ABSTRACT
Objective. To provide clinicians with a brief screening tool to predict accurately which individuals may develop aberrant behaviors when prescribed opioids for chronic pain.
Design. One ...hundred and eighty‐five consecutive new patients treated in one pain clinic took the self‐administered Opioid Risk Tool (ORT). The ORT measured the following risk factors associated in scientific literature with substance abuse: personal and family history of substance abuse; age; history of preadolescent sexual abuse; and certain psychological diseases. Patients received scores of 0–3 (low risk), 4–7 (moderate risk), or ≥ 8 (high risk), indicating the probability of their displaying opioid‐related aberrant behaviors. All patients were monitored for aberrant behaviors for 12 months after their initial visits.
Results. For those patients with a risk category of low, 17 out of 18 (94.4%) did not display an aberrant behavior. For those patients with a risk category of high, 40 out of 44 (90.9%) did display an aberrant behavior. The authors used the c statistic to validate the ORT, because it simultaneously assesses sensitivity and specificity. The ORT displayed excellent discrimination for both the male (c = 0.82) and the female (c = 0.85) prognostic models.
Conclusion. In a preliminary study, among patients prescribed opioids for chronic pain, the ORT exhibited a high degree of sensitivity and specificity for determining which individuals are at risk for opioid‐related, aberrant behaviors. Further studies in a variety of pain and nonpain settings are needed to determine the ORT's universal applicability.
Full text
Available for:
BFBNIB, DOBA, FSPLJ, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Abstract
Colonization efforts over time have changed Oneida relationships with corn drastically. This study examines that history through a collection of stories told by Oneida people for the Work ...Progress Administration (WPA) between 1938 and 1942. Furthermore, the people’s changing relationship with corn over time highlights the effects of removal, allotment, and assimilation on the Oneida within the American context. Finally, while change occurred, the WPA interviews uncover continuity in Oneida Country as members struggled to maintain their relationship with corn and other traditional foodways in the wake of colonialism.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Gestational diabetes, the most common medical disorder in pregnancy, is defined as glucose intolerance resulting in hyperglycaemia that begins or is first diagnosed in pregnancy. Gestational diabetes ...is associated with increased pregnancy complications and long-term metabolic risks for the woman and the offspring. However, the current diagnostic and management strategies recommended by national and international guidelines are mainly focused on short-term risks during pregnancy and delivery, except the Carpenter-Coustan criteria, which were based on the risk of future incidence of type 2 diabetes post-gestational diabetes. In this Personal View, first, we summarise the evidence for long-term risk in women with gestational diabetes and their offspring. Second, we suggest that a shift is needed in the thinking about gestational diabetes; moving from the perception of a short-term condition that confers increased risks of large babies to a potentially modifiable long-term condition that contributes to the growing burden of childhood obesity and cardiometabolic disorders in women and the future generation. Third, we propose how the current clinical practice might be improved. Finally, we outline and justify priorities for future research.
Although venous sinus stenting (VSS) has emerged as a promising treatment option for patients with idiopathic intracranial hypertension (IIH) and associated venous sinus stenosis, there is ...considerable ambiguity regarding patient selection criteria, treatment protocols, and management strategies.
An extensive literature review was performed to identify all reports of VSS in patients with IIH using PubMed. Recommendations for the selection and treatment of patients with IIH with VSS are outlined as determined based on author opinion from supporting studies. Due to the lack of randomized trials and few published prospective studies, standard grading scales for recommendations and level of evidence are not fully applicable and therefore a revised grading scale has been provided for recommendations.
The literature review identified a total of eight systematic reviews or meta-analyses and 29 published patient series on VSS. Recommendations for patient selection for diagnostic catheter angiography, angiography procedural considerations, stenting procedural considerations, and retreatment are provided based on the literature. Recommendations that were considered strong included: performance of venous sinus manometry to assess candidacy for treatment prior to stenting; administration of antiplatelet agents prior to stenting and for a follow-up period of at least 3-6 months; performance of post-stenting manometry to confirm resolution of pressure gradient; and performance of repeat angiography and manometry on patients with recurrence of symptoms after resolution with stenting to evaluate for recurrent stenosis.
VSS for patients with IIH with venous sinus stenosis is now an established and effective treatment option. These recommendations have been provided, based on a summative review of the available published literature, to assist in standardizing care for patients with IIH undergoing VSS.
Two Oneida Nation citizens and Ohe·láku (among the cornstalks) members use Indigenous theory and methodology to examine how growing and caring for heirloom corn provided reconnection with their ...traditional governing system, a traditional system that goes hand in hand with providing sustenance for their Nation. This experience facilitated the understanding and necessity of the function of participatory governing systems, and the impact on roles and responsibilities as Oneida people. Applying theory to practice, this article proposes implementation of this traditional model for Ohe·láku with hopes of encouraging the Oneida Nation government to transition back to reclaim this traditional governing system.
Full text
Available for:
BFBNIB, DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Land use planning in indigenous communities often takes place within state-based planning initiatives, leaving indigenous governments to serve as token participants. Through these initiatives, ...state-based governments have the ability to wield their power and control the planning process to the detriment of indigenous governments. This study sets forth an alternative option involving cooperative land use planning practices where neither government controls the planning process. Drawing upon a case study of the Oneida Reservation in Wisconsin, USA, this study explores ways to increase cooperative land use planning relationships between indigenous and state-based governments. As one of the few empirical studies to apply critical planning theory to advocate for increased cooperative land use planning, this paper proposes a series of recommendations that can help indigenous and state-based governments avoid conflicts and work toward cooperative relationships.
Full text
Available for:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Catchments with minimal disturbance usually have low dissolved inorganic nitrogen (DIN) export, but disturbances and anthropogenic inputs result in elevated DIN concentration and export and ...eutrophication of downstream ecosystems. We studied streams in the southern Appalachian Mountains, USA, an area dominated by hardwood deciduous forest but with areas of valley agriculture and increasing residential development. We collected weekly grab samples and storm samples from nine small catchments and three river sites. Most discharge occurred at baseflow, with baseflow indices ranging from 69% to 95%. We identified three seasonal patterns of baseflow DIN concentration. Streams in mostly forested catchments had low DIN with bimodal peaks, and summer peaks were greater than winter peaks. Streams with more agriculture and development also had bimodal peaks; however, winter peaks were the highest. In streams draining catchments with more residential development, DIN concentration had a single peak, greatest in winter and lowest in summer. Three methods for estimating DIN export produced consistent results. Annual DIN export ranged from less than 200 g ha−1 year−1 for the less disturbed catchments to over 2,000 g ha−1 year−1 in the catchments with the least forest area. Land cover was a strong predictor of DIN concentration but less significant for predicting DIN export. The two forested reference catchments appeared supply limited, the most residential catchment appeared transport limited, and export for the other catchments was significantly related to discharge. In all streams, baseflow DIN export exceeded stormflow export. Morphological and climatological variation among watersheds created complexities unexplainable by land cover. Nevertheless, regression models developed using land cover data from the small catchments reasonably predicted concentration and export for receiving rivers. Our results illustrate the complexity of mechanisms involved in DIN export in a region with a mosaic of climate, geology, topography, soils, vegetation, and past and present land use.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
First identified in 2002, diphtheritic stomatitis (DS) is a devastating disease affecting yellow-eyed penguins (Megadyptes antipodes, or hoiho in te reo Māori). The disease is associated with oral ...lesions in chicks and has caused significant morbidity and mortality. DS is widespread among yellow-eyed penguin chicks on mainland New Zealand yet appears to be absent from the subantarctic population. Corynebacterium spp. have previously been suspected as causative agents yet, due to inconsistent cultures and inconclusive pathogenicity, their role in DS is unclear. Herein, we used a metatranscriptomic approach to identify potential causative agents of DS by revealing the presence and abundance of all viruses, bacteria, fungi and protozoa - together, the infectome. Oral and cloacal swab samples were collected from presymptomatic, symptomatic and recovered chicks along with a control group of healthy adults. Two novel viruses from the Picornaviridae were identified, one of which - yellow-eyed penguin megrivirus – was highly abundant in chicks irrespective of health status but not detected in healthy adults. Tissue from biopsied oral lesions also tested positive for the novel megrivirus upon PCR. We found no overall clustering among bacteria, protozoa and fungi communities at the genus level across samples, although Paraclostridium bifermentans was significantly more abundant in oral microbiota of symptomatic chicks compared to other groups. The detection of a novel and highly abundant megrivirus has sparked a new line of inquiry to investigate its potential association with DS.
•Diphtheritic stomatitis (DS) is a devastating disease affecting yellow-eyed penguins.•A metatranscriptomic approach was used to identify potential causative agents of DS.•Yellow-eyed penguin megrivirus was identified, and was highly abundant in diseased chicks and absent from healthy controls.•The detection of a novel virus has sparked a new line of inquiry to investigate its potential association with DS.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Vitamin B12 (B12) is a micronutrient essential for one-carbon (1C) metabolism. B12 deficiency disturbs the 1C cycle and alters DNA methylation which is vital for most metabolic processes. Studies ...show that B12 deficiency may be associated with obesity, insulin resistance and gestational diabetes; and with obesity in child-bearing women. We therefore hypothesised that the associations between B12 deficiency, BMI and the metabolic risk could be mediated through altered 1C metabolites in early pregnancy. We explored these associations in two different early pregnancy cohorts in the UK (cohort 1; n = 244 and cohort 2; n = 60) with anthropometric data at 10-12 weeks and plasma/serum sampling at 16-18 weeks. B12, folate, total homocysteine (tHcy), methionine, MMA, metabolites of 1C metabolism (SAM, SAH) and anthropometry were measured. B12 deficiency (< 150 pmol/l) in early pregnancy was 23% in cohort 1 and 18% in cohort 2. Regression analysis after adjusting for likely confounders showed that B12 was independently and negatively associated with BMI (Cohort 1: β = - 0.260, 95% CI (- 0.440, - 0.079), p = 0.005, Cohort 2: (β = - 0.220, 95% CI (- 0.424, - 0.016), p = 0.036) and positively with HDL cholesterol (HDL-C) (β = 0.442, 95% CI (0.011,0.873), p = 0.045). We found that methionine (β = - 0.656, 95% CI (- 0.900, - 0.412), p < 0.0001) and SAH (β = 0.371, 95% CI (0.071, 0.672), p = 0.017) were independently associated with triglycerides. Low B12 status and alteration in metabolites in 1C metabolism are common in UK women in early pregnancy and are independently associated with maternal obesity and dyslipidaemia. Therefore, we suggest B12 monitoring in women during peri-conceptional period and future studies on the pathophysiological relationship between changes in 1C metabolites and its association with maternal and fetal outcomes on larger cohorts. This in turn may offer potential to reduce the metabolic risk in pregnant women and their offspring.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
PDF
