 95% confidence interval [CI] 2.11–6.04). Women in Navigating New Motherhood also were more likely to receive a WHO Tier 1 or 2 contraceptive method (adjusted OR 1.56, 95% CI 1.02–2.38), postpartum depression screening (adjusted OR 2.82, 95% CI 1.79–4.43), and influenza (adjusted OR 2.10, 95% CI 1.38–3.19) and human papillomavirus vaccination (adjusted OR 2.33, 95% CI 1.25–4.33).

CONCLUSION:

Implementation of a postpartum navigation program was associated with improved retention in routine postpartum care and frequency of contraception uptake, depression screening, and vaccination.
Evaluation of Introduction of a Delayed Cord Clamping Protocol for Premature Neonates in a High-Volume Maternity Center
Authors: Liu Lilly Y. , Feinglass Joe M. , Khan Janine Y. , Gerber Susan E. , Grobman William A. , Yee Lynn M.
Published: April 2017

OBJECTIVE:

To evaluate adherence to a delayed cord clamping protocol for preterm births in the first 2 years after its introduction, perform a quality improvement assessment, and determine neonatal outcomes associated with protocol implementation and adherence.

METHODS:

This is a retrospective cohort study of women delivering singleton neonates at 23–32 weeks of gestation in the 2 years before (preprotocol) and 2 years after (postprotocol) introduction of a 30-second delayed cord clamping protocol at a large-volume academic center. This policy was communicated to obstetric and pediatric health care providers and nurses and reinforced with intermittent educational reviews. Barriers to receiving delayed cord clamping were assessed using χ2 tests and multivariable logistic regression. Neonatal outcomes then were compared between all neonates in the preprotocol period and all neonates in the postprotocol period and between all neonates in the preprotocol period and neonates receiving delayed cord clamping in the postprotocol period using multivariable linear and logistic regression analyses.

RESULTS:

Of the 427 eligible neonates, 187 were born postprotocol. Of these, 53.5% (n=100) neonates received delayed cord clamping according to the protocol. The rate of delayed cord clamping preprotocol was 0%. Protocol uptake and frequency of delayed cord clamping increased over the 2 years after its introduction. In the postprotocol period, cesarean delivery was the only factor independently associated with failing to receive delayed cord clamping (adjusted odds ratio [OR] 0.49, 95% confidence interval [CI] 0.25–0.96). In comparison with the preprotocol period, those who received delayed cord clamping in the postprotocol period had significantly higher birth hematocrit (β=2.46, P=.007) and fewer blood transfusions in the first week of life (adjusted OR 0.49, 95% CI 0.25–0.96).

CONCLUSION:

After introduction of an institutional delayed cord clamping protocol followed by continued health care provider education and quality feedback, the frequency of delayed cord clamping progressively increased. Compared with historical controls, performing delayed cord clamping in eligible preterm neonates was associated with improved neonatal hematologic indices, demonstrating the effectiveness of delayed cord clamping in a large-volume maternity unit.
Effect of a pH-Balanced Vaginal Gel on Dyspareunia and Sexual Function in Breast Cancer Survivors Who Were Premenopausal at Diagnosis
Authors: Kim Yun Hwan , Park Sanghui , Lee Maria , Hahn Seokyung , Jeon Myung Jae
Published: April 2017

OBJECTIVE:

To assess whether a pH-balanced vaginal gel containing lactic acid is more effective than a placebo (lactate-free gel) in improving dyspareunia and sexual function among breast cancer survivors who were premenopausal at diagnosis and had dyspareunia after adjuvant chemotherapy.

METHODS:

In a single-center, double-blind, randomized trial, a pH-balanced gel or placebo was administered three times per week at bedtime as well as during sexual intercourse for 8 weeks. The primary outcome was the improvement of dyspareunia measured by pain score of the Female Sexual Function Index after the treatment. Secondary outcomes included the total and individual domains of Female Sexual Function Index score, sexual dysfunction (a total Female Sexual Function Index score less than 25.0), vaginal pH, vaginal maturation index, and adverse events related to the intervention. A sample size of 47 per group was planned to achieve 80% power to detect a 19% difference in the primary outcome.

RESULTS:

From October 2009 and March 2013, 167 women were screened and 136 were randomized: 69 to a pH-balanced gel and 67 to placebo. Baseline characteristics were similar in both groups. Although there was no difference between the two groups, both experienced a significant improvement of dyspareunia. The increase in median pain score from baseline was 1.2 in both groups (median [interquartile range] from 2.8 [2.0–4.0] to 4.0 [2.8–4.8] in the pH-balanced group and from 3.2 [2.0–4.0] to 4.4 [3.2–4.8] in the placebo group; all P<.01). Overall Female Sexual Function Index score and the frequency of sexual dysfunction also did not differ between the two groups although there was a significant improvement. On the other hand, vaginal pH and vaginal maturation index were slightly but significantly improved only in the pH-balanced group. There were no severe adverse events in either group.

CONCLUSION:

The pH-balanced vaginal gel is not superior to the placebo in improving dyspareunia and overall sexual function.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, https://www.clinicaltrials.gov, NCT00981305.
Differential Impact of Anastomotic Leak in Patients With Stage IV Colonic or Rectal Cancer: A Nationwide Cohort Study
Authors: Nordholm-Carstensen Andreas , Rolff Hans Christian , Krarup Peter-Martin
Published: April 2017

BACKGROUND:

Anastomotic leak has a negative impact on the prognosis of patients who undergo colorectal cancer resection. However, data on anastomotic leak are limited for stage IV colorectal cancers.

OBJECTIVE:

The purpose of this study was to investigate the impact of anastomotic leak on survival and the decision to administer chemotherapy and/or metastasectomy after elective surgery for stage IV colorectal cancer.

DESIGN:

This was a nationwide, retrospective cohort study.

SETTINGS:

Data were obtained from the Danish Colorectal Cancer Group, the Danish Pathology Registry, and the National Patient Registry.

PATIENTS:

Patients who were diagnosed with stage IV colorectal cancer between 2009 and 2013 and underwent elective resection of their primary tumors were included.

MAIN OUTCOME MEASURES:

The primary outcome was all-cause mortality depending on the occurrence of anastomotic leak. Secondary outcomes were the administration of and time to adjuvant chemotherapy, metastasectomy rate, and risk factors for leak.

RESULTS:

Of the 774 patients with stage IV colorectal cancer who were included, 71 (9.2%) developed anastomotic leaks. Anastomotic leak had a significant impact on the long-term survival of patients with colon cancer (p = 0.04) but not on those with rectal cancer (p = 0.91). Anastomotic leak was followed by the decreased administration of adjuvant chemotherapy in patients with colon cancer (p = 0.007) but not in patients with rectal cancer (p = 0.47). Finally, anastomotic leak had a detrimental impact on metastasectomy rates after colon cancer but not on resection rates of rectal cancer.

LIMITATIONS:

Retrospective data on the selection criteria for primary tumor resection and metastatic tumor load were unavailable.

CONCLUSIONS:

The impact of anastomotic leak on patients differed between stage IV colon and rectal cancers. Survival and eligibility to receive chemotherapy and metastasectomy differed between patients with colon and rectal cancers. When planning for primary tumor resection, these factors should be considered.
Musculoskeletal pain profile of obese individuals attending a multidisciplinary weight management service
Authors: MacLellan Grace A. , Dunlevy Colin , O'Malley Emer , Blake Catherine , Breen Cathy , Gaynor Karen , Wallace Natalie , Yoder Ruth , Casey Domhnall , Mehegan John , O'Shea Donal , Fullen Brona M.
Published: April 2017

Obesity is associated with numerous chronic diseases, including musculoskeletal (MSK) pain, which affects on quality of life (QoL). There is, however, limited research providing a comprehensive MSK pain profile of an obese cohort. This retrospective study used a patient database at a national weight management service. After ethical approval, anonymized patient data were statistically analyzed to develop a pain profile, investigate relationships between pain, sleep, and function, and explore variables associated with having low back pain (LBP) and knee pain. Overall, 915 individuals attended the weight management service from January 2011 to September 2015 [male, 35% (n = 318; confidence interval [CI] = 32-38); female, 65% (n = 597; CI = 62-68); mean age 44.6]. Mean body mass index was 50.7 kg/m2 [class III obese (body mass index ≥40 kg/m2), 92% (n = 835; CI = 91-94)]. Approximately 91% reported MSK pain: LBP, 69% (n = 539; CI = 65-72) [mean Numeric Rating Scale 7.4]; knee pain, 58% (n = 447; CI = 55-61) [mean Numeric Rating Scale 6.8]. Class III obese and multisite pain patients had lower QoL and physical activity levels, reduced sleep, and poorer physical function than less obese patients and those without pain (P < 0.05). Relationships were found between demographic, pain, self-report, psychological, and functional measures (P < 0.05). Patients who slept fewer hours and had poorer functional outcomes were more likely to have LBP; patients who were divorced, had lower QoL, and more frequent nocturia were more likely to have knee pain (P < 0.05). Multisite MSK pain is prevalent and severe in obese patients and is negatively associated with most self-report and functional outcomes. This high prevalence suggests that pain management strategies must be considered when treating obesity.
Intra- and Interobserver Variability of Cochlear Length Measurements in Clinical CT
Authors: Iyaniwura John E. , Elfarnawany Mai , Riyahi-Alam Sadegh , Sharma Manas , Kassam Zahra , Bureau Yves , Parnes Lorne S. , Ladak Hanif M. , Agrawal Sumit K.
Published: April 2017

Hypothesis:

The cochlear A-value measurement exhibits significant inter- and intraobserver variability, and its accuracy is dependent on the visualization method in clinical computed tomography (CT) images of the cochlea.

Background:

An accurate estimate of the cochlear duct length (CDL) can be used to determine electrode choice, and frequency map the cochlea based on the Greenwood equation. Studies have described estimating the CDL using a single A-value measurement, however the observer variability has not been assessed.

Methods:

Clinical and micro-CT images of 20 cadaveric cochleae were acquired. Four specialists measured A-values on clinical CT images using both standard views and multiplanar reconstructed (MPR) views. Measurements were repeated to assess for intraobserver variability. Observer variabilities were evaluated using intra-class correlation and absolute differences. Accuracy was evaluated by comparison to the gold standard micro-CT images of the same specimens.

Results:

Interobserver variability was good (average absolute difference: 0.77 ± 0.42 mm) using standard views and fair (average absolute difference: 0.90 ± 0.31 mm) using MPR views. Intraobserver variability had an average absolute difference of 0.31 ± 0.09 mm for the standard views and 0.38 ± 0.17 mm for the MPR views. MPR view measurements were more accurate than standard views, with average relative errors of 9.5 and 14.5%, respectively.

Conclusion:

There was significant observer variability in A-value measurements using both the standard and MPR views. Creating the MPR views increased variability between experts, however MPR views yielded more accurate results. Automated A-value measurement algorithms may help to reduce variability and increase accuracy in the future.
Polish Nurses’ Knowledge of Heart Failure Self-Care Education Principles
Authors: Jankowska-Polańska Beata , Brzykowska Marta , Uchmanowicz Izabella , Lisiak Magdalena , Rosinczuk Joanna
Published: April 2017

On the basis of management guidelines, multidisciplinary treatments are essential in the care of patients with heart failure (HF) to improve quality of life and clinical outcomes.

Purpose:

The aim of the study was to assess nurses’ knowledge of HF self-care principles as a way to be prepared for educating patients about HF self-care maintenance and management.

Methods:

Nurses providing cardiology intensive care (n = 48), nonintensive hospital care (n = 129), and family practices care (n = 50) completed the Nurses’ Knowledge of HF Education Principles survey. Data were analyzed using descriptive statistics, Student t test, analysis of variance for qualitative variables, the Kruskal-Wallis correlation test, simple linear regression, and Pearson rank correlation for continuous variables.

Results:

Mean (SD) HF self-care maintenance knowledge score was 12.1 (2.7) that equated to 60.4% (13.4%). Scores were highest among nurses working in cardiology intensive care (12.39 [2.7]) and noninvasive care (12.3 [2.7]) and lowest in family medicine (10.74 [2.3]), P < .001. Nurses’ knowledge was associated with level of education (r = 0.1399, P = .05), number of graduate courses (r = 0.1483, P = .05), and specialization in cardiac nursing (r = 0.1457, P = .05).

Conclusions:

Polish nurses’ knowledge deficits in HF self-care principles may lead to problems in providing patients with adequate education.
Advancing Nursing Practice
Authors: O’Brien Joanne , Keaveny Joseph , Pollard Valerie , Nugent Linda Elizabeth
Published: April 2017

Purpose/Aims:

The purpose of this study was to examine the management of patient’s neuropathic pain with capsaicin 8% in a nurse-led clinic when administered by 1 registered advanced nurse practitioner without physician supervision.

Design:

A longitudinal, single-group, descriptive research design was used to assess pain scores and quality of life 3 times over 3 months after treatment.

Methods:

Patients with a diagnosis of neuropathic pain were assessed and treated with capsaicin 8% by 1 advanced nurse practitioner with prescriptive authority in a nurse-led clinic. Pain scores were collected at baseline, and self-assessed pain, activity level, and quality of life were assessed at 1 week, 4 weeks, and 3 months after treatment. Twenty-four patients were recruited, and data were analyzed using Friedman’s test. In post hoc analysis, Wilcoxon signed-rank test was used with Bonferroni correction.

Results:

Pain scores differed from pretreatment to posttreatment at each of the 3 time points, at rest (χ23= 20.54,P= .001) and on movement (χ23= 23.644,P= .001), and remained significant after Bonferroni correction. Overall, 62.5% (n = 15) of patients achieved at least a 30% reduction in self-reported pain at rest from pretreatment to 3 months, and 54% (n = 13) achieved the same reduction in pain on movement. Most improvements in patient’s quality of life occurred between 1 and 4 weeks. Patient satisfaction was high, with 83% stating that they would be happy to have the treatment repeated.

Conclusion:

Single-dose capsaicin 8% decreased neuropathic pain after being administered in an outpatient setting by an experienced registered advanced nurse practitioner. Further multicenter research led by advanced nurse practitioners is needed to support high-quality, safe treatment of neuropathic pain with high-concentration capsaicin in nurse-led chronic pain clinics.
Availability of Foodborne Illness Reporting Mechanisms for the Public on Local Health Department Web Sites
Authors: Harris Jenine K. , Wong Roger , Matthew Megan G. , Mansour Raed
Published: April 2017

Context:

Foodborne illness is a serious and preventable public health problem, with high health and economic tolls in the United States. Local governments play an important role in food safety, with local health departments (LHDs) responsible for licensing and inspecting restaurants. Foodborne illness complaints from the public result in identification of more serious and critical food safety violations than regularly scheduled inspections; however, few people report foodborne illness. Availability of existing methods for the public to report foodborne illness to LHDs across the United States was examined.

Objective:

In 2016, data were collected and analyzed from a nationally representative stratified sample of 816 LHDs. Each LHD Web site was examined to determine whether the Web site included a way for constituents to report a suspected foodborne illness.

Results:

Just 27.6% of LHD Web sites included a way for constituents to report a suspected foodborne illness. LHDs with reporting mechanisms were serving significantly larger populations and had significantly more staff members, higher revenues, and higher expenditures. Health departments with reporting mechanisms were also significantly more likely to conduct environmental health surveillance activities, to regulate, inspect, and/or license food service establishments, and to be involved in food safety policy.

Conclusions:

Consumer reports of suspected foodborne illness help identify serious and critical food safety violations in food establishments; however, foodborne illness is vastly underreported by the US public. While more evidence is needed on how current systems are working, increasing the visibility and availability of Web-based reporting mechanisms through the following strategies is recommended: (1) test and modify search functions on LHD Web sites to ensure consumers find reporting mechanisms; (2) add a downloadable form as an option for reporting; (3) coordinate with state health departments to ensure clear instructions are available for reporting at both state and local levels; and (4) consider linking directly to state health department reporting mechanisms.
Lifelong Prophylaxis With Trimethoprim-Sulfamethoxazole for Prevention of Outbreak of Pneumocystis jirovecii Pneumonia in Kidney Transplant Recipients
Authors: Goto Norihiko , Takahashi-Nakazato Ai , Futamura Kenta , Okada Manabu , Yamamoto Takayuki , Tsujita Makoto , Hiramitsu Takahisa , Narumi Shunji , Tsuchiya Kiyoto , Gatanaga Hiroyuki , Watarai Yoshihiko , Oka Shinichi
Published: April 2017

Background

Outbreaks of Pneumocystis jirovecii pneumonia (PCP) in kidney transplant recipients are frequently reported worldwide. However, the general guidelines propose only short-term prophylaxis with trimethoprim-sulfamethoxazole after kidney transplantation. We experienced 3 PCP outbreaks in the last 10 years despite providing the recommended prophylaxis. The purpose of this study was to find a prophylaxis regimen that could successfully prevent future PCP outbreaks in immunosuppressed kidney transplant recipients.

Methods

Occurrence of PCP at our hospital since 2004 was reviewed. A total of 48 cases were diagnosed from July 2004 through December 2014. Genotypes of P. jirovecii were determined in these cases.

Results

Three PCP outbreaks by 3 different genotypes of P. jirovecii in each outbreak occurred with 2-year intervals in last 10 years. Molecular analysis showed that each intraoutbreak was caused by identical P. jirovecii, whereas interoutbreaks were caused by different genotypes. Although short-term prophylaxis was provided to all kidney recipients after each outbreak after identification of a single PCP case, additional outbreaks were not prevented because the universal prophylaxis had already been completed when new case of PCP emerged.

Conclusions

The contagious nature of P. jirovecii allows easy development of outbreaks of PCP in immunosuppressed kidney transplant recipients. Although the universal short-term prophylaxis is effective in controlling ongoing outbreak, lifelong prophylaxis of kidney transplant recipients should be considered to prevent new outbreaks.
DIVERSITY in binding, regulation, and evolution revealed from high-throughput ChIP
Authors: Mitra Sneha , Biswas Anushua , Narlikar Leelavati
Published: April 2017

A high-throughput chromatin immunoprecipitation (ChIP) experiment is like a black-box: it reports all regions that are associated with the profiled protein based on the initial cross-linking step. These regions can be a highly diverse set of DNA sequences, with some making direct contact with the protein, some binding through intermediaries, and some being a result of long-range interactions involving the protein. We presentdiversity, a method that identifies the distinct components of such a mixture, leaving no data behind, while at the same time, using no prior motif knowledge. Using the example of the REST protein, we show that these different components give insights into the various complexes that may be forming along the chromatin and their regulatory functions.

http://diversity.ncl.res.in/(webserver)

https://github.com/NarlikarLab/DIVERSITY(standalone for Mac OSX/Linux)
Distributed affective space represents multiple emotion categories across the brain
Authors: Saarimäki Heini , Ejtehadian Lara Farzaneh , Glerean Enrico , Jääskeläinen liro P. , Vuilleumier Patrik , Sams Mikko , Nummenmaa Lauri
Published: April 2017

The functional organization of human emotion systems as well as their neuroanatomical basis and segregation in the brain remains unresolved. Here we used pattern classification and hierarchical clustering to reveal and characterize the organization of discrete emotion categories in the human brain. We induced 14 emotions (6 “basic”, such as fear and anger; and 8 “non-basic”, such as shame and gratitude) and a neutral state in participants using guided mental imagery while their brain activity was measured with functional magnetic resonance imaging (fMRI). Twelve out of 14 emotions could be reliably classified from the fMRI signals. All emotions engaged a multitude of brain areas, primarily in midline cortices including anterior and posterior cingulate and precuneus, in subcortical regions, and in motor regions including cerebellum and premotor cortex. Similarity of subjective emotional experiences was associated with similarity of the corresponding neural activation patterns. We conclude that the emotions included in the study have discrete neural bases characterized by specific, distributed activation patterns in widespread cortical and subcortical circuits, and highlight both overlaps and differences in the locations of these for each emotion. Locally differentiated engagement of these globally shared circuits defines the unique neural fingerprint activity pattern and the corresponding subjective feeling associated with each emotion.
A novel ultra high-throughput 16S rRNA amplicon sequencing library preparation method on the Illumina HiSeq platform
Authors: de Muinck Eric J. , Trosvik Pål , Gilfillan Gregor D. , Sundaram Arvind Y. M.
Published: April 2017

Background

Advances in sequencing technologies and bioinformatics have made the analysis of microbial communities almost routine. Nonetheless, the need remains to improve on the techniques used for gathering such data, including increasing throughput while lowering cost, and benchmarking the techniques so that potential sources of bias can be better characterized.

Results

We present a triple-index amplicon sequencing strategy that uses a two-stage PCR protocol. The strategy was extensively benchmarked through analysis of a mock community in order to assess biases introduced by sample indexing, number of PCR cycles, and template concentration. We further evaluated the method through re-sequencing of a standardized environmental sample. Finally, we evaluated our protocol on a set of fecal samples from a small cohort of healthy adults, demonstrating good performance in a realistic experimental setting. Between-sample variation was mainly related to batch effects, such as DNA extraction, while sample indexing was also a significant source of bias. PCR cycle number strongly influenced chimera formation and affected relative abundance estimates of species with high GC content. Libraries were sequenced using the Illumina HiSeq and MiSeq platforms to demonstrate that this protocol is highly scalable to sequence thousands of samples at a very low cost.

Conclusions

Here, we provide the most comprehensive study of performance and bias inherent to a 16S rRNA gene amplicon sequencing method to date. Triple-indexing greatly reduces the number of long custom DNA oligos required for library preparation, while the inclusion of variable length heterogeneity spacers minimizes the need for PhiX spike-in. This design results in a significant cost reduction of highly multiplexed amplicon sequencing. The biases we characterize highlight the need for highly standardized protocols. Reassuringly, we find that the biological signal is a far stronger structuring factor than the various sources of bias.