bluuebunny/crossref_metadata_2025 huggingface dataset:
Camelid hunting and herding in Inca times
Authors: Mengoni Goñalons Guillermo Luis
Published: April 2017

South American Camelids (SAC) occupied a central role in the development of Andean societies and were an essential element of the cultural landscape. During the Inca period camelids had a major significance to people, integrating their economy, social, political, and ritual life. Camelids were a key instrument for the expansion and establishment of the Inca Empire. Llamas were used as beasts of burden for transporting goods along extensive redistribution networks that connected the highlands, valleys, and Pacific coast. From a utilitarian perspective camelids provided different products (e.g. meat, wool). This chapter illustrates the strategies used by the Incas for managing these ungulates by presenting some case studies from the Qollasuyu, the southeastern quarter of the Inca Empire.
Forests, steppes, and coastlines
Authors: Borrero Luis A.
Published: April 2017

The human colonization of southern Patagonia began over 11,500 radiocarbon years bp. The first colonizers exploited Pleistocene megamammals and camelids. During the Early Holocene, after the extinction of the megamammals, hunter-gatherers concentrated on the exploitation of camelids. During the Middle Holocene a full exploitation of coastal resources began—pinnipeds, molluscs, and coastal birds. The main trends observed in the exploitation of these animals through time were in the intensity of utilization. Huemul and Rheidae were discontinuously exploited in the interior, particularly in the forests. On the coasts, molluscs, fish, and birds complemented the human diet, especially during the Late Holocene. The main subsistence changes after the European contact resulted from the introduction of sheep and horses.
Regional and chronological variations in energy harvests from prehistoric fauna in New Zealand
Authors: Smith Ian W. G.
Published: April 2017

Regional variations in the subsistence practices of New Zealand’s indigenous Maori were recognized by the first Europeans who studied them closely in the late eighteenth century. There is now a critical need to reassess the evidence for both regional and chronological variations in evidence for the types and relative importance of the foods that prehistoric Maori ate to establish when, where, and how changes took place. Reliably dated archaeological assemblages from two New Zealand study areas are examined to generate estimates of the dietary energy harvested from major classes of fauna. These reveal changes over time which are attributable to human predation, and regional differences that reflect differing trajectories of human population growth.
Sheep, sacrifices, and symbols
Authors: Halstead Paul , Isaakidou Valasia
Published: April 2017

Images, texts, and bones shed light on the place of animals in the later Bronze Age societies of southern Greece. Iconography offers an idealized vision of encounters with dangerous, exotic, and mythical beasts, of travel in elaborate horse-drawn chariots, and of ceremonial slaughter of bulls. Reality, even for the elite and as revealed by textual and faunal evidence, was more mundane: killing and consumption of sheep, goats, and pigs more than lions, deer, and bulls; and dependence, to finance a palatial lifestyle, on draught oxen for grain production and wool-sheep for exchangeable prestige textiles. Linear B texts describe aspects of animal management of interest to the Mycenaean palaces, while faunal data make clear how restricted were these interests. Faunal and ceramic data highlight the importance of commensality throughout the Neolithic and Bronze Age, and the shift from overtly egalitarian gatherings in the Neolithic to ostentatiously inegalitarian in the Bronze Age.
Introduction
Authors: Brady David , Burton Linda M.
Published: April 2017

Introduction
Job-Finding among the Poor
Authors: Smith Sandra Susan
Published: April 2017

This article examines whether social ties play a significant role in job seeking by poor people. A number of studies provide evidence that in relative and absolute terms, the poor rely heavily on social networks for job-finding. Without networks, poor job seekers are significantly less likely to find work. After considering what kinds of ties help the poor get ahead, this article discusses the role of weak ties as a source of job information and influence. It then explores the link between employment outcomes and network structure and composition as well as how people make leveraging ties, and how might this process of tie formation inform our understanding of network inequality. It also asks why leveraging ties are effective and concludes with an assessment of conditions that facilitate social capital activation.
Education
Authors: Hannum Emily , Xie Yu
Published: April 2017

This article explores the correlation between poverty and education. Poverty has been a core concept of interest in research on educational inequality. However, the conceptualization of poverty in empirical educational research does not always, or even usually, conform to definitions and measures that are prevalent in the poverty literature. To further complicate matters, the educational literature subscribes to no uniform set of alternative conceptualizations. This article begins with a discussion of three important functions of education in almost every modern society: imparting knowledge, socializing children, and transmitting family advantage or disadvantage. It then considers the impact of poverty on education at the national level and how education is affected by community and neighborhood poverty as well as household poverty. It concludes with an assessment of the impact of education on poverty.
Social Policy, Transfers, Programs, and Assistance
Authors: Lein Laura , Danziger Sandra K. , Shaefer H. Luke , Tillotson Amanda
Published: April 2017

This article examines poverty policies and programs in four areas: cash transfer programs, public provision of childcare, publically provided medical care, and public/social housing. Public provision for families in poverty includes programs that provide childcare, income supports, medical assistance, public housing, and employment assistance to family units. There are also policies that operate at a more general level to provide workforce and economic development and child welfare and early childhood education and support. Across nations, these policies vary along a number of dimensions. This article first considers each of the four poverty programs in detail before discussing the ramifications of differing national approaches to poverty in the context of the turn toward neoliberalism and the worldwide recession that began in 2007.
Why and When Do Peasants Rebel?
Authors: Trejo Guillermo
Published: April 2017

This article explores the origins and consequences of direct political action as a means for the rural poor to overcome economic destitution. Three forms of rural collective action are discussed: peaceful protest, armed rebellion, and civil war. The article first reviews classic statements and recent findings in the literature on peasant collective action before considering why poor peasants rebel. Drawing on recent studies of peasant protest, armed insurgency, and civil war, it then outlines four lessons that help us rethink dynamics of poor people’s movements. It also assesses the long-term economic and political consequences of peasant collective action and whether violent or nonviolent forms of rural mobilization have an impact on land redistribution and democratization. Finally, it describes conditions under which the poor try to overcome their destitution through direct political action.
Unions and Poverty
Authors: Rosenfeld Jake , Laird Jennifer
Published: April 2017

This article examines the ways that labor unions seek to curtail poverty by systematizing the available evidence both by geography and according to whether the research focuses on indirect or direct linkages between organized labor and poverty. Lobbying the government to maintain funding for an antipoverty program such as food stamps represents an indirect effect of unions on poverty. Fighting to expand health insurance coverage for the elderly and raising the minimum wage are other indirect pathways that unions have undertaken on behalf of the poor. This article first considers the influences of unions on poverty in the United States, advanced industrialized democracies, and developing countries before discussing the specific mechanisms that link unionization rates with levels of economic disadvantage.
Housing Programs
Authors: Kemp Peter A.
Published: April 2017

This article examines the nature and role of housing programs for low-income households in the rich democracies. It first describes the characteristics of housing and why these can be problematic for people living in poverty before discussing the social construction of “the housing question.” It then explores private and public responses to these problematic aspects of housing. Private “solutions” include poor dwelling conditions, undermaintenance, overcrowding, high rent-to-income ratios, and homelessness. Public “solutions” include public health regulations, minimum building standards, rent controls, public housing, housing vouchers, and tax expenditures. The article shows that some public solutions have been regarded as the causes of other “poverty problems”—including high levels of joblessness and ethnic segregation—that have in turn been the subject of policy responses. Finally, it analyzes housing affordability as well as the impact of housing allowances and mortgage subsidies in relation to poverty.
Microfinance and Financial Inclusion
Authors: Mader Philip
Published: April 2017

This article examines the impact of microfinance—the provision of financial services to poor and low-income populations, usually in the global South—on poverty. Microfinance is regarded as a financial market solution to the social problem of poverty, promising poverty alleviation in a market-friendly and cost-efficient way. Proponents hope that the financial inclusion of poor and low-income population segments will help them cope better with multifaceted problems of poverty, in particular their uncertain and low incomes. This article first provides an overview of microfinance, focusing on its economic and gender impacts, before tracing the microfinance sector’s historical origins and rise. It also considers the practices of the microfinance sector as well as the critical debates over microfinance. Finally, it describes three sets of recent developments relating to microfinance: a spate of crises including overindebtedness and collapse, new methods and mission, and the sector’s expanding scope of activities.
Conclusion
Authors: Rank Mark R.
Published: April 2017

This concluding article proposes a new paradigm in which to understand poverty, focusing primarily on the United States even as several dimensions of the paradigm apply globally across other countries. It first considers the major tenets of the “old” paradigm, which is to a large extent a reflection and affirmation of both the free market economic structure and the culture of individualism that have profoundly shaped the American ideology. It then introduces the new paradigm, which aims to stimulate a fundamental shift in how we conceptualize and act toward the problem of poverty, and some of its major themes: poverty results from structural failings; poverty is a conditional state in which individuals move in and out; poverty constitutes deprivation; poverty as injustice; the condition of poverty affects and undermines each one of us.
Ideologies and Beliefs about Poverty
Authors: Hunt Matthew O. , Bullock Heather E.
Published: April 2017

This article examines ideologies and beliefs about poverty. In 1981, Kluegel and Smith provided the first comprehensive summary and critique of scholarly research on beliefs about social stratification. Focusing primarily on the United States and Great Britain, they reviewed research on public beliefs in three primary areas: opportunity, the distributive process, and social class. In so doing, they identified four key questions that continue to define research in this area: What is believed about social inequality? What principles organize thought around social inequality? What determines what is believed? What are the consequences of these beliefs? This article considers what Americans (and to a lesser extent, the British) perceive and believe about social inequality; the nature of ideologies and other social psychological processes governing the intrapersonal organization of beliefs; selected factors that shape patterns of belief; and selected consequences that stratification beliefs hold for the person and for politics.
How Politics and Institutions Shape Poverty and Inequality
Authors: Brady David , Blome Agnes , Kleider Hanna
Published: April 2017

This article explores the influence of politics and institutions on poverty and inequality. It first considers the general contention that poverty is shaped by the combination of power resources and institutions. On one hand, scholars in the power resources tradition have emphasized the role of class-based collective political actors for mobilizing “power resources” in the state and economy. On the other hand, institutionalists have highlighted the role of formal rules and regulations. The article goes on to discuss the theoretical arguments of power resources theory and the evidence for key power resources (that is, collective political actors like labor unions and parties). It also reviews institutional explanations, focusing on the key concepts and theories and as well as the evidence linking the most salient institutions to poverty. Finally, it examines how state policy influences poverty and presents several challenges for future research.
Linking Poverty and Children’s Development
Authors: McLoyd Vonnie C. , Jocson Rosanne M. , Williams Abigail B.
Published: April 2017

This article examines the effects and mediators of childhood poverty, with particular emphasis on the confluence of forces that gave rise to these foci and perspectives. It first considers macroeconomic trends as a context for the study of childhood poverty in the United States, followed by a review of developments that directed attention to the dynamics and context of childhood poverty as research topics, along with a summary of the findings generated by this research. It then discusses perspectives that have emerged about processes that mediate links between poverty and child development, including the social causation and social selection perspectives, as well as the applicability of these perspectives for understanding the effects of poverty on children living in developing countries. Finally, it assesses the role of poverty in maternal and child mental health and the influence of parenting practices and investments on child development.
Hydraulic Fracturing and Legal Frameworks
Authors: Wiseman Hannah
Published: April 2017

An oil and gas extraction technique called hydraulic fracturing has been common in the United States for many decades. However, a recent change in this technique—the development of a specific fracturing or “fracking” practice called slickwater or slickwater fracturing—has turned the world of petroleum extraction on its head, opening up massive new deposits of oil and gas in the United States and around the world. This article uses the United States as a case study of the benefits and risks of fracturing and the legal frameworks that apply to this practice, exploring how the legal approach has been largely piecemeal and reactive. US states have been the primary regulatory bodies responsible for controlling risks, and their regulations vary substantially. The federal government also has regulated in limited areas, however—again in a largely reactive and patchwork manner.
Employment and Vocation Programs in Prison
Authors: Smith Paula , Mueller Lindsey M. , Labrecque Ryan M.
Published: April 2017

Historically, work has played an important role in managing correctional populations and providing a means to reduce prisoner idleness. As correctional ideologies have shifted over time, the concept of working while incarcerated has taken on more of a rehabilitative approach. Several policies and correctional initiatives have been developed to integrate prison industry and employment services into correctional systems in an effort to address the poor employment histories and low job-related skills of offenders. Evaluations of these programs demonstrate that participation in prison industry and employment services can increase job prospects and lower the chances of recidivism. The effectiveness of prison-based employment programs vary, however, and is dependent upon the key components incorporated into their design. Despite the differences between programs, employment services offered in prison seem to be an effective approach to addressing employment deficits among offenders.
Dual-Force Vaginoplasty for Treatment of Segmental Vaginal Aplasia
Authors: El Saman Ali M. , Farag Mohamad A. , Shazly Sherif A. , Noor Mohamed , Ali Mohammed K. , Othman Essam R. , Khalifa Mansour , Farghly Tarek A. , El Saman Dina A.
Published: April 2017

BACKGROUND:

Vaginal aplasia occurs in 1 in 5,000–10,000 female live births. In this report, we evaluated a novel dual-force vaginoplasty technique for treatment of 11 patients with segmental vaginal aplasia.

TECHNIQUE:

The principle of the approach is to thin the atretic part between two counteracting forces. The instrument was inserted laparoscopically into the proximal hematocolpos. Two balloon catheters, one for drainage and one for traction, were threaded over the inserter. The traction catheter was then threaded over a silicon tube, leaving the balloon in the proximal portion of the vagina and connecting across the vaginal septum to a fenestrated Teflon olive, which was positioned against the distal surface of the vaginal septum. This created a dual “pushing and pulling” force across the septum, which, over 3–4 days, pulls the upper vaginal pouch down while the vaginal dimple is pushed up. The aplastic segment becomes thin and easy to dilate and permits achievement of vaginal patency. The drainage of the hematocolpos is predominantly through the balloon catheter so postoperative wound management is facilitated.

EXPERIENCE:

Eleven menarchal girls were diagnosed with segmental vaginal aplasia. The dual-force vaginoplasty was performed on each and was tolerated well with no operative complications. They all reported establishment of the menstrual cycle and significant improvement of pain during follow-up.

CONCLUSION:

Creation of a dual pushing–pulling force on the atretic vaginal segment is a feasible short procedure for management of segmental vaginal aplasia.
State Medicaid Coverage of Medically Necessary Abortions and Severe Maternal Morbidity and Maternal Mortality
Authors: Jarlenski Marian , Hutcheon Jennifer A. , Bodnar Lisa M. , Simhan Hyagriv N.
Published: April 2017

OBJECTIVE:

To estimate the association between state Medicaid coverage of medically necessary abortion and severe maternal morbidity and in-hospital maternal mortality in the United States.

METHODS:

We used data on pregnancy-related hospitalizations from the Nationwide Inpatient Sample from 2000 to 2011 (weighted n=38,016,845). State-level Medicaid coverage of medically necessary abortion for each year was determined from Guttmacher Institute reports. We used multivariable logistic regression to examine the association between state Medicaid coverage of abortion and severe maternal morbidity and in-hospital maternal mortality, overall and stratified by payer.

RESULTS:

The unadjusted rate of severe maternal morbidity was lower among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion relative to those in states without such coverage (62.4 compared with 69.3 per 10,000). Among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, there were 8.5 per 10,000 fewer cases (95% confidence interval [CI] 4.0–16.5) of severe maternal morbidity in adjusted analyses relative to those in states without such Medicaid coverage. Similarly, there were 10.3 per 10,000 fewer cases (95% CI 3.5–17.2) of severe maternal morbidity in adjusted analyses among private insurance–paid hospitalizations in states with Medicaid coverage of medically necessary abortion relative to those in states without such Medicaid coverage. The adjusted rate of in-hospital maternal mortality was not different for Medicaid-paid hospitalizations in states with and without Medicaid coverage of medically necessary abortion (9.2 and 9.0 per 100,000, respectively) nor for private insurance–paid hospitalizations (5.6 and 6.1 per 100,000, respectively).

CONCLUSION:

State Medicaid coverage of medically necessary abortion was associated with an average 16% decreased risk of severe maternal morbidity. An association between state Medicaid coverage of medically necessary abortion and a reduced risk of severe maternal morbidity was observed in women covered by both Medicaid and private insurance. Results suggest that Medicaid coverage of medically necessary abortion is not harmful to maternal health.
Outcomes of Twin Pregnancies in Women 45 Years of Age or Older
Authors: Gerber Rachel S. , Fields Jessica C. , Barberio Andrea L. , Bodenlos Kimberly , Fox Nathan S.
Published: April 2017

OBJECTIVE:

To investigate outcomes of twin gestations in women 45 years or older at the time of delivery.

METHODS:

This was a retrospective cohort study of 139 women with twin gestations who were at least 45 years old when they delivered. They were cared for at two referral centers between 2005 and 2016. Analysis included baseline characteristics and pregnancy outcomes including mode of delivery, gestational age at delivery, hypertensive disease in pregnancy, gestational diabetes, and fetal growth restriction. Univariate analysis of the association between patient characteristics and outcomes was performed.

RESULTS:

The mean maternal age at delivery was 47.3±1.9 years with 99.3% undergoing in vitro fertilization and 95% using donor eggs. Patients had low baseline rates of hypertension (7.2%), obesity (9.5%), and pregestational diabetes (1.4%). The average gestational age of delivery was 35.4 weeks; 22.3% delivered before 34 weeks of gestation. There were high rates of cesarean delivery (93.5%, 95% confidence interval [CI] 87.7–96.8%), preeclampsia (44.6%, 95% CI 36.3–53.3%), and gestational diabetes (19%, 95% CI 13.0–26.8%). Preeclampsia developed in 50.5% of nulliparous women compared with 30.5% of women with a prior birth (P=.028). Preterm birth at less than 34 weeks of gestation occurred in 18.1% of women of white race compared with 30.3% of women of nonwhite race (P=.036).

CONCLUSION:

Twin pregnancy in a predominantly healthy cohort of women who were at least 45 years old when they delivered was associated with high rates of cesarean delivery, preeclampsia, and gestational diabetes, but overall favorable outcomes.
The Maternal Quality Improvement Program
Authors: Butler Timberly , Hasley Steve , Currigan Sean M. , Levy Barbara S.
Published: April 2017

Advancing the quality and safety of maternity care should be data-driven. Defining a standard set of clinical data elements, across electronic health record platforms and facilities, could accelerate performance measurement, benchmarking, and identification of better practices. In 2014, the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists launched the Maternal Quality Improvement Program, a data-driven national clinical registry for maternity care. Having an agreed-on set of discrete data elements related to labor and delivery will set the stage for analysis of this care. Through the use of clinical performance measures and data quality metrics, the Maternal Quality Improvement Program will provide an opportunity for health care providers to better understand the overall quality and safety of the maternity care provided within their institution.
Timing of Systemic Chemotherapy in Patients With Colorectal Peritoneal Carcinomatosis Treated With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Authors: van Eden Wijntje J. , Kok Niels F. , Jóźwiak Katarzyna , Lahaye Max L. , Beets Geerard L. , van Leerdam Monique E. , Boot Henk , Aalbers Arend G.
Published: April 2017

BACKGROUND:

Timing of systemic chemotherapy in patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is controversial. Preoperative systemic chemotherapy may offer benefits.

OBJECTIVE:

The purpose of this study was to evaluate the effect of timing of systemic chemotherapy on survival.

DESIGN:

This was a retrospective cohort study.

SETTINGS:

The study was conducted at a tertiary referral center.

PATIENTS:

Patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy from January 2004 until June 2015 were included.

MAIN OUTCOME MEASURES:

The influence of patient-related, tumor-related, and treatment-related factors on survival were investigated using Cox regression models. Main outcome was overall survival.

RESULTS:

A total of 280 consecutive patients underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. In group A, 78 patients (28%) were treated with preoperative or perioperative chemotherapy, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy. In group B, 169 patients (60%) were intentionally treated with cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, and adjuvant chemotherapy. In group C, 33 patients (12%) had received their chemotherapy before peritoneal carcinomatosis was diagnosed. Median overall survival was 36.9 months (interquartile range, 20.6–79.7 mo) in group A, 43.1 months (interquartile range, 25.7–95.9 mo) in group B, and 34.0 months (interquartile range, 20.0–53.7 mo) in group C (p = 0.19). The extent of peritoneal carcinomatosis (region count of 3–5, HR = 1.58 (95% CI, 1.02–2.45), and 6–7, HR = 3.34 (95% CI, 1.66–6.72) vs 1–2 regions), a higher lymph node ratio (HR = 7.96 (95% CI, 2.16–29.31)), and cycles of systemic chemotherapy (0 cycles, HR = 2.52 (95% CI, 1.48–4.29)) and partial chemotherapy (HR = 2.15 (95% CI, 1.27–3.65) vs complete chemotherapy) were associated with poorer overall survival.

LIMITATIONS:

Selection bias is present because of the retrospective design of this study.

CONCLUSIONS:

Timing of systemic chemotherapy does not appear to have impact on survival in patients with colorectal peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Efficacy of 3-Dimensional Endorectal Ultrasound for Staging Early Extraperitoneal Rectal Neoplasms
Authors: Pinto Rodrigo Ambar , Corrêa Neto Isaac José Felippe , Nahas Sérgio Carlos , Rizkalah Nahas Caio Sérgio , Sparapan Marques Carlos Frederico , Ribeiro Junior Ulysses , Kawaguti Fábio Shiguehissa , Cecconello Ivan
Published: April 2017

BACKGROUND:

Adequate oncologic staging of rectal neoplasia is important for treatment and prognostic evaluation of the disease. Diagnostic methods such as endorectal ultrasound can assess rectal wall invasion and lymph node involvement.

OBJECTIVE:

The purpose of this study was to correlate findings of 3-dimensional endorectal ultrasound and pathologic diagnosis of extraperitoneal rectal tumors with regard to depth of rectal wall invasion, lymph node involvement, percentage of rectal circumference involvement, and tumor extension.

DESIGN:

Consecutive patients with extraperitoneal rectal tumors were prospectively assessed by 3-dimensional endorectal ultrasound blind to other staging methods and pathologic diagnosis.

PATIENTS:

Patients who underwent endorectal ultrasound followed by surgery were included in the study.

SETTINGS:

The study was conducted at a single academic institution.

MAIN OUTCOME MEASURES:

Sensitivity, specificity, positive and negative predictive values, area under curve, and κ coefficient between 3-dimensional endorectal ultrasound and pathologic diagnosis were determined. Intraclass correlation coefficient was calculated for tumor extension and percentage of rectal wall involvement.

RESULTS:

Forty-four patients (27 women; mean age = 63.5 years) were evaluated between September 2010 and June 2014. Most lesions were malignant (72.7%). For depth of submucosal invasion, 3-dimensional endorectal ultrasound showed sensitivity of 77.3%, specificity of 86.4%, positive predictive value of 85.0%, a negative predictive value of 79.2%, and an area under curve of 0.82. The weighted κ coefficient for depth of rectal wall invasion staging was 0.67, and there was no agreement between 3-dimensional endorectal ultrasound and pathologic diagnosis for lymph node involvement (κ = –0.164). Intraclass correlation coefficient for lesion extension and percentage of rectal circumference involvement were 0.45 and 0.66. A better correlation between 3-dimensional endorectal ultrasound and pathologic diagnosis was observed in tumors <5 cm and with <50% of rectal wall involvement.

LIMITATIONS:

The relatively small sample size of patients with early rectal lesions referred directly for surgery could represent a potential selection bias.

CONCLUSIONS:

Three-dimensional endorectal ultrasound was effective for determining rectal wall invasion and lesion extension in tumors <5 cm and with <50% of rectal wall invasion but was limited for detecting lymph node involvement in early rectal lesions.
Long-term Outcomes After Continent Ileostomy Creation in Patients With Crohn’s Disease
Authors: Aytac Erman , Dietz David W. , Ashburn Jean , Remzi Feza H.
Published: April 2017

BACKGROUND:

Patients with Crohn’s disease have a higher failure rate after ileal pouch surgery compared with their counterparts with ulcerative colitis.

OBJECTIVE:

We hypothesized that risk of continent ileostomy failure can be stratified based on the timing of Crohn’s disease diagnosis and aimed to assess long-term outcomes.

DESIGN:

This was a retrospective cohort study.

SETTINGS:

The investigation took place in a high-volume, specialized colorectal surgery department.

PATIENTS:

Patients with Crohn’s disease who underwent continent ileostomy surgery between 1978 and 2013 were evaluated.

MAIN OUTCOME MEASURES:

Functional outcomes, postoperative complications, requirement of revision surgery, and continent ileostomy failure were analyzed.

RESULTS:

There were 48 patients (14 male patients) with a median age of 33 years at the time of continent ileostomy creation. Crohn’s disease diagnosis was before continent ileostomy (intentional) in 15 or made in a delayed fashion at a median 4 years after continent ileostomy in 33 patients. Median follow-up was 19 years (range, 1–33 y) after index continent ileostomy creation. Major and minor revisions were performed in 40 (83%) and 13 patients (27%). Complications were fistula (n = 20), pouchitis (n = 16), valve slippage (n = 15), hernia (n = 9), afferent limb stricture (n = 9), difficult intubation (n = 8), incontinence (n = 7), bowel obstruction (n = 7), valve stricture (n = 5), leakage (n = 4), bleeding (n = 3), and valve prolapse (n = 3). Median Cleveland global quality-of-life score was 0.8. Continent ileostomy failure occurred in 22 patients (46%). Based on Kaplan–Meier estimates, continent ileostomy survival was 48 % (95% CI, 33%–63%) at 20 years. Continent ileostomy failure was similar regardless of timing of diagnosis of Crohn’s disease (p = 0.533).

LIMITATIONS:

This study was limited by its retrospective and nonrandomized nature.

CONCLUSIONS:

Outcomes of continent ileostomy in patients with Crohn’s disease are poor, regardless of the timing of diagnosis. Very careful consideration should be given by both the surgeon and the patient before undertaking this procedure in patients with Crohn’s disease. See Video Abstract at http://links.lww.com/DCR/A327.
Time Window Is Important for Adenosine Preventing Cold-induced Injury to the Endothelium
Authors: Li Yan , Hu Xiao-Xia , Fu Li , Chen Jing , Lu Li-he , Liu Xiang , Xu Zhe , Zhou Li , Wang Zhi-Ping , Zhang Xi , Ou Zhi-Jun , Ou Jing-Song
Published: April 2017

Cold cardioplegia is used to induce heart arrest during cardiac surgery. However, endothelial function may be compromised after this procedure. Accordingly, interventions such as adenosine, that mimic the effects of preconditioning, may minimize endothelial injury. Herein, we investigated whether adenosine prevents cold-induced injury to the endothelium. Cultured human cardiac microvascular endothelial cells were treated with adenosine for different durations. Phosphorylation and expression of endothelial nitric oxide synthase (eNOS), p38MAPK, ERK1/2, and p70S6K6 were measured along with nitric oxide (NO) production using diaminofluorescein-2 diacetate (DAF-2DA) probe. Cold-induced injury by hypothermia to 4°C for 45 minutes to mimic conditions of cold cardioplegia during open heart surgery was induced in human cardiac microvascular endothelial cells. Under basal conditions, adenosine stimulated NO production, eNOS phosphorylation at serine 1177 from 5 minutes to 4 hours and inhibited eNOS phosphorylation at threonine 495 from 5 minutes to 6 hours, but increased phosphorylation of ERK1/2, p38MAPK, and p70S6K only after exposure for 5 minutes. Cold-induced injury inhibited NO production and the phosphorylation of the different enzymes. Importantly, adenosine prevented these effects of hypothermic injury. Our data demonstrated that adenosine prevents hypothermic injury to the endothelium by activating ERK1/2, eNOS, p70S6K, and p38MAPK signaling pathways at early time points. These findings also indicated that 5 minutes after administration of adenosine or release of adenosine is an important time window for cardioprotection during cardiac surgery.
Therapeutic Drug Monitoring in Children and Adolescents Under Pharmacotherapy With Olanzapine in Daily Clinical Practice
Authors: Fekete Stefanie , Wewetzer Christoph , Mehler-Wex Claudia , Holtkamp Kristian , Burger Rainer , Reichert Susanne , Taurines Regina , Romanos Marcel , Gerlach Manfred , Egberts Karin
Published: April 2017

Background:

The relationship between daily dose, serum concentrations, and clinical outcomes of olanzapine as well as the influencing factors thereof in children and adolescents treated for different psychiatric disorders were investigated in daily clinical practice. In addition, it was examined whether the current recommended therapeutic range (TR) for adult patients with psychotic disorders is valid for minors.

Methods:

The Competence Network for Therapeutic Drug Monitoring (www.tdm-kjp.com) routinely collects demographic and clinical outcome data as well as serum concentrations of children and adolescents treated with psychotropics. The therapeutic effect is documented using the Clinical Global Impression Scale subscale for Global Improvement. Adverse drug reactions (ADRs) are assessed using the Udvalg for Kliniske Undersogelser–Side Effect Rating Scale.

Results:

One hundred fifteen patients (mean age = 15.9 years; range = 10.4–18.8 years; 40.9% male) were included. The majority (72.1%) was cotreated with other psychotropic drugs. A positive medium linear relationship (r = 0.619; P < 0.001) between olanzapine dose (mean = 11.64 mg/d) and serum concentration (mean = 35.65 ng/mL) was found with a marked interindividual variability of serum concentrations. Neither relationship between olanzapine serum concentration and treatment response (clinical benefit documented in 80%) nor ADRs (documented in 53.3%, in 7.5% judged as severe) was detected. Most of the patients with psychotic and eating disorders (68.8% and 71.8%, respectively) had an olanzapine serum concentration within the TR suggested for adults.

Conclusions:

There are several limitations of this study because of the naturalistic design, and our results should therefore be interpreted with caution. As most of the patients showed a clinical benefit under olanzapine concentrations within the TR for adults and only a minority had severe ADRs, it is reasonable to conclude a similar TR for children, adolescents, and adults.
Clinical Profiles of Respiratory Syncytial Virus Subtypes A AND B Among Children Hospitalized with Bronchiolitis
Authors: Laham Federico R. , Mansbach Jonathan M. , Piedra Pedro A. , Hasegawa Kohei , Sullivan Ashley F. , Espinola Janice A. , Camargo Carlos A.
Published: April 2017

In this analysis of a prospective, multicenter study of children hospitalized with bronchiolitis, 925 had respiratory syncytial virus (RSV)-A and 649 had RSV-B. Overall, bronchiolitis severity did not differ by RSV subtype. However, among children with RSV-only bronchiolitis, those children with RSV-A had higher risk of intensive care treatment (odds ratio, 1.31; 95% confidence interval, 1.00–1.71; P = 0.048) when compared with those having RSV-B.
Amantadine for Antipsychotic-Related Weight Gain
Authors: Zheng Wei , Wang Shibin , Ungvari Gabor S. , Ng Chee H. , Yang Xin-Hu , Gu Yu-Hong , Li Ming , Xiang Ying-Qiang , Xiang Yu-Tao
Published: April 2017

Purpose

Weight gain associated with antipsychotics in schizophrenia has been an ongoing concern. This meta-analysis examined the efficacy and safety of amantadine as an adjunctive treatment of weight gain in schizophrenia by systematically searching and analyzing randomized controlled trials (RCTs). RCTs comparing adjunctive amantadine with placebo in adult patients with schizophrenia were included in the meta-analysis.

Methods

Two independent investigators searched the literature and extracted data. Weighted and standardized mean differences (WMDs/SMDs) and risk ratio ± 95% confidence intervals were calculated.

Results

Five RCTs (n = 265) with double-blinded design lasting 8.2 ± 5.9 weeks were included in the analysis. Amantadine outperformed placebo regarding weight reduction with moderate effect size (trials, 3; n = 205; WMD −2.22 kg; P = 0.001, I
2 = 45%). Amantadine also outperformed placebo at endpoint in the negative symptom (the Positive and Negative Syndrome Scale [PANSS] [1 trial] and the Scale for the Assessment of Negative Symptoms [1 trial]) scores (trials, 2; n = 84; SMD, −0.56; P = 0.01, I
2 = 12%), but not in the PANSS total scores (trials, 2) (SMD, −0.31; P = 0.16, I
2 = 0%) and the positive symptom (PANSS [1 trial] and the Scale for the Assessment of Positive Symptoms [1 trial]) scores (SMD, 0.13; P = 0.54, I
2 = 0%). Except for insomnia (P = 0.007; number needed to harm, 6; 95% confidence interval, 4–16), all-cause discontinuation (risk ratio, 1.12; P = 0.54, I
2 = 0%) and other adverse events were similar between the amantadine and placebo groups.

Conclusions

According to this meta-analysis of 5 RCTs, adjunctive amantadine seems to be an effective option for attenuating antipsychotic-related weight gain in patients with schizophrenia. More RCTs are needed to inform clinical recommendations.
Emerging Therapies for Sensorineural Hearing Loss
Authors: Crowson Matthew Gordon , Hertzano Ronna , Tucci Debara L.
Published: April 2017

Objective:

To critically review and evaluate the proposed mechanisms and documented results of the therapeutics currently in active clinical drug trials for the treatment of sensorineural hearing loss.

Data Sources:

US National Institutes of Health (NIH) Clinical Trials registry, MEDLINE/PubMed.

Study Selection & Data Extraction:

A review of the NIH Clinical Trials registry identified candidate hearing loss therapies, and supporting publications were acquired from MEDLINE/PubMed. Proof-of-concept, therapeutic mechanisms, and clinical outcomes were critically appraised.

Data Synthesis:

Twenty-two active clinical drug trials registered in the United States were identified, and six potentially therapeutic molecules were reviewed. Of the six molecules reviewed, four comprised mechanisms pertaining to mitigating oxidative stress pathways that presumably lead to inner ear cell death. One remaining therapy sought to manipulate the cell death cascade, and the last remaining therapy was a novel cell replacement therapy approach to introduce a transcription factor that promotes hair cell regeneration.

Conclusion:

A common theme in recent clinical trials registered in the United States appears to be the targeting of cell death pathways and influence of oxidant stressors on cochlear sensory neuroepithelium. In addition, a virus-delivered cell replacement therapy would be the first of its kind should it prove safe and efficacious. Significant challenges for bringing these bench-to-bedside therapies to market remain. It is never assured that results in non-human animal models translate to effective therapies in the setting of human biology. Moreover, as additional processes are described in association with hearing loss, such as an immune response and loss of synaptic contacts, additional pathways for targeting become available.
LDL particle number and size and cardiovascular risk: anything new under the sun?
Authors: Allaire Janie , Vors Cécile , Couture Patrick , Lamarche Benoît
Published: April 2017

Purpose of review

We provide here an up-to-date perspective on the potential use of LDL particle number and size as complementary risk factors to predict and manage cardiovascular disease (CVD) risk in the clinical realm.

Recent findings

Studies show that a significant proportion of the population has discordant LDL particle number and cholesterol indices [non-HDL cholesterol (HDL-C)]. Data also show that risk prediction may be improved when using information on LDL particle number in patients with discordant particle number and cholesterol data. Yet, most of the current CVD guidelines conclude that LDL particle number is not superior to cholesterol indices, including non-HDL-C concentrations, in predicting CVD risk. LDL particle size, on the other hand, has not been independently associated with CVD risk after adjustment for other risk factors such as LDL cholesterol, triglycerides, and HDL-C and that routine use of information pertaining to particle size to determine and manage patients’ risk is not yet justified.

Additional studies are required to settle the debate on which of cholesterol indices and LDL particle number is the best predictor of CVD risk, and if such measures should be integrated in clinical practice.
Quality Improvement in Clinical Nutrition
Authors: Yordy Beverly Morgan , Roberts Sarah , Taggart Helen M.
Published: April 2017

Purpose:

The purpose of the quality improvement project was to (1) enhance awareness, accuracy, and use of the validated nutrition screening tool by the nurse and (2) improve compliance to the nutrition care plan that included increasing patient meal intake percentage.

Description of the Project:

Nurses were provided with an in-depth educational program focused on the implementation of the nutrition screening tool on patient admission to the clinical site. Second, a unit-level patient protected mealtime program was implemented in an effort to decrease unnecessary mealtime interruptions and promote nurses and nursing assistants to assist with meals during mealtime to improve patient meal intake percentage and, finally, to encourage collaboration between the clinical nurse specialist, unit level nurses, and registered dietitians to improve patient nutritional care.

Outcome:

The results indicate that the quality improvement strategies were successful in promoting the patient protected mealtime program and use of the nutrition screening tool.

Conclusions:

The clinical nurse specialist plays a valuable role in program development, implementation, and evaluation to achieve quality healthcare through interdisciplinary collaboration. Adhering to nutrition guidelines for the hospitalized adult patient improves nutrition care plan guidance and meal intake.
Mouse embryonic stem cells can differentiate via multiple paths to the same state
Authors: Briggs James A. , Li Victor C. , Lee Seungkyu , Woolf Clifford J. , Klein Allon M. , Kirschner Marc W.
Published: April 2017

In embryonic development, cells must differentiate through stereotypical sequences of intermediate states to generate mature states of a particular fate. By contrast, direct programming can generate similar fates through alternative routes, by directly expressing terminal transcription factors. Yet the cell state transitions defining these new routes are unclear. We applied single-cell RNA sequencing to compare two mouse motor neuron differentiation protocols: a standard protocol approximating the embryonic lineage, and a direct programming method. Both undergo similar early neural commitment. Then, rather than transitioning through spinal intermediates like the standard protocol, the direct programming path diverges into a novel transitional state. This state has specific and abnormal gene expression. It opens a ‘loop’ or ‘worm hole’ in gene expression that converges separately onto the final motor neuron state of the standard path. Despite their different developmental histories, motor neurons from both protocols structurally, functionally, and transcriptionally resemble motor neurons from embryos.
Using local family farm products for school feeding programmes: effect on school menus
Authors: Soares Panmela , Martinelli Suellen Secchi , Melgarejo Leonardo , Cavalli Suzi Barletto , Davó-Blanes Mari Carmen
Published: April 2017

Purpose

The purpose of this paper is to explore the effect of the use of food products from family farms on school menus of the school feeding program (SFP) of a municipality in Southern Brazil.

Design/methodology/approach

A qualitative content analysis was carried out of 16 key informant interviews involved in the SFP, or in agriculture production related to SFP planning, development and supply. The resulting categories were used to construct a quantitative analysis protocol for school menus for three years both prior to and after (n=130 days) procurement of the SFP with food from family farms. The studied variables were the presence (yes/no) of vegetables, fruits, legumes and concentrated foods. Monthly frequency and contrast of proportions were calculated for each variable during the years studied.

Findings

The interviewees recognized that the proximity between food production and the school increased the variety of fresh, natural and organic foods in school menus. The direct supply of the SFP with foods from local family farms resulted in a significant increase (p<0.05) in the frequency of vegetables, fruits and legumes in school menus as well as a progressive reduction in concentrated foods.

Originality/value

The design of food and agriculture policy increases the availability of healthy foods in school menus and has beneficial results for promoting healthy meals in schools.