bluuebunny/crossref_metadata_2025 huggingface dataset:
Archaeology and Native Northerners
Authors: Lyons Natasha
Published: September 2016

Archaeology is undergoing a sustained shift in the North American Arctic, as factors both internal and external to the discipline work to expand and transform the structure, demographics, and objectives of professional practice. A major part of this shift hinges on the relationships between indigenous peoples and the archaeological establishment. Over the past 40 years, Inuit, Dene, Alaskan Native, and other local communities have increasingly demanded a stake in their archaeological heritage; archaeological practitioners have responded in varying ways, from resistance and naïveté to both tentative and concerted moves toward more inclusive practices. This chapter describes the historical and evolving relationship between Native Northern communities and archaeologists, characterizes elements of community-based practice, and examines some of the forms, approaches, and applications of this emergent paradigm.
Arctic Archaeometallurgy
Authors: Cooper Kory
Published: September 2016

By at least the first century A.D., metals were being integrated into the technologies of indigenous cultures across Arctic and Subarctic North America. In addition to naturally occurring pure forms of copper and iron in the region, Old World metals were also available via trade across Bering Strait to the west and with Norse in the east. The importance of metals, both before and after contact with Europeans, has been recognized by scholars since the early days of Arctic exploration, but despite long-term interest in the topic there is still much to be learned about metallurgical innovation in the region. This chapter provides an overview of precontact metal use in the Arctic, discusses analytical methods, and offers suggestions for future research on the topic.
Paleoeskimo Lithic Technology
Authors: Sørensen Mikkel , Desrosiers Pierre
Published: September 2016

In this chapter the evolution of lithic technology during the Paleoeskimo period is explored. The diversity of lithic raw materials is considered, as well as how they have been extracted and transformed into tool blanks. This was done mainly through the production of flakes and microblades, followed by the making of a wide range of tools. The evolution from spalled burins to burin-like tools, as well as the evolution of chipped tools and microblade production, and the circulation of raw materials, are some of the main topics considered. Lithic technology helps to understand the differences that have existed and the relative homogeneity of Paleoeskimo cultures in consideration of the size of their territory.
First Traces
Authors: Potter Ben , Goebel Ted
Published: September 2016

This chapter encompasses the earliest human occupations of the Arctic and Subarctic, focusing on paleoclimate and human-environment interactions and the colonization of Beringia and northern North America. It discusses new discoveries in the high latitudes of Eurasia and North America. For each period, from 32,000 to 12,000 years ago, there are summaries of technology, typology, subsistence economy, and settlement systems. After a Late Glacial Maximum hiatus, humans recolonized northeastern Asia around 16,000 cal B.P. and Beringia by 14,000 cal B.P. Early Beringian diets were diverse, incorporating large and small mammals, waterfowl, and fish. These early populations likely had high residential mobility strategies.
Norton Hunters and Fisherfolk
Authors: Dumond Don
Published: September 2016

By the late centuries B.C., occupations assigned to Norton people are reported from a southern point on the Alaska Peninsula, then north and eastward along coastal areas to a point east of the present border with Canada. The relatively uniform material culture suggests origin from the north and west (pottery from Asia, chipped-stone artifacts from predecessors in northern Alaska), as well as from the south and east (lip ornaments or labrets, and pecked-stone lamps burning sea-mammal oil). In early centuries A.D., Norton people north and east of Bering Strait yielded to Asian-influenced peoples more strongly focused on coastal resources, while those south of the Strait collected in sites along salmon-rich streams where they developed with increasing sedentarism until about A.D. 1000, when final Thule-related expansion along coasts from the north displaced or incorporated Norton remnants.
Archaeology of the Late Western Thule/Iñupiat in North Alaska (. 1300–1750)
Authors: Jensen Anne M.
Published: September 2016

This chapter covers the Late Western Thule (LWT) and precontact Iñupiat of Northern Alaska, the most recent archaeological manifestation of the Northern Maritime tradition. From a maritime-adapted, whale-hunting culture living in semisubterranean sod-covered houses, this culture expanded to include inland settlements along rivers and in caribou hunting regions. The chronology of the LWT period is refined, based on recent advances in dating and many new dates. Other topics covered include settlement patterns and demography, technology, trade, architecture, social relations, mortuary practices, and the history and effects of contact with Euro-Americans. Several unresolved questions, including climate-change effects, the existence and nature of resource stress, and factors governing interior occupation are highlighted.
The Aleutian Tradition
Authors: Corbett Debra , Yarborough Michael
Published: September 2016

Archaeological research in the last 35 years has greatly increased our understanding of the complexity and dynamism of prehistoric Aleutian cultures. The traditional view of a uniform and unchanging culture spanning 1,000 miles and 4,000 years has collapsed under this new research. This chapter brings together for the first time recent scholarship on archipelago-wide cultural change through time and across space. The role of cultural influences from elsewhere in Alaska is explored, demolishing the paradigm of cultural isolation. This was instead a population of highly specialized maritime hunter-gatherers who undertook voyages of trade and warfare, sometimes covering distances of hundreds of kilometers, as well as inland movements to discover abundant resources.
Molecular Genetic Evidence from Contemporary Populations for the Origins of Native North Americans
Authors: Crawford Michael , Rubicz Rohina C.
Published: September 2016

An overview of the current molecular genetic evidence for the origins of North American populations is presented, including specific examples from the authors’ work with the Aleutian Island inhabitants. Shared mitochondrial DNA and Y-chromosome DNA markers among Siberians and Native Americans point to a Pleistocene migration from Siberia into the Americas via Beringia. There was likely a later migration from Siberia to Alaska, based on the analysis of whole-genome sequence data from a Greenland Paleoeskimo that clusters this individual with Siberian populations. Coalescence date estimates for Native American mitochondrial DNA and Y-chromosome DNA haplogroups indicate that there was a population expansion approximately 15,000–18,000 that was associated with a pre-Clovis settlement of the Americas and coastal migration, and then a later expansion of circum-Arctic populations. Settlement of the Aleutian Archipelago took place via east-to-west migration of Aleut kin groups, accompanied by a clinal loss in mitochondrial DNA haplotype diversity.
Labrador Inuit
Authors: Woollett James , Kaplan Susan
Published: September 2016

The Thule groups that migrated into Labrador around the late thirteenth century settled in a part of the north that was away from the well-traveled migration routes of their cousins. However, the newcomers to Labrador did not settle into a marginal environment. Their new home offered a diversity of marine and terrestrial resources, some of them novel, that by the end of the eighteenth century supported large Inuit communities. While moving into Labrador may have isolated Labrador Inuit from their northern relatives, their interactions with the Western world were early and intense. As a result of history and geography, as well as Inuit adaptability, eighteenth-century Labrador Inuit were participants in a world economy and their culture evolved accordingly, socially, economically, and politically. They adapted to changing environmental and social circumstances, employing technologies and strategies with which their ancestors came to Labrador, while selectively adopting useful European materials and networks.
Archaeology of the Inuit of Southern Labrador and the Quebec Lower North Shore
Authors: Fitzhugh William
Published: September 2016

Early European accounts document the presence of Labrador Inuit in northern Newfoundland, the Strait of Belle Isle, and the northeastern Gulf of St. Lawrence in the late sixteenth and seventeenth centuries. Controversy over the interpretation of the historical record and the extent and nature of Southern Inuit presence has been clarified by recent archaeological research on the Quebec Lower North shore, which demonstrates a series of seventeenth- and eighteenth-century winter sod-house villages in every major region from Brador to Petit Mécatina. House types are similar to those found on the Central Labrador coast, and all contain much Basque and other European material culture, indicating extensive trade contacts rather than the spoils of sporadic raids. The Hare Harbor Inuit settlement at Petit Mécatina is found at a Basque/European whaling and fishing station and appears to have been a European-Inuit enterprise facilitated by the Little Ice Age expansion of Arctic marine mammals.
Archaeological Evidence for Transport, Trade, and Exchange in the North American Arctic
Authors: Rasic Jeffrey T.
Published: September 2016

A wide variety of materials, including lithics, manufactured goods, and food circulated within and between communities in the North American Arctic, including fish and sea-mammal oil, dried meat and fish, skins and furs, walrus ivory, and wood, as well as nephrite jade, soapstone, chert, obsidian, slate, graphite, pyrite, galena, jet, lignite coal, amber, quartz crystal, and hematite. This review considers only the inorganic materials. To establish provenance, Arctic researchers employ standard methods including trace-element characterization, geochemistry, petrography, stable isotope values, visual appearance, and geochronology. The geographic coverage extends across the North American Arctic from western Alaska to Labrador, considering each material’s precontact uses, geological source locations, and distribution patterns in time and space, concluding with the prospects and status of provenance studies.
From the Norton Culture to the Ipiutak Cult in Northwest Alaska
Authors: Mason Owen
Published: September 2016

Between A.D. 200 and 900, the Ipiutak regional system developed an intercontinental trade in obsidian and iron, associated with a shamanic crisis cult in Northwest Alaska. People gathered seasonally within community structures (qargi) for cultic performances, maintained an extensive trade network, and warred with their neighbors. Ipiutak was supported by the hunting of walrus, seal, and caribou; the possible contribution of whaling remains uncertain. Most settlements were small, including 3 to 6 houses, although the principal village at Point Hope had over 30 contemporaneous houses, producing a total of >600 houses and over 100 interments. Lacking pottery and oil lamps, Ipiutak people were specialized ivory workers, producing an elaborate and profound art, often employed as grave offerings. Ipiutak was affiliated and on occasion opposed to the Old Bering Sea culture of Bering Strait but its origins remain disputed between Central Asian and Alaska sources.
Ancient Eskimo Cultures of Chukotka
Authors: Bronshtein Mikhail M. , Dneprovsky Kirill A. , Savinetsky Arkady B.
Published: September 2016

Remnants of one Paleoeskimo and several Neoeskimo cultural traditions have been revealed in the coastal regions of Chukotka since the mid-1940s. The Chukotka Paleoeskimo cultural tradition, discovered on Wrangel Island, is comparable with the Paleoeskimo cultures of North America—Old Whaling (Alaska) and Independence (Greenland). It existed from 1700 to 1400 B.C. The Neoeskimo tradition is represented in Chukotka by Old Bering Sea (OBS), Okvik, Birnirk and Punuk cultures, found on Chukotka’s shores from the south part of the Bering Strait to the mouth of Kolyma River. The earliest are dated to the end of the first millennium B.C., the latest to the sixteenth and seventeenth centuries A.D. Chukotka archaeological sources point to close bonds between OBS, Birnirk and Punuk peoples. It is highly probable that a syncretic OBS-Birnirk-Punuk cultural community emerged in Chukotka from the end of the first millennium to the beginning of the second millennium A.D.
Holocene Prehistory of the Northwestern Subarctic
Authors: Potter Ben
Published: September 2016

This chapter synthesizes our current understanding of Holocene prehistory (from 11,500 years ago) of the northwest Subarctic, encompassing Alaska, Yukon Territory, and northern British Columbia. Various cultural chronologies are considered, as are new interpretations based on recently excavated sites. These data indicate conservation of lithic technologies concurrent with economic change throughout the region. Periods of cultural transitions occurred at 6,000 and 1,000 years ago. High residential mobility is inferred for most of the Holocene, with radical shifts in settlement and technology throughout the region at 1,000 years ago, though there are elements of continuity. Current debates on ethnogenesis of Athapaskans and the utility of typological approaches are also discussed.
The Dorset-Thule Transition
Authors: Park Robert
Published: September 2016

This chapter addresses the question of whether the people of the Thule culture met and interacted with people of the Dorset culture when they ventured eastward from Alaska. Most archaeologists have long believed that such a meeting took place and that the Dorset either assimilated into Thule communities and quickly adopted their way of life or, in order to avoid the Thule newcomers, retreated to ecologically marginal areas where they were unable to survive for long. However, researchers haven’t found any sites that provide even reasonably unambiguous proof of face-to-face contact, so our inferences have been based on very circumstantial types of evidence. This chapter argues that the very minimal evidence of acculturation actually derives from Thule salvage of Dorset sites and artifacts, and that all other evidence is consistent with the Dorset having disappeared prior to the earliest likely date of the Thule arrival.
A Jurist Confronting Himself
Authors: Agamben Giorgio
Published: September 2016

This chapter was originally published as a preface to a collection of Italian translations of texts by and interviews with Carl Schmitt. It shows how each text offers an image of Schmitt that can best be seen in light of what Walter Benjamin called the "now of knowability": in a constellation formed by the decisive political problems of Schmitt’s time. The challenge these texts thus propose is akin to that of finding figures hidden in a landscape painting. The chapter argues that the hidden figures in Schmitt’s works designate those points at which their contemporary relevance is greatest. Only in this constellation can the crux of Schmittian exegesis-that of a fascist thinker who continues to concern contemporary society profoundly-be fully experienced.
Carl Schmitt’s Spatial Rhetoric
Authors: Simons Oliver
Published: September 2016

By the end of the 1930s space (Raum) had become a common catchword in the writings of Carl Schmitt. This chapter argues that space was not merely a theme during this phase of his career, but was linked to a rhetorical strategy and mode of argumentation. Focusing on Land and Sea (1942) and “Nomos” of the Earth (1950), the first two sections show how Schmitt developed two contrasting modes of argumentation inextricably intertwined with his theory of space and the poetics of his writing. In the final section Agamben’s comments on Schmitt’s “topology” and the collaborative work A Thousand Plateaus by Deleuze and Guattari serve as case studies for recent reconfigurations of Schmitt’s spatial thought. The analysis of their appropriations of Schmitt points to major differences between his original perspective on space and these contemporary theories. Schmitt’s spatial theory is deeply rooted in the epistemology of the early twentieth century.
Faculty Talk About Teaching at the Community College
Authors: Finley Diane L. , Kinslow Sherry L.
Published: September 2016

This article examines what it means to teach at a community college from the viewpoint of two experienced faculty members. The comprehensive community college holds a unique place in American higher education, as it performs many functions, including workforce development, transfer education, and often developmental (remedial) education. The open-admissions nature of the community college gives anyone access to a college education or other training. That access results in a classroom that is different from those at four-year institutions. This article examines what it means to teach at the community college level by examining the community college and its place in American higher education. It includes an exploration of how open admission affects the classroom and the teacher. It discusses how the multiple missions of the community college, as well as political and funding issues, influence the faculty and their primary responsibility of teaching.
Social Psychology and Social Justice: Citizenship and Migrant Identity in the Post 9/11 Era
Authors: Bhatia Sunil
Published: September 2016

This chapter discusses the implications for creating a social psychology that is rooted in social justice issues within contexts of migration and globalization. In particular, it examines how the political events surrounding 9/11 have reframed the meaning of citizenship in the South Asian diaspora. It further analyzes how the US state–sponsored immigration, naturalization, and citizenship laws were historically based on racist ideologies and the role they played in shaping and defining the experiences of many “Third World,” non-European immigrants. The chapter specifically uses examples from the American-Sikh community to show how 9/11 portrayed them as illegitimate American citizens, nonpatriotic, and as belonging to the enemy camp. I discuss how Sikh Americans have employed the discourses of distancing and empowering discrimination to navigate their model minority identities. It concludes by arguing for a reconceptualization of social psychology as a transformative discipline that is anchored in social action and social justice.
Benevolent Heterosexism and the “Less-than-Queer” Citizen Subject
Authors: Langdridge Darren
Published: September 2016

This chapter explores the dangers of “benevolent heterosexism” through an analysis of the implicit assumptions underpinning research on sexual prejudice and “coming out.” Although there has been considerable progress in the West with regard to increasing rights for people who are lesbian, gay, bisexual, or queer (LGBQ), this progress has been predicated on an individualistic liberal model of politics that is not without cost; namely, the danger of a gradual and pernicious assimilation and the growth of a “less-than-queer” citizen subject. This new sexual subject is being produced in psychological research that is ostensibly about advancing social justice for people who are LGBQ, as well as within the broader social world. All psychologists that are interested in social justice need to allow space—and indeed, embrace—the “anti-social” queer in order to realize the justifiable anger needed to effect radical social change for sexual minorities.
Impact of Incarceration on Families and Communities
Authors: Rodriguez Nancy , Turanovic Jillian J.
Published: September 2016

This essay describes the implications of confinement for offenders’ families (both children and spouses) and for their communities, including coercive mobility, weakened social controls, family disruption, and stigmatization. The pros and cons of removing criminal fathers are discussed, focusing on possible differences in the implications of removing criminal fathers versus criminal mothers. The dramatically higher incarceration rates of black men from the most disadvantaged urban neighborhoods relative to any other demographic subgroup is discussed in the context of possible implications for the social and economic environments of poor neighborhoods. An overview of the debate on whether these higher incarceration rates actually reduce crime is also offered, including possible implications for a deterrent effect on crime (or a lack thereof). The need for research on the collateral consequences of incarceration for Latino families and communities is highlighted, given that Latinos represent the fastest growing segment of the US correctional population.
Treating Sex Offenders in Prison
Authors: Polaschek Devon L. L. , Blackwood Kristina M.
Published: September 2016

This essay considers the challenges associated with managing and treating sex offenders within the prison setting. What is known from scientific research about the most effective approaches to treating sex offenders is reviewed, followed by the major rehabilitation theories. The role of assessment with sex offenders (e.g., interviews, composite risk and need assessments for both sexual and general recidivism, penile plethysmography) as well as the challenges and limitations of conducting assessments with incarcerated sex offenders are also discussed. The various approaches to sex offender treatment are critiqued, including physiological strategies, behavioral strategies, cognitive strategies, and relapse prevention. Each phase of treatment (preparation, addressing criminogenic needs, planning for the future) is considered separately, and directions for future research are considered.
Preventing Suicide in Detention and Correctional Facilities
Authors: Canning Robert D. , Dvoskin Joel A.
Published: September 2016

This essay describes and critiques suicide-prevention strategies in prison, including the extent to which screening and prevention programs are used in the United States. The epidemiology of suicide and suicide attempts in both jails and prisons is reviewed, with discussions of differences in suicide risk by demographic factors, individual risk and suicide protective factors, and contextual factors. A cross-section of legal cases leading to the establishment of a legal basis for suicide prevention in US correctional facilities is provided, followed by an overview of current national standards and best practice guidelines for preventing inmate suicides. The essential components of correctional suicide-prevention strategies are described and critiqued, including core values at the center of these strategies, aspects of most effective systems management, and evidenced-based clinical care. Finally, special considerations for different types of confinement settings are described.
Procreative Responsibility in View of What Parents Owe Their Children
Authors: DeGrazia David
Published: September 2016

Under what circumstances is it morally responsible to procreate with the intention of having children, in view of what parents owe their children? Three conditions are necessary for procreation to be morally responsible: the worthwhile-life condition, the doing-more condition, and the basic-needs condition. The worthwhile-life condition requires that a life be expected to be worth starting in the sense that existence is not noncomparatively bad for its subject, containing much that is bad without offsetting compensations. The doing-more condition requires that parents do more for their children than the worthwhile-life condition requires, if they can do so without undue sacrifice. The basic-needs condition provides that parents owe their children efforts to ensure that their basic needs or essential interests are met. Other considerations about the intentions of the parents are relevant to responsible procreation but do not bear on the parents’ responsibilities to the child.
Is Surrogacy Ethically Problematic?
Authors: Francis Leslie
Published: September 2016

Commercial surrogacy is widely criticized as exploitive, as baby selling, or as even trafficking in persons. Less well-explored questions concern whether surrogacy is problematic in itself, a form of bodily labor that it is impermissible for one person to perform for another. This chapter argues first that grounds advanced for judging surrogacy as impermissible bodily labor sweep too broadly. It then rejects claims that surrogacy impermissibly burdens the autonomy of the pregnant woman or the intended female parent, that surrogacy wrongly devalues the child-to-be, or that surrogacy disrespects the parent–child relationship. With appropriate protections against exploitation and coercion, both commercial surrogacy and altruistic surrogacy are ethically appropriate.
Boundaries, Subjection to Laws, and Affected Interests
Authors: Pavel Carmen E.
Published: September 2016

Political decisions in one country can have negative effects in other countries. The defenders of the “all affected interests principle” (AAIP) propose that political decisions should be made by those whose interests are likely to be affected by them. AAIP purports to offer normative criteria for drawing boundaries around political communities in less arbitrary and more morally legitimate ways, by ultimately endorsing a global democracy as the only legitimate form of political rule. This chapter offers an alternative explanation for (1) why certain people should be included in the political decision-making of a group and others should not, that better captures the reasons for extending the democratic franchise, and (2) how to take the idea of affected interests into account. This alternative, called the “all subjected” principle, shares the concern about the shortcomings of existing modes of political organization, but has different implications for political practice.
Platonic Freedom
Authors: Miller Fred D.
Published: September 2016

Plato’s term eleutheria may be translated as “freedom” because it signifies the same triadic relation as the English term—freedom of an agent from impediments to a goal. While it is generally recognized that Plato rejects the democratic idea of personal freedom, it is often overlooked that he offers in its place an alternative, “aristocratic,” conception of freedom, originating in the moral psychology of Socrates and reflecting a popular view of freedom as opposed to slavery. In the Republic Plato describes aristocratic freedom as the rule of reason over the soul unimpeded by desires. In the Laws aristocratic freedom entails “willing enslavement to the laws,” which represents a due measure between extreme slavery and extreme freedom. Though different from the modern liberal concept of liberty, Plato’s conception leads to important innovations. Plato’s ideal of aristocratic freedom was shared and developed further by Aristotle.
Adam Smith’s Libertarian Paternalism
Authors: Otteson James R.
Published: September 2016

Richard Thaler and Cass Sunstein argue for “libertarian paternalism,” defined as the strategy to devise policy that will “maintain or increase freedom of choice” and at the same time “influence people’s behavior in order to make their lives longer, healthier, and better”. These two goals are often in conflict, and striking the right balance between them has proved difficult in both theory and practice. Where does Adam Smith fall in this debate? This chapter argues that Smith developed his own version of “libertarian paternalism.” It differs in important ways from that of Thaler and Sunstein, but it shares with them an attempt to balance respect for individual autonomy with a desire to help people lead better lives. Smith’s position accommodates the importance of both liberty and paternalism in enabling individuals to construct lives worth living, while avoiding some of the problems that have beset more recent versions of libertarian paternalism.
nifDK Clusters Located on the Chromosome and Megaplasmid of Bradyrhizobium sp. Strain DOA9 Contribute Differently to Nitrogenase Activity During Symbiosis and Free-Living Growth
Authors: Wongdee Jenjira , Songwattana Pongpan , Nouwen Nico , Noisangiam Rujirek , Fardoux Joel , Chaintreuil Clémence , Teaumroong Neung , Tittabutr Panlada , Giraud Eric
Published: September 2016

Bradyrhizobium sp. strain DOA9 contains two copies of the nifDK genes, nifDKc, located on the chromosome, and nifDKp, located on a symbiotic megaplasmid. Unlike most rhizobia, this bacterium displays nitrogenase activity under both free-living and symbiotic conditions. Transcriptional analysis using gusA reporter strains showed that both nifDK operons were highly expressed under symbiosis, whereas nifDKc was the most abundantly expressed under free-living conditions. During free-living growth, the nifDKp mutation did not affect nitrogenase activity, whereas nitrogenase activity was drastically reduced with the nifDKc mutant. This led us to suppose that nifDKc is the main contributor of nitrogenase activity in the free-living state. In contrast, during symbiosis, no effect of the nifDKc mutation was observed and the nitrogen-fixation efficiency of plants inoculated with the nifDKp mutant was reduced. This suggests that nifDKp plays the main role in nitrogenase enzyme activity during symbiosis. Together, these data suggest that Bradyrhizobium sp. strain DOA9 contains two functional copies of nifDK genes that are regulated differently and that, depending on their lifestyle, contribute differently to nitrogenase activity.
The Standardized Letter of Evaluation for Postgraduate Training: A Concept Whose Time Has Come?
Authors: Love Jeffrey N. , Ronan-Bentle Sarah E. , Lane David R. , Hegarty Cullen B.
Published: September 2016

A medical student’s letter of recommendation for postgraduate training applications should provide a fair and accurate assessment of academic and clinical performance, as well as define character attributes pertinent to the practice of medicine. Since its inception in 1997, the emergency medicine (EM) standardized letter of evaluation (SLOE) has evolved into an instrument that provides just such an assessment. Concise, standardized, and discriminating in its assessment of performance relevant to the practice of EM, the SLOE is judged by program directors in EM as the most valuable component of a potential resident’s application. Other specialties would benefit from such a specialty-specific perspective, which is currently lacking in most Electronic Residency Application Service application materials. Creation of specialty-specific SLOEs which define performance metrics or competencies and noncognitive personality traits critical to each unique specialty would add substantially to the holistic review of our graduating students. As a result, specialty-specific SLOEs would increase the likelihood that programs could effectively identify applicants who would not only be a “good fit” for their programs but also graduate to become successful physicians.
The Characteristics of International Medical Graduates Who Have Been Disciplined by Professional Regulatory Colleges in Canada: A Retrospective Cohort Study
Authors: Alam Asim , Matelski John J. , Goldberg Hanna R. , Liu Jessica J. , Klemensberg Jason , Bell Chaim M.
Published: September 2016

Purpose

This study evaluated the proportion and characteristics of international medical graduates (IMGs) who have been disciplined by professional regulatory colleges in Canada in comparison with disciplined North American medical graduates (NAMGs).

Method

The authors compiled a database of the nature of professional misconduct and penalties incurred by disciplined physicians from January 2000 to May 2015 using public records. They compared discipline data for IMGs versus those for NAMGs, and calculated risk ratios (RRs) and 95% confidence intervals (CIs) for select outcomes.

Results

There were 794 physicians disciplined; 922 disciplinary cases during the 15-year study period. IMGs composed an average of 23.4% (standard deviation = 1.1%) of the total physician population and represented one-third of disciplined physicians and discipline cases. The overall disciplinary rate for all Canadian physicians was 8.52 cases per 10,000 physician years (95% CI [7.77, 9.31]). This rate per group was higher for IMGs than for NAMGs (12.91 [95% CI (11.50, 14.43)] vs. 8.16 [95% CI (7.53, 8.82)] cases per 10,000 physician years, P < .01, and RR 1.58 (95% CI [1.38, 1.82]). IMGs were disciplined at significantly higher rates than NAMGs if they were trained in South Africa (RR 1.73 [95% CI (1.14, 2.51), P < .01), Egypt (RR 3.59 [95% CI (2.18, 5.52)], P < .01), or India (RR 1.66 [95% CI (1.01, 2.55)], P = .03).

Conclusions

IMGs are disciplined at a higher rate than NAMGs. Future initiatives should be focused to delineate the exact cause of this observation.
Deceased Donor Uterine Transplantation
Authors: Flyckt Rebecca L. , Farrell Ruth M. , Perni Uma C. , Tzakis Andreas G. , Falcone Tommaso
Published: September 2016

This commentary endeavors to share our practical experience in developing and implementing the first uterine transplant clinical trial in the United States. Uterine transplant is a promising novel treatment for uterine factor infertility. After reported successful live births after uterine transplant in Sweden, research teams around the world are either embarking on or are considering the development of uterine transplant protocols. Our observations on the applied rather than theoretical aspects of uterine transplantation research in human subjects are detailed in this article. Important among these considerations are composing a broad and experienced multidisciplinary team as well as performing adequate preclinical preparations, including ideally animal studies and practice organ procurements. Ethical preparation is tantamount to clinical preparation for the complexities inherent in uterine transplant, and our suggestions for updating the current ethical criteria for uterine transplant are outlined here. We also describe our perspectives on the strengths and weaknesses of living compared with deceased donor models. Finally, we describe how a strong program can recover and adapt in the face of setbacks to continue a path toward innovation.
Health Care Disparity and State-Specific Pregnancy-Related Mortality in the United States, 2005–2014
Authors: Moaddab Amirhossein , Dildy Gary A. , Brown Haywood L. , Bateni Zhoobin H. , Belfort Michael A. , Sangi-Haghpeykar Haleh , Clark Steven L.
Published: September 2016

OBJECTIVE:

To investigate factors associated with differential state maternal mortality ratios and to quantitate the contribution of various demographic factors to such variation.

METHODS:

In a population-level analysis study, we analyzed data from the Centers for Disease Control and Prevention National Center for Health Statistics database and the Detailed Mortality Underlying Cause of Death database (CDC WONDER) that contains mortality and population counts for all U.S. counties. Bivariate correlations between maternal mortality ratio and all maternal demographic, lifestyle, health, and medical service utilization characteristics were calculated. We performed a maximum likelihood factor analysis with varimax rotation retaining variables that were significant (P<.05) in the univariate analysis to deal with multicollinearity among the existing variables.

RESULTS:

The United States has experienced a continued increase in maternal mortality ratio since 2007 with rates of 21–22 per 100,000 live births in 2013 and 2014. This increase in mortality was most dramatic in non-Hispanic black women. There was a significant correlation between state mortality ranking and the percentage of non-Hispanic black women in the delivery population. Cesarean deliveries, unintended births, unmarried status, percentage of non-Hispanic black deliveries, and four or less prenatal visits were significantly (P<.05) associated with increased maternal mortality ratio.

CONCLUSION:

Interstate differences in maternal mortality ratios largely reflect a different proportion of non-Hispanic black or unmarried patients with unplanned pregnancies. Racial disparities in health care availability, access, or utilization by underserved populations are an important issue faced by states in seeking to decrease maternal mortality.
Distinguishing Arterial Ischemic Stroke From Hypoxic–Ischemic Encephalopathy in the Neonate at Birth
Authors: Adami Rebecca R. , Grundy Maureen E. , Poretti Andrea , Felling Ryan J. , Lemmon Monica , Graham Ernest M.
Published: September 2016

OBJECTIVE:

To identify perinatal risk factors that can distinguish arterial ischemic stroke from hypoxic–ischemic encephalopathy at birth.

METHODS:

This is a cohort study of all neonates born at 35 weeks of gestation or greater admitted to our neonatal intensive care unit from January 1, 2010, to December 31, 2015, that compares neonates with stroke with those with hypoxic–ischemic encephalopathy undergoing whole-body hypothermia with abnormal brain magnetic resonance imaging.

RESULTS:

During this 6-year period, there were 22 neonates with stroke and 47 with hypoxic–ischemic encephalopathy undergoing whole-body hypothermia with abnormal magnetic resonance imaging. Three neonates triaged to hypothermia initially thought to have hypoxic–ischemic encephalopathy were later diagnosed with stroke. All neonates with stroke had a negative thrombophilia workup. Neonates with stroke had a significantly higher incidence of seizures and increased initial platelet counts on univariate analysis. A multivariable model of variables with P<.1 on univariate analysis present within 6 hours of birth found significant increases in nonreassuring fetal heart rate tracings, sentinel events, low Apgar score at 5 minutes, and metabolic acidosis at birth with hypoxic–ischemic encephalopathy. Stroke was associated with a significantly increased initial platelet count.

CONCLUSION:

Stroke is associated with increased initial platelet counts and is not associated with cesarean delivery for nonreassuring fetal heart rate tracings, sentinel events, or perinatal metabolic acidosis. Stroke is a form of neonatal brain injury not associated with perinatal risk factors that allow early identification.
Maternal Marijuana Use and Adverse Neonatal Outcomes
Authors: Conner Shayna N. , Bedell Victoria , Lipsey Kim , Macones George A. , Cahill Alison G. , Tuuli Methodius G.
Published: September 2016

OBJECTIVE:

To estimate whether marijuana use in pregnancy increases risks for adverse neonatal outcomes and clarify if any increased risk is attributable to marijuana use itself or to confounding factors such as tobacco use.

DATA SOURCES:

Two authors performed a search of the data through August 2015 utilizing PubMed, Embase, Scopus, Cochrane reviews, ClinicalTrials.gov, and Cumulative Index to Nursing and Allied Health.

METHODS OF STUDY SELECTION:

We looked at observational studies that compared rates of prespecified adverse neonatal outcomes in women who used marijuana during pregnancy with women who did not.

TABULATION, INTEGRATION, AND RESULTS:

Two authors independently extracted data from the selected studies. Primary outcomes were low birth weight (less than 2,500 g) and preterm delivery at less than 37 weeks of gestation. Secondary outcomes were birth weight, gestational age at delivery, small for gestational age, level II or greater nursery admission, stillbirth, spontaneous abortion, low Apgar score, placental abruption, and perinatal death. DerSimonian-Laird random-effects models were used. We assessed heterogeneity using the Q test and I
2 statistic. Stratified analyses were performed for the primary outcomes and pooled adjusted estimates were calculated. We included 31 studies that assessed the effects of maternal marijuana use on adverse neonatal outcomes. Based on pooled unadjusted data, marijuana use during pregnancy was associated with an increased risk of low birth weight (15.4% compared with 10.4%, pooled relative risk [RR] 1.43, 95% confidence interval [CI] 1.27–1.62) and preterm delivery (15.3% compared with 9.6%, pooled RR 1.32, 95% CI 1.14–1.54). However, pooled data adjusted for tobacco use and other confounding factors showed no statistically significant increased risk for low birth weight (pooled RR 1.16, 95% CI 0.98–1.37) or preterm delivery (pooled RR 1.08, 95% CI 0.82–1.43).

CONCLUSION:

Maternal marijuana use during pregnancy is not an independent risk factor for adverse neonatal outcomes after adjusting for confounding factors. Thus, the association between maternal marijuana use and adverse outcomes appears attributable to concomitant tobacco use and other confounding factors.
Extended adjuvant endocrine therapy in hormone-receptor-positive early breast cancer
Authors: O’Leary Connor G. , Ellis Haley , Higgins Michaela
Published: September 2016

Purpose of review

The risk of relapse associated with oestrogen receptor-positive early breast cancer persists for at least 15 years after diagnosis. Several large clinical trials have examined extended adjuvant endocrine therapy.

Recent findings

The MA.17 trial demonstrated improved disease-free survival (DFS) with use of letrozole for 5 years after some years of tamoxifen and an overall survival advantage for this approach in women with node-positive oestrogen receptor-positive cancer at diagnosis. The subsequent adjuvant tamoxifen – to offer more? and adjuvant tamoxifen: longer against shorter trials demonstrated a DFS advantage for 10 years of tamoxifen over 5 years. The recently reported MA.17R trial randomized women who had already completed 5 years of aromatase inhibitor therapy with or without previous tamoxifen to further 5 years of letrozole or placebo. DFS was significantly improved in the extended letrozole group, quality of life was similar but bone fracture rates were higher. The absolute benefit in terms of reduced distant recurrences in these studies is modest, and tolerability and compliance challenges remain.

Physicians and patients now have multiple evidence-based treatment options for women who complete 5 years of adjuvant endocrine therapy. Extended therapy with either tamoxifen or letrozole should be considered for all and decision based on menopausal status, individual risk, tolerance and magnitude of potential benefit.
Extended anti-HER2 therapy in early breast cancer: longer beats shorter?
Authors: Refae Sadal , Pistilli Barbara , Delaloge Suzette
Published: September 2016

Purpose of review

One-year duration of adjuvant trastuzumab is the gold standard since 2005. During the last decade many attempts have been made to both increase and reduce the treatment duration. The purpose of this article is to review the current available evidence regarding alternative anti-HER2 therapy durations in the (neo)adjuvant treatment of HER2-positive localized breast cancer patients.

Recent findings

According to the majority of published data, shorter trastuzumab schedule has shown a decreased benefit in the overall HER2 population, whereas extending adjuvant trastuzumab, beyond 1 year, does not improve the outcome and is associated with increased cardiac toxicity. However, new challenging questions are raised by the recent results of ExteNet trial, in which sequential introduction of 1 year neratinib after standard trastumab-based therapy improved the outcome, especially in the estrogen receptor-positive subset of patients.

To date the standard duration of adjuvant trastuzumab remains 1 year in the adjuvant setting. It is likely that ongoing trials will clarify which patients could benefit from a shorter or a longer treatment. Taking into account patient's specific risk/benefit ratio and new biomarkers, in future, a ‘personalized’ treatment duration would be warranted.
Practical implications of integrated glioma classification according to the World Health Organization classification of tumors of the central nervous system 2016
Authors: Malzkorn Bastian , Reifenberger Guido
Published: September 2016

Purpose of review

Morphological features identifiable by light microscopy have been the basis of brain tumor diagnostics for many decades. The revised WHO classification of tumors of the central nervous system 2016 combines histological and molecular features for an integrated classification. This new approach builds upon advances in brain tumor molecular genetics and has important practical implications.

Recent findings

Molecular genetic studies revealed distinct glioma entities with specific genetic and epigenetic profiles. Evidence has been accumulated that molecular classification more reliably discriminates glioma entities and better predicts patient outcome than histological classification. Major glioma entities can be distinguished by four molecular biomarkers included in the new WHO classification, namely isocitrate dehydrogenase mutation, codeletion of chromosome arms 1p and 19q, codon 27 lysine-to-methionine mutation in H3 histones, and C11orf95-RELA gene fusions. Each is detectable by common techniques in routinely processed tissue specimens. Their integration into glioma classification greatly improves diagnostic accuracy but also has practical implications concerning establishment and quality control of novel techniques, increased costs and prolonged time to diagnosis.

We summarize the relevant changes in the revised WHO classification of gliomas, outline the integrated approach, and discuss its practical implications and potential challenges.
A Systematic Review of Local Excision After Neoadjuvant Therapy for Rectal Cancer: Are ypT0 Tumors the Limit?
Authors: Hallam Sally , Messenger David E. , Thomas Michael G.
Published: September 2016

BACKGROUND:

Neoadjuvant therapy reduces local recurrence after radical surgery for rectal cancer with complete pathological response in 15% to 25% of patients. Radical surgery is associated with significant morbidity that may be avoided by local excision in selected cases.

OBJECTIVE:

This systematic review aimed to determine the oncological outcomes and morbidity of local excision after neoadjuvant therapy.

DATA SOURCES:

Data sources included MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases.

STUDY SELECTION:

A systematic search of the databases using validated terms for rectal cancer, neoadjuvant therapy, and local excision was conducted.

INTERVENTIONS:

Neoadjuvant therapy and local excision were the included interventions.

MAIN OUTCOME MEASURES:

Pooled local recurrence, median survival, and pooled morbidity were measured.

RESULTS:

Twenty unique studies were included (14 cohort, 5 comparative cohort, and 1 randomized controlled trial), describing 1068 patients. Patient choice, prohibitive comorbidity, good clinical response, and early stage disease were the most frequent indications for local excision. Pretreatment T2 and T3 tumors accounted for 46.4% and 30.7% of cases. Long-course treatment was administered in all of the studies, except to a cohort of 64 patients who received short-course radiotherapy. Pooled complete clinical response was 45.8% (95% CI, 31.4%–60.5%), and pooled complete pathological response was 44.2% (95% CI, 36.4%–52.0%). Median follow-up was 54 months (range, 12–81 months). ypT0 tumors had a pooled local recurrence rate of 4.0% (95% CI, 1.9%–6.9%) and a median disease-free survival rate of 95.0% (95% CI, 87.4%–100%). Pooled local recurrence and median disease-free survival rates for ypT1 tumors or higher were 21.9% (95% CI, 15.9%–28.5%) and 68.0% (58.3%–69.0%). Pooled incidence of complications was 23.2% (95% CI, 15.7%–31.7%), with suture-line dehiscence reported in 9.9% (95% CI, 4.8%–16.7%).

LIMITATIONS:

Limitations included study quality, high risk of selection bias and detection bias in study designs, and limited sample sizes.

CONCLUSIONS:

Local excision after neoadjuvant therapy should only be considered a curative treatment if complete pathological response is obtained. Given the high rate of local recurrence among incomplete responders, future studies should focus on predicting patients who will achieve complete pathological response.