bluuebunny/crossref_metadata_2025 huggingface dataset:
The “Dorset Problem” Revisited
Authors: Ryan Karen
Published: September 2016

The origins and development of Dorset culture, recognized in 1925 by Diamond Jenness, remain poorly understood despite decades of research. This chapter considers how Dorset was initially defined, before highlighting the three competing theories proposed to explain the transition from Pre-Dorset to Dorset: the first arguing for widespread continuity and gradual change from Pre-Dorset into Dorset throughout the Eastern Arctic; the second contending that large-scale population discontinuities occurred as regional Pre-Dorset groups were replaced by a single expanding “Core Area” Dorset populace; with the third envisioning a more complex demographic history involving local developments and multiple minicore areas. Following this, the traits most frequently used to distinguish Early and Middle Dorset are summarized before the ramifications of new analyses on the perceived culture-historical position of Early and Middle Dorset are discussed.
Pan-Arctic Population Movements
Authors: Friesen Max
Published: September 2016

This chapter provides description and interpretation of the two major, well-documented episodes of Arctic-wide migrations. The Paleo-Inuit (also called Paleoeskimo or Arctic Small Tool tradition) migration began around 3,200 B.C., with penetration of the central Arctic by highly mobile, small-scale hunter-gatherer groups. By around 2,500 B.C., the entire eastern Arctic had been peopled by cultures known as Pre-Dorset, Saqqaq, and Independence I. The Thule Inuit migration began around A.D. 1200, when complex maritime-oriented groups from the western Arctic initiated an extremely rapid population movement, spanning the North American Arctic within a generation. The chapter considers the timing and nature of each migration episode, as well as the motivating factors which have been proposed for them, including climate change, social or economic hardship, and acquisition of specific resources such as bowhead whales or metal.
Classic Thule [Classic Precontact Inuit]
Authors: Whitridge Peter
Published: September 2016

During the thirteenth to fifteenth centuries A.D., the ancestors of modern Inuit settled into the Eastern Arctic, building durable regional economies that were integrated through a far-flung trading network. Although cultural and economic diversity increased over time, a hallmark of this period was bowhead whaling, which supplied a significant proportion of the food, fuel, and raw materials consumed in many areas, and shaped social and political life by virtue of the importance of boat-crew-based organization. A western Arctic flavor to this pattern is reflected in the ubiquity of a combined dance house–men’s house and associated shared-mound house group, both of which decline or undergo substantial transformation during later precontact times, after a collapse of whaling coincident with the onset of the Little Ice Age.
Development of Polar Inughuit Culture in the Smith Sound Region
Authors: LeMoine Genevieve , Darwent Christyann
Published: September 2016

The Inughuit of northwestern Greenland are the most northerly indigenous people in the world. They have long been of interest to scholars and the general public due to their evident isolation when first contacted by Europeans in 1818, their loss of key hunting technologies such as kayaks and bows and arrows before contact, their extensive use of meteoric iron, and their important role in exploration of the far north. This chapter summarizes the archaeological record from the thirteenth century, when Thule migrants first arrived in the region, through the historic period. The key period of emerging Inughuit culture, between the sixteenth and nineteenth centuries, has left few archaeological remains. Work by the Inglefield Land Archaeology Project and studies in ethnohistory and paleoclimatology suggest that many factors, including epidemics and environmental changes associated with the Little Ice Age, led to the distinctive Inughuit culture described by explorers in the nineteenth century.
The Thule-Inuit Succession in the Central Arctic
Authors: Dawson Peter
Published: September 2016

The development of Inuit culture out of an ancestral Thule culture base has been a central research question in Arctic archaeology for over a century. Archaeologists were intrigued by the fact that the Inuit lifeways of the ethnographic present, while highly variable, had seemingly developed from a relatively uniform Thule cultural base. However, the past few decades have seen relatively little research directed toward this important issue. This chapter explores the history of research into the origins of Central Arctic Inuit cultures, as well as some of the explanations that have been advanced. It ends by suggesting that Resilience Theory may be a useful theoretical approach for framing the Thule-Inuit transformation in this region.
The Precontact History of Subarctic Northwest Canada
Authors: MacKay Glen , Andrews Thomas D.
Published: September 2016

This chapter provides an overview of precontact hunter-gatherer land use in the Subarctic region of northwest Canada. The earliest evidence of human presence in this region is found in the unglaciated areas of Yukon Territory at Bluefish Caves and the Little John Site. The role of an ice-free corridor in the Mackenzie Valley in the dispersal of early peoples remains unclear. Caribou-hunting strategies are used as a theme to explore regional histories between 7,000 B.P. and the beginning of the historic period. Migratory tundra caribou were a focal resource for many hunter-gatherer societies in this region. The emerging archaeological record of alpine ice patches provides a unique view of hunter-gatherer land use in alpine regions. The archaeological record of the Mackenzie Valley is one of the poorest known in all of North America. Throughout, the chapter highlights the strengths and weaknesses of the Subarctic archaeological record for interpreting precontact land use.
Reconstructing Middle and Late Holocene Paleoclimates of the Eastern Arctic and Greenland
Authors: Finkelstein Sarah
Published: September 2016

The eastern Arctic and Greenland are characterized by diverse paleoclimatic histories. A range of biological, geochemical, and geophysical indicators preserved in ice cores, lake, and ocean sediments, landscape features, or boreholes can be applied to reconstructing Holocene climates over the period of human occupation. Soon after humans arrived in the eastern Arctic around 4800 cal B.P., regional temperatures began to decline. While the proxy records show a strong regional signal, this period of Neoglacial cooling has considerable local variability related to degree of continentality, sea ice conditions and elevation. Much later, the effect of the Medieval Warm Period (AD 850-1360) on the Thule migration appears to have been overstated. Because of the considerable spatiotemporal variability in available paleoclimate reconstructions from the eastern Arctic, data from multiple sites must be integrated, and for archaeological applications, regional syntheses need to be considered alongside highly local reconstructions.
Protect, Correct, and Eject
Authors: Hales Andrew H. , Ren Dongning , Williams Kipling D.
Published: September 2016

Ostracism—ignoring and excluding—is an evolutionarily adaptive response that protects groups from burdensome members either by correcting the misbehavior while promoting sameness and civility, or, if correction is not achieved, then ejecting the member, resulting again in a homogeneous, albeit smaller, group. Over 20 years of research demonstrates that ostracism is a powerful tool of social influence. Being the target of ostracism activates brain regions associated with pain, threatens fundamental needs, worsens mood, and causes behavior changes aimed at fortifying threatened needs. We review research showing three functions of ostracism: (1) to protect—shielding groups from threatening members; (2) to correct—signaling to individuals that their behavior needs modification to remain in the group; and (3) to eject—permanently removing deviant individuals who resist correction. Although ostracism is a powerful and effective social influence tool, it can cause unintended and potentially dangerous consequences for those who employ it.
Compliance
Authors: Guadagno Rosanna E.
Published: September 2016

This chapter reviews the literature on compliance, a type of social influence that occurs when a person changes their behavior in response to a direct request. Specifically, I review research on compliance organized by the six classic principles of social influence (Cialdini, 2009)—reciprocity, commitment and consistency, authority, social validation or social proof, and liking and similarity, and examine how they are used to change peoples’ behaviors. Furthermore, this chapter reviews the mechanisms that underlie these principles, particularly mindlessness. Finally, this chapter concludes by examining whether this framework for understanding compliance applies to the new realm of social influence—social media—and calls for more research on the effectiveness of the principles of influence when the mode of interpersonal interaction is software based rather than in person.
Social Facilitation
Authors: Seitchik Allison E. , Brown Adam J. , Harkins Stephen G.
Published: September 2016

Research conducted for more than a century has shown that the presence of others improves performance on simple tasks and debilitates it on complex tasks, whether these others are audience members or coactors. In this chapter, we review theories offered to account for how two features of these others, their mere presence and/or the potential for evaluation they represent, produce these effects, and we conclude that we are no closer now to isolating the relevant process(es) than we were 100 years ago. We then consider the molecular task analysis proposed by Harkins (2006) as an approach to attacking this problem, followed by a review of the work supporting the mere effort account suggested by this analysis. Finally, we place the mere effort account in the larger context represented by the Threat-Induced Potentiation of Prepotent Responses model, which aims to account for the effect of threat on task performance.
Regional Organizations in the Middle East
Authors: Pinfari Marco
Published: September 2016

This article introduces and reviews critically the main regional and subregional institutions currently operating in the Middle East. After presenting some analytical perspectives that shed light on the weakness of regional institutions in the Middle East, it presents the main institutional features of six regional, subregional, or “hybrid” organizations (including the Arab League, the Gulf Cooperation Council, and the Euro-Mediterranean cooperation framework) before turning to explore their activities from four critical angles, focusing on their effectiveness, their role, the impact of interregional institutional overlap and of regime types. It concludes with an assessment of how the so-called Arab Uprisings have affected the institutional architecture of the region.
Three-Dimensionalism
Authors: Donnelly Maureen
Published: September 2016

Three-Dimensionalism is a position on how objects persist over time. Three-Dimensionalism is standardly construed as the claim that objects persist by being “wholly present” at each moment of their careers and is typically endorsed in opposition to the standard four-dimensionalist claim that objects extend through time by having temporal parts at each moment of their careers. This article reviews and highlights serious shortcomings of various proposals for filling out the three-dimensionalist account of persistence through claims about persisting objects’ parts or locations. This article suggests that Three-Dimensionalism is best understood as a position on the grounds for facts about objects’ presence over time.
News, Biography, and Eighteenth-Century Celebrity
Authors: Cowan Brian
Published: September 2016

Celebrity was not invented in the eighteenth century, but it was transformed by the new publics, and the new media that emerged to cultivate and maintain these publics, from the mid-seventeenth until the later eighteenth centuries. Celebrity is therefore best understood as a certain kind of fame rather than a phase in the history of fame. Contemporaneity, publicity, and personality are key aspects of the kind of fame one may identify as celebrity. This chapter argues that attention to genre in the process of celebrity formation makes it possible to distinguish between regimes of fame as constituted by the media available and the ways in which public personalities were variously constructed. Two genres were particularly influential in shaping the development of the new celebrity of the long eighteenth century: news writing and life writing. The contributions of news and biography to eighteenth-century conceptions of celebrity are explored in detail.
Aristotelian Criticism in Sixteenth-Century England
Authors: Lazarus Micha
Published: September 2016

Aristotle’sPoeticshas been thought to be inaccessible or misunderstood in sixteenth-century England, but this inherited assumption has drifted far from the primary evidence and lagged behind advances in contiguous fields. As a member of thecorpus Aristotelicum, the shared foundation of Western education until the late seventeenth century, thePoeticsenjoyed wide circulation, ownership, and interest in Latin and Italian as well as the original Greek. Placing thePoeticsin its intellectual context suggests a very different narrative for its reception in English criticism, one that accounts for a multiplicity of readings and uses on both sides of the academic divide. Some of those readings—in Cheke, Ascham, Rainolds, Sidney, and others—are considered in this article, and directions are proposed for future research in what remains a rich and mostly unworked vein of literary history.
Trans Ecology and the Transgender Road Narrative
Authors: Seymour Nicole
Published: September 2016

This article identifies a particular subgenre of the road narrative, the transgender road narrative, analyzing the filmTransamericaand the novelNevadaas representative examples. The first part draws on transgender studies scholarship, showing how these texts both depict a long history of trans (im)mobility and engage with the affective geographies of gender transitioning, including the idea of the body as home. The second part draws on ecocriticism and environmental humanities scholarship, comparing howTransamericaandNevadadepict landscapes and environments in relation to trans bodies. This article thus takes this subgenre as an opportunity to explore the intersection of transgender issues and environmental issues and subsequently to develop a new line of inquiry that we might call “trans ecology.” (This article has been commissioned as a supplement toThe Oxford Handbook of Ecocriticism, edited by Greg Garrard.)
The Places of Roman Isis
Authors: Hackworth Petersen Lauren
Published: September 2016

This article examines ancient Rome’s ties to Egypt via the goddess Isis. More specifically, it considers the political meanings of Isis and her place in Roman religion and ritual. It first provides an overview of the connection between Egyptomania and Roman Isis, taking as a point of departure the Temple of Isis in the city of Pompeii. It then explores competing explanations of the significance of Isis in Roman society: one account places Isis in the midst of political maneuverings among the Roman elite, and another presents Isis and things Egyptian as exotic and mysterious. The article also reveals how Isis problematizes scholarly notions of religion in ancient Roman society.
Culture, Psychology, and Social Justice: Toward a More Critical Psychology of Asians and Asian Americans
Authors: Okazaki Sumie
Published: September 2016

Asian Americans and Asians, particularly from East Asian nations, have been central subjects of various cultural psychology and cross-cultural psychology research. Theoretical and empirical work with Asians and Asian Americans have made significant contributions toward moderating the cultural ethnocentrism of American psychology and legitimizing culture as an important consideration in psychology. However, persistent efforts to identify “cultural differences” that rely heavily on the theory of Individualism-Collectivism as an explanatory variable and equating ethnicity and nationality with “culture” have had an inadvertent effect of homogenizing Asians and Asian Americans to the exclusion of important within-group variations and contextual and situational variables. I propose a research agenda for cultural psychological research that would promote goals of social justice for diverse populations.
“Who is Tossing Whom into the Current”?: A Social Justice Perspective on Gender and Well-Being
Authors: Stewart Abigail J. , Zucker Alyssa N.
Published: September 2016

Psychologists tend to focus on individual difference factors when examining why some people flourish and others suffer from physical or psychological health problems. This chapter argues that women’s well-being is profoundly influenced by social structures (policies, laws, cultural practices) that infringe on their human rights. These structures create damaging social conditions, encompassing several forms of discrimination (such as workplace harassment and incivilities, and sexual and self-objectification) that may occur in overt or subtle ways. Such discrimination limits women’s abilities to achieve well-being and positive enjoyment of life (life satisfaction and “eudaemonic well-being”). Women’s gendered experiences of discrimination are shaped by the other social identities they hold (e.g., race, class, sexual orientation), further complicating the discrimination-health relationship. Framing such gendered discrimination as a violation of women’s human rights will help psychologists and policy makers argue that discrimination is a social justice issue and identify practices that eliminate mistreatment at its roots.
A General Model of Harm in Correctional Settings
Authors: Wolff Nancy
Published: September 2016

The literature on inmate “harm” and inmate victimization within prison settings is reviewed with emphasis on the prevalence, predictors, and consequences associated with inmate misconduct, physical victimization, and sexual victimization in prison. The degree of overlap between “offenders” and “victims” is also discussed. The relevance of considering both inmate and facility characteristics for a more comprehensive understanding of both violent and property victimization is underscored. The potential impact of victimization on inmates’ feelings of safety is also covered. Strategies for preventing victimization and their limitations (e.g., protective custody, administrative segregation, disciplinary custody, prison transfers) are reviewed. A dyadic model of harm is developed that draws on routine activities theory and rational choice theory, to more clearly and systematically predict the effects of harm- and victim-propensity attributes of incarcerated people and correctional facilities on levels of harm.
Women in Prison
Authors: Wright Emily M. , Cain Calli M.
Published: September 2016

This essay provides some of the general profiles of female inmates across the United States and how they differ from those for male inmates. The unique problems faced by women in prisons that can interfere with their adaptation to confinement (e.g., pregnancies, recent births, separation from children) are described. How histories of physical and sexual abuse can impact institutional adjustment is also discussed in conjunction with a review of “gender-responsive” programs and why some programs should not be used for both men and women. Possible reasons for the rising incarceration rates of women are also considered. Prison administrators should consider making changes to their policies, management styles, and programming or service provisions in order to better respond to women’s unique needs. The future of gender-responsiveness in corrections will likely entail an expanded recognition of gender-responsive needs and, eventually, the implementation of a wide range of services across all correctional systems.
Reproduction as a Civil Right
Authors: Silvers Anita , Francis Leslie
Published: September 2016

In calling for access to health care needed to achieve reproductive goals, defenders of reproductive freedom typically appeal to rights. Behind these appeals lie important differences about rights: Are they human rights or civil rights? Rights to protection from interference, to legal process, or to some further distribution of resources? This chapter develops a civil rights approach to reproduction. It first explains foundational differences between human rights claims and civil rights claims. The former rest on conceptions of what it is to be human and thus risk rendering rightless those individuals who do not fit the specified idea. The latter ground rights in claims of both typical and atypical individuals to inclusion in given social circumstances. Civil rights claims thus challenge unequal treatment of atypical people’s reproductive functioning, whether the issue is involuntary sterilization, lack of access to reproductive care, or threatened termination of parental rights.
Can Constitutions Limit Government?
Authors: Huemer Michael
Published: September 2016

There are systematic reasons why the U.S. constitution has failed to limit the power of the federal government in the way that it was intended to do. After examining which kinds of constitutional provisions have been respected and which have not, we can devise alternative constitutional provisions that would have a greater chance of successfully limiting the power of government. In particular, (i) there should be supermajority rule for passage of all legislation, (ii) there should be a separate, “negative legislature” with the sole power of repealing laws, and (iii) there should be a separate “constitutional court” with stronger powers for enforcing the constitution than the current Supreme Court.
Democracy and Freedom
Authors: Brennan Jason
Published: September 2016

There seems to be an intimate connection between democracy and freedom. But the nature of this connection is disputed. This chapter outlines possible connections between democracy and freedom. First, it is shown that there is indeed a robust positive correlation between democracy and various forms of liberal freedom. Second, the chapter examines and critiques an argument purporting to show that exercising equal political power in a democracy directly enhances citizens’ autonomy by making them authors of the laws. Third, it examines and critiques the argument that republican democracy is essential to enhancing freedom because it prevents citizens from being dominated. It is argued that we should be skeptical of these latter two positions. Empirically, democratic countries tend to be more free. But there is probably no essential connection between democracy and freedom.
Exploitation and Freedom
Authors: Zwolinski Matt
Published: September 2016

Karl Marx argued that capitalist economies are necessarily exploitative. Nineteenth-century classical liberal political economists agreed that exploitation was rampant, but blamed government grants of privilege rather than capitalism. This chapter argues that while both schools of thought produced genuine insights into exploitation in markets and politics, neither developed a tenable account of what exploitation actually is. Understanding exploitation in terms of the more basic concept of fairness allows us to appreciate when wage labor and government transfers are exploitative, and when they are not. The chapter concludes by arguing that exploitation is probably a permanent feature of a free society because the moral costs of attempting to eliminate it will often prove unacceptable. In particular, it might be impossible to ensure that a government invested with the power to stamp out one form of exploitation does not become a tool for an even more troubling form of exploitation itself.
Prisoners of Misbelief
Authors: Buchanan Allen
Published: September 2016

This chapter explores the epistemic conditions of freedom, arguing that even on a relatively thin conception of freedom, misbelief can make us seriously unfree in several ways. Freedom-undermining false beliefs include (1) beliefs about what one is doing, (2) false beliefs about the circumstances in which one is acting, (3) beliefs about the effective means for achieving one’s ends, (4) beliefs about the range of options open to one, and (5) shared beliefs that impair collective freedom. It follows that anyone who is committed to leading a life of integrity, self-direction, and self-knowledge ought to be much more concerned about the problem of misbelief than people generally and moral theorists typically are. For cognitively flawed but belief-driven creatures like us, who get most of our beliefs second-hand through the "testimony" of others, such concern is mandatory, both morally and prudentially.
Moralized Conceptions of Liberty
Authors: Bader Ralf M.
Published: September 2016

This chapter discusses rights-based conceptions of freedom that distinguish liberty from license. It elucidates how rights-based accounts moralize liberty, identifying two ways in which rights enter into the analysis of freedom: (i) by characterizing the domain of actions that an agent can be free to perform in terms of legitimate courses of action, and (ii) by determining which obstacles classify as constraints on freedom. It distinguishes moralized negative conceptions of liberty from positive conceptions of liberty, characterizing the former as an opportunity concept and the latter as an exercise concept. Thus, moralizing liberty is not tantamount to adopting a positive conception. Finally, it contrasts rights-based conceptions with the moral responsibility view. The latter is not a viable alternative, since the characterization of constraints collapses into a rights-based view, and since liberty must be distinguished from license in order to assign intrinsic normative significance to freedom and defend the presumption of liberty.
Virulence of Genetically Distinct Geosmithia morbida Isolates to Black Walnut and Their Response to Coinoculation with Fusarium solani
Authors: Sitz Rachael A. , Luna Emily K. , Caballero Jorge Ibarra , Tisserat Ned A. , Cranshaw Whitney S. , Stewart Jane E.
Published: September 2016

Geosmithia morbida is well documented as the causal agent of thousand cankers disease of black walnut trees. However, it is not well understood how G. morbida strains differ in virulence and how their interactions with co-occurring pathogens contribute to disease severity. In this study, we systematically investigated virulence of genetically distinct G. morbida strains. Overall, we found varying degrees of virulence, although differences were not related to genetic groupings. Furthermore, the pathogen Fusarium solani is also commonly isolated from thousand canker-diseased trees. The degree of disease contribution from F. solani is unknown, along with interactions it may have with G. morbida. This research shows that coinoculation with these pathogens does not yield a synergistic response.
Acquired and Participatory Competencies in Health Professions Education: Definition and Assessment in Global Health
Authors: Eichbaum Quentin
Published: September 2016

Many health professions education programs in high-income countries (HICs) have adopted a competency-based approach to learning. Although global health programs have followed this trend, defining and assessing competencies has proven problematic, particularly in resource-constrained settings of low- and middle-income countries (LMICs) where HIC students and trainees perform elective work. In part, this is due to programs failing to take sufficient account of local learning, cultural, and health contexts.

A major divide between HIC and LMIC settings is that the learning contexts of HICs are predominantly individualist, whereas those of LMICs are generally collectivist. Individualist cultures view learning as something that the individual acquires independent of context and can possess; collectivist cultures view learning as arising dynamically from specific contexts through group participation.

To bridge the individualist–collectivist learning divide, the author proposes that competencies be classified as either acquired or participatory. Acquired competencies can be transferred across contexts and assessed using traditional psychometric approaches; participatory competencies are linked to contexts and require alternative assessment approaches. The author proposes assessing participatory competencies through the approach of self-directed assessment seeking, which includes multiple members of the health care team as assessors.

The proposed classification of competencies as acquired or participatory may apply across health professions. The author suggests advancing participatory competencies through mental models of sharing. In global health education, the author recommends developing three new competency domains rooted in participatory learning, collectivism, and sharing: resourceful learning; transprofessionalism and transformative learning; and social justice and health equity.
Redesign of the System for Evaluation of Teaching Qualities in Anesthesiology Residency Training (SETQ Smart)
Authors: Lombarts Kiki M. J. M. H. , Ferguson Andrew , Hollmann Markus W. , Malling Bente , Arah Onyebuchi A. ,   SMART Collaborators, Berger M. M. , van Gessel E. , Hoff R. , Houweling P. , Loer S. , Padosch S. A. , Schramm M. J. , Schlack W. S. , Steiner L. A. , Stolker R. J.
Published: September 2016

Background

Given the increasing international recognition of clinical teaching as a competency and regulation of residency training, evaluation of anesthesiology faculty teaching is needed. The System for Evaluating Teaching Qualities (SETQ) Smart questionnaires were developed for assessing teaching performance of faculty in residency training programs in different countries. This study investigated (1) the structure, (2) the psychometric qualities of the new tools, and (3) the number of residents’ evaluations needed per anesthesiology faculty to use the instruments reliably.

Methods

Two SETQ Smart questionnaires—for faculty self-evaluation and for resident evaluation of faculty—were developed. A multicenter survey was conducted among 399 anesthesiology faculty and 430 residents in six countries. Statistical analyses included exploratory factor analysis, reliability analysis using Cronbach α, item-total scale correlations, interscale correlations, comparison of composite scales to global ratings, and generalizability analysis to assess residents’ evaluations needed per faculty.

Results

In total, 240 residents completed 1,622 evaluations of 247 faculty. The SETQ Smart questionnaires revealed six teaching qualities consisting of 25 items. Cronbach α’s were very high (greater than 0.95) for the overall SETQ Smart questionnaires and high (greater than 0.80) for the separate teaching qualities. Interscale correlations were all within the acceptable range of moderate correlation. Overall, questionnaire and scale scores correlated moderately to highly with the global ratings. For reliable feedback to individual faculty, three to five resident evaluations are needed.

Conclusions

The first internationally piloted questionnaires for evaluating individual anesthesiology faculty teaching performance can be reliably, validly, and feasibly used for formative purposes in residency training.
National Partnership for Maternal Safety
Authors: D'Alton Mary E. , Friedman Alexander M. , Smiley Richard M. , Montgomery Douglas M. , Paidas Michael J. , D'Oria Robyn , Frost Jennifer L. , Hameed Afshan B. , Karsnitz Deborah , Levy Barbara S. , Clark Steven L.
Published: September 2016

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.
Fetal Release of Copeptin in Response to Maternal Oxytocin Administration
Authors: Wellmann Sven , Koslowski Andrea , Spanaus Katharina , Zimmermann Roland , Burkhardt Tilo
Published: September 2016

OBJECTIVE:

To test whether an oxytocin challenge test raises neonatal levels of copeptin, the C-terminal portion of proarginine vasopressin, a sensitive stress marker elevated in neonates born by vaginal delivery as opposed to elective cesarean delivery.

METHODS:

In a randomized controlled trial in women with a singleton pregnancy undergoing elective cesarean delivery at greater than 36 weeks of gestation and no contractions or rupture of membranes, we compared arterial umbilical cord plasma concentrations of copeptin between neonates exposed to an oxytocin challenge test before elective cesarean delivery and those administered saline infusion (placebo group). Women randomized to an oxytocin challenge test received 5 international units/500 mL oxytocin Ringer lactate infused at a rate of 12 mL/h and doubled every 10 minutes until it induced three uterine contractions per 10-minute interval, at which point it was discontinued. Neonatal copeptin levels were the primary endpoint. Secondary endpoints included biochemical and physiologic parameters of fetal and maternal well-being.

RESULTS:

From January 2012 to October 2012 and from September 2013 to January 2015, 78 women underwent an oxytocin challenge test and 78 placebo infusion, of whom 12 and 11, respectively, were excluded as a result of insufficient blood sample volume for analysis. Umbilical cord plasma copeptin levels [median (range)] were higher in neonates who underwent an oxytocin challenge test than those who underwent placebo infusion: 22.2 (3.22–2,319) compared with 7.39 (2.5–344.6) pmol/L (P<.001). There were no statistically significant differences between the two groups in secondary outcomes.

CONCLUSION:

Oxytocin challenge test-induced contractions before elective cesarean delivery trigger fetal copeptin release.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, https://clinicaltrials.gov, NCT01962701.
Gynecologic Outcomes After Hysteroscopic and Laparoscopic Sterilization Procedures
Authors: Perkins Rebecca B. , Morgan Jake R. , Awosogba Temitope P. , Ramanadhan Shaalini , Paasche-Orlow Michael K.
Published: September 2016

OBJECTIVE:

To compare rates of gynecologic morbidity after laparoscopic and hysteroscopic sterilization.

METHODS:

This retrospective cohort study used a commercial claims administrative database, 2007–2013, to compare rates of pregnancy, menstrual dysfunction, pelvic pain, hysteroscopic surgery, and intra-abdominal gynecologic surgery after laparoscopic and hysteroscopic sterilization. Women with 12 or more continuous months of data before and after their index procedure were included. Pregnancy rates after laparoscopic and hysteroscopic sterilization were compared for the entire population of women who underwent hysteroscopic sterilization and the subset who had completed postprocedure hysterosalpingograms. Cox proportional hazard models were calculated controlling for age, comorbidities, U.S. geographic region, metropolitan statistical area designation, and insurance type.

RESULTS:

A total of 42,391 women underwent laparoscopic and 27,724 underwent hysteroscopic sterilization. The pregnancy rate was higher after hysteroscopic than laparoscopic sterilization (adjusted hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09–1.33; 2.4% compared with 2.0% risk of pregnancy at 2 years). Only 66.1% (n=18,318) of women who underwent hysteroscopic sterilization received a hysterosalpingogram. This group had similar pregnancy rates as those who underwent laparoscopic sterilization (adjusted HR 0.90, 95% CI 0.80–1.02; 1.8% compared with 2.0% at 2 years). After undergoing hysteroscopic sterilization, more women were diagnosed with menstrual dysfunction (adjusted HR 1.23, 95% CI 1.20–1.27; 26.8% compared with 22.3% at 2 years), and more women underwent hysteroscopic surgeries (adjusted HR 2.05, 95% CI 1.96–2.14; 13.8% compared with 6.4% at 2 years), but fewer women were diagnosed with pelvic pain (adjusted HR 0.83, P<.001; 21.0% compared with 25.6% at 2 years) and fewer women underwent intra-abdominal gynecologic surgeries (adjusted HR 0.95, 95% CI 0.90–0.99; 7.7% compared with 8.1% at 2 years), including hysterectomy (adjusted HR 0.65, 95% CI 0.61–0.69; 10.9% compared with 14.3% at 5 years).

CONCLUSION:

Hysteroscopic sterilization may be associated with a higher rate of pregnancy, more menstrual dysfunction, more hysteroscopic surgeries, less pelvic pain, and fewer intra-abdominal gynecologic surgeries than laparoscopic sterilization. Pregnancy rates appear to be similar for women who completed their postprocedure hysterosalpingogram, but only 66% of women did so.
Active Management of the Third Stage of Labor With a Combination of Oxytocin and Misoprostol to Prevent Postpartum Hemorrhage
Authors: Quibel Thibaud , Ghout Idir , Goffinet François , Salomon Laurent J. , Fort Julie , Javoise Sophie , Bussieres Laurence , Aegerter Philippe , Rozenberg Patrick ,   for the Groupe de Recherche en Obstétrique et Gynécologie (GROG)
Published: September 2016

OBJECTIVE:

To evaluate the effectiveness and safety of misoprostol administered simultaneously with oxytocin as part of the active management of the third stage of labor.

METHODS:

This multicenter, double-blind, randomized, placebo-controlled trial recruited women in the first stage of labor with expected vaginal deliveries at 36–42 weeks of gestation. Exclusion criteria were multiple pregnancies, hypersensitivity to misoprostol, and cesarean delivery. Participants received routine intravenous oxytocin and were randomly allocated to receive 400 micrograms misoprostol or placebo orally immediately after delivery of the newborn. The primary outcome was postpartum hemorrhage (500 mL or greater within 2 hours of birth). Secondary outcomes included severe postpartum hemorrhage (1,000 mL or greater) and adverse maternal events such as fever, shivering, and nausea. Two groups of 1,550 women were required to demonstrate a 33% decrease of postpartum hemorrhage according to a two-tailed α at 0.05 with 80% power. An interim analysis was planned after 50% enrollment.

RESULTS:

Participant enrollment occurred from April 2010 to September 2013. Baseline characteristics were similar in the two groups. The study was discontinued after the planned interim analysis including 1,721 patients showed that misoprostol was not effective and was associated with significantly more adverse effects. The rate of postpartum hemorrhage was 8.4% (68/806) in the misoprostol and 8.3% (66/797) in the placebo group (P=.98), and rates of severe postpartum hemorrhage were 1.8% and 2.4%, respectively (P=.57). Maternal adverse events occurred significantly more frequently in the misoprostol group (for fever 30.4% in the misoprostol group compared with 6.3% in the placebo group, P<.001; for shivering 10.8% in the misoprostol group compared with 0.6% in the placebo group, P<.001).

CONCLUSION:

Misoprostol administered with prophylactic routine oxytocin did not reduce the rate of postpartum hemorrhage risk and increased the rate of adverse events.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, https://clinicaltrials.gov, NCT01113229.
Burch Retropubic Urethropexy Compared With Midurethral Sling With Concurrent Sacrocolpopexy
Authors: Trabuco Emanuel C. , Klingele Christopher J. , Blandon Roberta E. , Occhino John A. , Weaver Amy L. , McGree Michaela E. , Lemens Maureen A. , Gebhart John B.
Published: September 2016

OBJECTIVE:

To compare efficacy and safety of retropubic Burch urethropexy and a midurethral sling in women with stress urinary incontinence (SUI) undergoing concomitant pelvic floor repair with sacrocolpopexy.

METHODS:

Women were randomly assigned to Burch retropubic urethropexy (n=56) or retropubic midurethral sling (n=57) through dynamic allocation balancing age, body mass index, history of prior incontinence surgery, intrinsic sphincter deficiency, preoperative incontinence diagnosis, and prolapse stage. Overall and stress-specific continence primary outcomes were ascertained with validated questionnaires and a blinded cough stress test.

RESULTS:

Enrollment was June 1, 2009, through August 31, 2013. At 6 months, no difference was found in overall (29 midurethral sling [51%] compared with 23 Burch [41%]; P=.30) (odds ratio [OR] 1.49, 95% confidence interval [CI] 0.71–3.13) or stress-specific continence rates (42 midurethral sling [74%] compared with 32 Burch [57%]; P=.06) (OR 2.10, 95% CI 0.95–4.64) between groups. However, the midurethral sling group reported greater satisfaction (78% compared with 57%; P=.04) and were more likely to report successful surgery for SUI (71% compared with 50%; P=.04) and to resolve pre-existing urgency incontinence (72% compared with 41%; P=.03). No difference was found in patient global impression of severity or symptom improvement, complication rates, or mesh exposures.

CONCLUSION:

There was no difference in overall or stress-specific continence rates between midurethral sling and Burch urethropexy groups at 6 months. However, the midurethral sling group reported better patient-centered secondary outcomes.
Distance From Cervicovaginal Junction to Anterior Peritoneal Reflection Measured During Vaginal Hysterectomy
Authors: Balgobin Sunil , Hamid Cherine A. , Carrick Kelley S. , Montoya T. Ignacio , Schaffer Joseph I. , Corton Marlene M.
Published: September 2016

OBJECTIVE:

To quantify the distance of the dissection plane from the cervicovaginal junction to the anterior peritoneal reflection for vaginal hysterectomy.

METHODS:

This is a descriptive study examining the dissection plane for anterior colpotomy in 22 surgical patients undergoing vaginal hysterectomy and in nine cadaver specimens. Intraoperatively, the distance from the vaginal incision to the anterior peritoneal reflection was measured on the uterus after removal. In nine of these patients, this distance was also measured before anterior peritoneal incision. Embalmed cadavers with intact pelvic viscera were dissected and the distance of the same dissection plane was measured.

RESULTS:

Median (interquartile range) surgical patient age was 51.5 (42–63) years and the main surgical indications were abnormal uterine bleeding and pelvic organ prolapse. In these patients, the median (interquartile range) distance from cervicovaginal incision to anterior peritoneal reflection was 3.4 (2.6–3.7) cm. In cadavers, the median (interquartile range) age was 81 (72–86) years with a measured distance of 2.7 (2.4–2.9) cm.

CONCLUSION:

When performing a vaginal hysterectomy, surgeons can expect a median (range) dissection distance of 3.4 (1.8–4.6) cm from initial incision to the peritoneal reflection for anterior colpotomy.
Tailored Education to Increase Self-Efficacy for Caregivers of Children With Asthma
Authors: Iio Misa , Hamaguchi Mana , Narita Masami , Takenaka Koji , Ohya Yukihiro
Published: September 2016

We examined the efficacy of a tailored education program using touch-screen computers for caregivers of young children with asthma, aged 0 to 6 years. Fifty-three caregivers (mean age, 36.54 years; 51 mothers and two fathers) were recruited during typical visits to a national children's hospital. Caregivers were assigned randomly to 28 in the tailored education or 25 in the booklet education groups. The tailored education group received messages generated by a computer program, and the researchers provided them with counseling. The booklet education group only received an educational booklet. The primary outcome variable was parental self-efficacy and its subscales (ie, medication behavior, environmental behavior, barriers to self-management, and consultation behavior). The tailored education group showed an increase in barriers to management and asthma knowledge compared with the booklet education group. Over time, caregivers' quality of life improved significantly in both groups. Tailored education programs for caregivers of asthmatic children require further educational content modifications to match the learners' characteristics more closely. This study supports the notion that the development of patient education with tailored computer programs improves parental quality of life of asthma.
Dynamic Article: Percutaneous Nerve Evaluation Versus Staged Sacral Nerve Stimulation for Fecal Incontinence
Authors: Rice Teresa C. , Quezada Yarini , Rafferty Janice F. , Paquette Ian M.
Published: September 2016

BACKGROUND:

Sacral neuromodulation using a 2-staged approach is an established therapy for fecal incontinence. Office-based percutaneous nerve evaluation is a less-invasive alternative to the stage 1 procedure but is seldom used in the evaluation of patients with fecal incontinence.

OBJECTIVE:

The aim of this study was to determine the clinical success of percutaneous nerve evaluation versus a staged approach.

DESIGN:

This was a retrospective review of a prospectively maintained, single-institution database of patients treated with sacral neuromodulation for fecal incontinence.

SETTINGS:

This study was conducted at a single academic medical center.

PATIENTS:

Eighty-six consecutive patients were treated with sacral neuromodulation for fecal incontinence.

INTERVENTIONS:

Percutaneous nerve evaluation was compared with a staged approach.

MAIN OUTCOME MEASURES:

The primary outcome measured was the proportion of patients progressing to complete implantation based on >50% improvement in Wexner score during the testing phase.

RESULTS:

Percutaneous nerve evaluation was performed in 45 patients, whereas 41 underwent a staged approach. The mean baseline Wexner score did not differ between testing groups. Success was similar between the staged approach and percutaneous nerve evaluation (90.2% versus 82.2%; p = 0.36). The mean 3-month Wexner score was not significantly different between testing methods (4.4 versus 4.1; p = 0.74). However, infection was more likely to occur after the staged approach (10.5% versus 0.0%; p < 0.05).

LIMITATIONS:

This study was limited by its retrospective nature and potential for selection bias.

CONCLUSIONS:

Percutaneous nerve evaluation offers a viable alternative to a staged approach in the evaluation of patients for sacral neuromodulation in the setting of fecal incontinence. Not only are success rates similar, but percutaneous nerve evaluation also has the benefit of limiting patients to 1 operating room visit and has lower rates of infection as compared with the traditional staged approach for sacral neuromodulation.