Coyotes and lynx are the two most important mammalian predators of snowshoe hares throughout much of the North American boreal forest. Populations of hares cycle in abundance, with peaks in density ...occurring every 8-11 years. We used snow-tracking to measure the diets, use of habitats, and hunting tactics of coyotes and lynx during a cyclic fluctuation of hare populations in the southwest Yukon. Our objective was to determine changes in foraging behaviour of the predators leading to functional responses to densities of hares. Coyotes and lynx both preferred snowshoe hares over available alternative prey at all phases of the cycle. Lynx switched to preying on red squirrels during the cyclic low and subsequent early increase. The pattern of changes in habitat use by coyotes and lynx paralleled that of snowshoe hares, and both concentrated their hunting activity in areas of high density of hares. Coyotes used more open cover to hunt voles during years of low abundance of hares and high numbers of small mammals. Lynx increasingly used ambush beds for hunting hares and red squirrels during the cyclic decline and low. Hunting success was not higher from beds. Lynx hunted in adult groups for the first time during the cyclic decline and low.
This study investigated the extent to which people interpret real-life moral dilemmas in terms of an internal moral orientation, as Gilligan (1982, 1988) has suggested, or in terms of the content of ...the dilemma, as Wark and Krebs (1996, 1997) have reported. Thirty women and 30 men listed the issues they saw in descriptions of real-life prosocial, antisocial and social pressure types of moral dilemma. Results revealed that Gilligan's model underestimates the influence of dilemma content. Moral dilemmas differed in the extent to which they were viewed in terms of the same issues by different participants. There was relatively little within-person consistency in moral orientation. There were four gender differences. Compared to men, women rated social pressure dilemmas as involving more care-orientated issues, and prosocial dilemmas as more significant. Compared to women, men viewed all dilemmas as involving more justice-based issues, and reported experiencing more antisocial dilemmas.
: Kohlberg's model of moral development is viewed from the perspective of evolutionary biology. Moral judgments defining Kohlberg's stages of moral development are seen as manifestations of ...structures evolved to uphold systems of cooperation. Game theory research on adaptive strategies of cooperation supports the conclusion that humans inherit dispositions to uphold the systems of cooperation implicit in the first three stages in Kohlberg's sequence, but not the systems of cooperation implicit in the highest stages. The empirical evidence on real‐life morality is more consistent with a biological model of ontogenesis than is the model espoused by Kohlbergians. Although people occasionally make moral judgments in their everyday lives to reveal their solutions to moral dilemmas, as Kohlberg's model assumes, they more often make moral decisions that advance their adaptive interests.
Objective
We sought to classify causes of stillbirth for six low‐middle‐income countries using a prospectively defined algorithm.
Design
Prospective, observational study.
Setting
Communities in ...India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya.
Population
Pregnant women residing in defined study regions.
Methods
Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer‐based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions.
Main outcome measures
Primary cause of stillbirth.
Results
Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre‐eclampsia/eclampsia. About two‐thirds (67.4%) of the stillbirths did not have signs of maceration.
Conclusions
Our algorithm determined cause of stillbirth from basic data obtained from lay‐health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre‐eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system.
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Major causes of stillbirth are asphyxia, pre‐eclampsia and haemorrhage. Infections are important in Africa.
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Major causes of stillbirth are asphyxia, pre‐eclampsia and haemorrhage. Infections are important in Africa.
Most cases of non-small-cell lung cancer (NSCLC) with dramatic responses to gefitinib have specific activating mutations in the epidermal growth factor receptor (EGFR), but the predictive value of ...these mutations has not been defined in large clinical trials. The goal of this study was to determine the contribution of molecular alterations in EGFR to response and survival within the phase II (IDEAL) and phase III (INTACT) trials of gefitinib.
We analyzed the frequency of EGFR mutations in lung cancer specimens from both the IDEAL and INTACT trials and compared it with EGFR gene amplification, another genetic abnormality in NSCLC.
EGFR mutations correlated with previously identified clinical features of gefitinib response, including adenocarcinoma histology, absence of smoking history, female sex, and Asian ethnicity. No such association was seen in patients whose tumors had EGFR amplification, suggesting that these molecular markers identify different biologic subsets of NSCLC. In the IDEAL trials, responses to gefitinib were seen in six of 13 tumors (46%) with an EGFR mutation, two of seven tumors (29%) with amplification, and five of 56 tumors (9%) with neither mutation nor amplification (P = .001 for either EGFR mutation or amplification v neither abnormality). Analysis of the INTACT trials did not show a statistically significant difference in response to gefitinib plus chemotherapy according to EGFR genotype.
EGFR mutations and, to a lesser extent, amplification appear to identify distinct subsets of NSCLC with an increased response to gefitinib. The combination of gefitinib with chemotherapy does not improve survival in patients with these molecular markers.
Stillbirth rates remain nearly ten times higher in low-middle income countries (LMIC) than high income countries. In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based ...studies have documented characteristics or care for mothers with stillbirths. Non-macerated stillbirths, those occurring around delivery, are generally considered preventable with appropriate obstetric care.
We undertook a prospective, population-based observational study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). Staff collected demographic and health care characteristics with outcomes obtained at delivery.
From 2010 through 2013, 269,614 enrolled women had 272,089 births, including 7,865 stillbirths. The overall stillbirth rate was 28.9/1000 births, ranging from 13.6/1000 births in Argentina to 56.5/1000 births in Pakistan. Stillbirth rates were stable or declined in 6 of the 7 sites from 2010-2013, only increasing in Pakistan. Less educated, older and women with less access to antenatal care were at increased risk of stillbirth. Furthermore, women not delivered by a skilled attendant were more likely to have a stillbirth (RR 2.8, 95% CI 2.2, 3.5). Compared to live births, stillbirths were more likely to be preterm (RR 12.4, 95% CI 11.2, 13.6). Infants with major congenital anomalies were at increased risk of stillbirth (RR 9.1, 95% CI 7.3, 11.4), as were multiple gestations (RR 2.8, 95% CI 2.4, 3.2) and breech (RR 3.0, 95% CI 2.6, 3.5). Altogether, 67.4% of the stillbirths were non-macerated. 7.6% of women with stillbirths had cesarean sections, with obstructed labor the primary indication (36.9%).
Stillbirth rates were high, but with reductions in most sites during the study period. Disadvantaged women, those with less antenatal care and those delivered without a skilled birth attendant were at increased risk of delivering a stillbirth. More than two-thirds of all stillbirths were non-macerated, suggesting potentially preventable stillbirth. Additionally, 8% of women with stillbirths were delivered by cesarean section. The relatively high rate of cesarean section among those with stillbirths suggested that this care was too late or not of quality to prevent the stillbirth; however, further research is needed to evaluate the quality of obstetric care, including cesarean section, on stillbirth in these low resource settings.
Clinicaltrials.gov (ID# NCT01073475).
Objective
To describe the causes of maternal death in a population‐based cohort in six low‐ and middle‐income countries using a standardised, hierarchical, algorithmic cause of death (COD) ...methodology.
Design
A population‐based, prospective observational study.
Setting
Seven sites in six low‐ to middle‐income countries including the Democratic Republic of the Congo (DRC), Guatemala, India (two sites), Kenya, Pakistan and Zambia.
Population
All deaths among pregnant women resident in the study sites from 2014 to December 2016.
Methods
For women who died, we used a standardised questionnaire to collect clinical data regarding maternal conditions present during pregnancy and delivery. These data were analysed using a computer‐based algorithm to assign cause of maternal death based on the International Classification of Disease—Maternal Mortality system (trauma, termination of pregnancy‐related, eclampsia, haemorrhage, pregnancy‐related infection and medical conditions). We also compared the COD results to healthcare‐provider‐assigned maternal COD.
Main outcome measures
Assigned causes of maternal mortality.
Results
Among 158 205 women, there were 221 maternal deaths. The most common algorithm‐assigned maternal COD were obstetric haemorrhage (38.6%), pregnancy‐related infection (26.4%) and pre‐eclampsia/eclampsia (18.2%). Agreement between algorithm‐assigned COD and COD assigned by healthcare providers ranged from 75% for haemorrhage to 25% for medical causes coincident to pregnancy.
Conclusions
The major maternal COD in the Global Network sites were haemorrhage, pregnancy‐related infection and pre‐eclampsia/eclampsia. This system could allow public health programmes in low‐ and middle‐income countries to generate transparent and comparable data for maternal COD across time or regions.
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An algorithmic system for determining maternal cause of death in low‐resource settings is described.
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An algorithmic system for determining maternal cause of death in low‐resource settings is described.
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