The magical realism of body counts: How media credulity and flawed statistics sustain a controversial policy

The drone war in Pakistan poses humanitarian, legal, ethical and political challenges. The tactic is controversial and has been condemned by the United Nations’ special rapporteur on extrajudicial killings. Yet, polls have shown high support for the tactic in the United States (and to a lesser degree in the United Kingdom). Much of this has to do with the media reporting on the war, which consistently underestimates its human toll. Dubious statistics have sustained the image of a surgical war with little collateral damage. But as this article shows, there are reasons to doubt these numbers. The article argues that two interrelated factors have contributed to a flawed accounting of the war’s human toll: (1) rituals of objectivity that privilege ‘official sources’ and (2) fetishizing of statistics as hard facts without regard for the underlying data. The coverage has also been distorted by news values that downplay or ignore deaths in distant places unless they cross an inordinately high threshold

Oneida nation of New York: health needs assessment 1990

This is the report of a health needs assessment for the Oneida Indian Nation of New York (ONNY). This needs assessment was conducted in order to collect population-based data related to behavioral risks and reproductive health for Oneida males and females. The survey of the Oneida was initiated because there is almost no risk factor data available on Indian tribes of the northeast, and none available for the Oneida Nation of New York. There are four primary goals for the 1990 Oneida Nation Health Needs Assessment. They are 1) to collect behavioral risk factor and reproductive health data for adult Oneida Nation members living on or near Oneida Nation lands, 2) to assess the current basic health needs of the ONNY, 3) to document the medical providers and hospitals which are currently being utilized by the Nation members and. 4) to develop recommendations for use by health planners from this baseline data.The Oneida Nation Health Needs Assessment (ONHNA) was carried out among enrolled members of the Oneida Nation who were 18 years of age and older who lived in the six counties that are contiguous to the Oneida Nation lands. The Nation Enrollment List was used to identify the Oneida population located in the six-county area. The choice to interview only adults was made to avoid legal difficulties in interviewing minors. Interviewing was conducted in each household face-to-face rather than using mailed questionnaires or telephone contact. All interviewers were enrolled Oneida Nation members. Interviews were conducted by interviewers of the same sex as the respondent. All interviewers participated in one week of training prior to the start of the field work. Four types of data were collected. First, the behavioral risk factors surveyed were related to the 10 leading causes of death in the United States. Behavioral factors include seat belt usage, physical exercise, diet, cigarette and smokeless tobacco usage, alcohol consumption, and the existence of high blood pressure. The second data set included health needs. The survey questions dealt with the prevalence of current diseases and health problems among the Oneidas, and with whether the Oneida people have routine screening tests such as cholesterol, diabetes, and hypertension, and eye exams, pap smears, breast exams, and rectal exams. The third set of data questions focused on reproductive health factors. Questions covered topics such as fertility, contraception, and general maternal-child health conditions. The fourth and final set of questions gathered data on health care utilization. This data will be used to establish health provider contracts with physicians, dentists, pediatricians, and hospitals to provide quality health care for a more reasonable cost. For each risk factor, comparisons were made between the Oneida Nation and data from the 1988 New York State Behavioral Risk Factor Survey.The individual completion rates were 54% for females and 69% for males for a total of 211 respondents in all. The following is an abbreviated summary of selected data from the survey. Seat belt use was only slightly lower than for all New Yorkers. Non-use was highest among young drivers. Sixty percent of Oneida males and 78 percent of Oneida females reported having their blood pressure taken within a year of the survey. All Oneida members were more active physically than the general New York population. However, all Oneida members were more likely to be overweight by comparison Forty percent of all Oneida people are smokers compared to 25 percent of the New York population. Fifty-seven percent of Oneida males and 32 percent of Oneida females are classified as acute and heavy drinkers. Percentages for regular health checks across all factors vary considerably among the Oneida people. Several areas of concern were identified including cholesterol checks, diabetes screening, rectal exams and mammograms. The completed fertility of the Oneida women in this survey is 2.1 children which is lower than that of all U.S. women surveyed in the 1980 census. Female sterilization is the most prevalent contraceptive method among Oneida women. as it is among the general U.S. population.With respect to behavioral risks, cigarette smoking and alcohol consumption are of major concern. This impacts on concerns for overall reproductive health. The task now is to identify the highest priority objectives and to secure resources needed to accomplish these tasks

Views and Experiences of Sex, Sexuality and Relationships Following Spinal Cord Injury: A Systematic Review and Narrative Synthesis of the Qualitative Literature

Research examining the effects of spinal cord injury on sexuality has largely focused on physiological functioning and quantification of dysfunction following injury. This paper reports a systematic review of qualitative research that focused on the views and experiences of people with spinal cord injury on sex and relationships. The review addressed the following research question: What are the views and experiences of people with spinal cord injury of sex, sexuality and relationships following injury? Five databases were relevant and employed in the review: CINAHL (1989-2016 only), PsychInfo, PubMed, Scopus and Web of Science, for research published between 1 January 1980 and 30 November 2019. After removing duplicates, 257 records remained and were screened using a two-stage approach to inclusion and quality appraisal. Following screening, 27 met the criteria for inclusion and are reported in the paper. The review includes studies from fifteen countries across five continents. Two main approaches to data analysis summary and thematic synthesis were undertaken to analyze the qualitative data reported in the papers. The analysis revealed four main themes: sexual identity; significant and generalized others, sexual embodiment; and; sexual rehabilitation and education

Determining level of care appropriateness in the patient journey from acute care to rehabilitation

Background: The selection of patients for rehabilitation, and the timing of transfer from acute care, are important clinical decisions that impact on care quality and patient flow. This paper reports utilization review data on inpatients in acute care with stroke, hip fracture or elective joint replacement, and other inpatients referred for rehabilitation. It examines reasons why acute level of care criteria are not met and explores differences in decision making between acute care and rehabilitation teams around patient appropriateness and readiness for transfer. Methods: Cohort study of patients in a large acute referral hospital in Australia followed with the InterQual utilization review tool, modified to also include reasons why utilization criteria are not met. Additional data on team decision making about appropriateness for rehabilitation, and readiness for transfer, were collected on a subset of patients. Results: There were 696 episodes of care (7189 bed days). Days meeting acute level of care criteria were 56% (stroke, hip fracture and joint replacement patients) and 33% (other patients, from the time of referral). Most inappropriate days in acute care were due to delays in processes/scheduling (45%) or being more appropriate for rehabilitation or lower level of care (30%). On the subset of patients, the acute care team and the utilization review tool deemed patients ready for rehabilitation transfer earlier than the rehabilitation team (means of 1.4, 1.3 and 4.0 days from the date of referral, respectively). From when deemed medically stable for transfer by the acute care team, 28% of patients became unstable. From when deemed stable by the rehabilitation team or utilization review, 9% and 11%, respectively, became unstable. Conclusions: A high proportion of patient days did not meet acute level of care criteria, due predominantly to inefficiencies in care processes, or to patients being more appropriate for an alternative level of care, including rehabilitation. The rehabilitation team was the most accurate in determining ongoing medical stability, but at the cost of a longer acute stay. To avoid inpatients remaining in acute care in a state of \u27terra nullius\u27, clinical models which provide rehabilitation within acute care, and more efficient movement to a rehabilitation setting, is required. Utilization review could have a decision support role in the determination of medical stability

21-Hydroxylase Genotyping in Australasian Patients with Congenital Adrenal Hyperplasia

Mutations in CYP21 (21-hydroxylase) lead to congenital adrenal hyperplasia (CAH). We genotyped 26 probands with CAH by PCR-sequencing the entire CYP21 gene. 25/26 had homozygous or compound heterozygous mutations. The frequencies of mutations were similar to other populations with deletion/hybrid, 12 G splice and 1172N the most common. Five patients with a 1172N allele predicting simple-virilising CAH had a salt-wasting phenotype. Two other probands also had a more severe phenotype than predicted by genotype. Two families had both non-classic and salt-wasting phenotypes arising from combinations of three deleterious alleles. Two novel CYP21 alleles were detected: D106N and a large deletion encompassing CYP21 and adjacent pseudogene. Two rare CYP21 alleles were also found. Three of these four novel/rare alleles were only detected as a result of sequencing the entire CYP21 gene. Entire CYP21 sequencing will increase the number of mutations detected in CAH, and in combination with functional studies should contribute a greater understanding of phenotype-genotype correlations.

Temperature and Malaria Trends in Highland East Africa

There has been considerable debate on the existence of trends in climate in the highlands of East Africa and hypotheses about their potential effect on the trends in malaria in the region. We apply a new robust trend test to mean temperature time series data from three editions of the University of East Anglia's Climatic Research Unit database (CRU TS) for several relevant locations. We find significant trends in the data extracted from newer editions of the database but not in the older version for periods ending in 1996. The trends in the newer data are even more significant when post-1996 data are added to the samples. We also test for trends in the data from the Kericho meteorological station prepared by Omumbo et al. We find no significant trend in the 1979-1995 period but a highly significant trend in the full 1979-2009 sample. However, although the malaria cases observed at Kericho, Kenya rose during a period of resurgent epidemics (1994-2002) they have since returned to a low level. A large assembly of parasite rate surveys from the region, stratified by altitude, show that this decrease in malaria prevalence is not limited to Kericho

Estrogen-Eluting Stents

Coronary stenting is routinely utilized to treat symptomatic obstructive coronary artery disease. However, the efficacy of bare metal coronary stents has been historically limited by restenosis, which is primarily due to excessive neointima formation. Drug-eluting stents (DES) are composed of a stainless steel backbone encompassed by a polymer in which a variety of drugs that inhibit smooth muscle cell proliferation and excessive neointima formation are incorporated. DES have significantly reduced the incidence of restenosis but are also associated with a small (~0.5% per year) but significant risk of late stent thrombosis. In that regard, estrogen-eluting stents have also undergone clinical evaluation in reducing restenosis with the additional potential benefit of enhancing reendothelialization of the stent surface to reduce stent thrombosis. Estrogen directly promotes vasodilatation, enhances endothelial healing, and prevents smooth muscle cell migration and proliferation. Due to these mechanisms, estrogen has been postulated to reduce neointimal hyperplasia without delaying endothelial healing. In animal studies, estrogen treatment was effective in decreasing neointimal hyperplasia after both balloon angioplasty and stenting regardless of the method of drug delivery. The first uncontrolled human study using estrogen-coated stents demonstrated acceptable efficacy in reducing late lumen loss. However, subsequent randomized clinical trials did not show superiority of estrogen-eluting stents over bare metal stents or DES. Further studies are required to determine optimal dose and method of estrogen delivery with coronary stenting and whether this approach will be a viable alternative to the current DES armamentarium

Magnetic resonance imaging of the knee in Norway 2002–2004 (national survey): rapid increase, older patients, large geographic differences

<p>Abstract</p> <p>Background</p> <p>Magnetic resonance imaging (MRI) of the knee is the second most common MRI examination in Norway after head/brain MRI. Little has been published internationally on trends in the use of knee MRI after 1999. This study aimed to describe levels and trends in ambulant knee MRI utilisation in Norway 2002–2004 in relation to type of radiology service, geographic regions, number of MRI-scanners, patient age and gender, and type of referring health care provider.</p> <p>Methods</p> <p>We analysed administrative data on all claims for reimbursement of ambulant knee MRI performed in Norway in 2002, 2003 and 2004 and noted nominal reimbursement. We also recorded the referring health care provider from clinical requests of ambulant knee MRI done consecutively during two months in 2004 at one private institute and three hospitals. Number of MRI-scanners was given by manufacturers and radiology services.</p> <p>Results</p> <p>In Norway, the rate of knee MRI claims for 2004 was 15.6 per 1000 persons. This rate was 74% higher in East than in North region (18.4 vs. 10.6), slightly higher for men than women (16.4 vs. 14.7) and highest for ages 50–59 years (29.0) and 60–69 years (21.2). Most claims (76% for 2004) came from private radiology services. In 2004, the referring health care provider was a general practitioner in 63% of claims (unspecified in 24%) and in 83.5% (394/472) of clinical requests. From 2002 to 2004, the rate of knee MRI claims increased 64%. In the age group 50 years or above the increase was 86%. Rate of MRI-scanners increased 43% to 21 scanners per million persons in 2004. Reimbursement for knee MRI claims (nominal value) increased 80% to 70 million Norwegian kroner in 2004.</p> <p>Conclusion</p> <p>Ambulant knee MRI utilisation in Norway increases rapidly especially for patients over 50, and shows large geographic differences. Evaluation of clinical outcomes of this activity is needed together with clinical guidelines for use of knee MRI.</p