Hepatitis C Diagnoses in an American Indian Primary Care Population

BACKGROUND: Despite large disparities in the burden of chronic liver disease, data on hepatitis C virus (HCV) infection among American Indians (AIs) are lacking. We reviewed hepatitis C diagnoses in 35,712 AI/AN primary care patients. MAIN FINDINGS: At least one HCV-associated ICD-9 code was recorded in 251 (1%) patients between October 1, 2001 and September 30, 2003. An HCV enzyme-linked immunoassay (HCVEIA) was sent in 209 (83.0%); 206/209 (99%) were positive. Confirmatory testing was performed in 144/206 (70%) HCV-EIA positive patients; HCV infection was confirmed in 144 (100%). In the 90/144 (63%) charts with risk factor documentation, injection drug use was the most common risk factor (61/90, 68%). Deficiencies were present in hepatitis B and HIV testing, and hepatitis A and B vaccination. PRINCIPAL CONCLUSIONS: Improvements in laboratory workup of HCV and co-infections, risk factor ascertainment and documentation, and adult vaccination are needed to address HCV effectively in this population

Ecology and Valuation: Big Changes Needed

Ecological Economics has developed as a “transdisciplinary science,” but it has not taken significant steps toward a truly integrated process of evaluating anthropogenic ecological change. The emerging dominance within ecological economics of the movement to monetize “ecological services,” when combined with the already well-entrenched dominance of contingent pricing as a means to evaluate impacts on amenities, has created a “monistic” approach to valuation studies. It is argued that this monistic approach to evaluating anthropogenic impacts is inconsistent with a sophisticated conception of ecology as a complex science that rests on shifting metaphors. An alternative, pluralistic and iterative approach to valuation of anthropogenic ecological change is proposed

Fragments Of The Concrete: Ecology And Technical Media In German Romanticism

This dissertation investigates how German romantic speculation concerning the possibility of constructing a perpetuum mobile sheds light on the central role played by technical media in the relationship between politics, poetics, and the life sciences around 1800. Focusing on the figures of Novalis, Schelling, Goethe, and Hölderlin, the project traces the contours of a discursive shift in the romantic reception of what Immanuel Kant calls the “technic of nature,” a concept Kant employs as a heuristic device for explaining the appearance of self-motivated activity in nature. While for Kant, this term refers to the ways internal forms of human cognition lead the observer to perceive a distinction between the autotelic activity of organic life and events determined by mechanical causality, for Kant’s romantic readers, the ‘technic of nature’ comes to signify a reciprocal mode of material relationality between humans and nature that combines organic and mechanical processes. This relational, exteriorizing comportment towards the making of technical objects and natural knowledge, what the philosopher of technology Gilbert Simondon calls mechanology in his overlooked engagement with romanticism, becomes the basis for a series of thought experiments concerning perpetual motion which seek to develop a negentropic ecology of spatial relations for romantic poetics and nature philosophy

Beyond Value Neutrality: An Alternative to Monetary Monism in Ecological Economics

Ecological Economics has developed as a "transdisciplinary science," but it has not taken significant steps toward a truly integrated process of evaluating anthropogenic ecological change. The emerging dominance within ecological economics of the movement to monetize "ecological services," when combined with the already well-entrenched dominance of contingent pricing as a means to evaluate impacts on amenities, has created a "monistic" approach to valuation studies. It is argued that this monistic approach to evaluating anthropogenic impacts is inconsistent with a sophisticated conception of ecology as a complex science that rests on shifting metaphors. An alternative, pluralistic and iterative approach to valuation of anthropogenic ecological change is propose

Models as Languages: How Can Scientific Modeling Improve Environmental Policy Process?

While scientific models are often thought of as "descriptive" and as mainly designed to generate predictions, in fact scientific models can be constructed for many and varied purposes. Like formal languages, scientific models are conventional representations designed for better understanding and communication. Just as languages have many uses, only some of them to describe and predict the world, models can be constructed to fulfill many purposes. One key--and growing--use of models is to improve communication among stakeholders in contentious and public environmental management processes. Jan Rotmans, Director of the International Center for Integrative Studies, Maastricht, Netherlands, has proposed that we distinguish between "supply" and "demand" modeling. The former involves cutting-edge use of disciplinary or multi-disciplinary tools to develop state-of-the-art models, while the latter models are developed specifically to respond to particular, real-world problems in environmental management. It will be argued that the development of useful "demand" models will require a significant re-thinking of the criteria by which we form and judge scientific models. Especially, it will require that we reconsider important aspects of the way scientists participate in public processes to manage the environment. These ideas will be illustrated by reference to research on modeling and management of Lake Lanier (a large, multipurpose impoundment of the Chattahoochee River North of Atlanta), undertaken by the presenter and colleagues from Georgia Tech and the University of Georgia

Rethinking Appropriateness of Actions in Environmental Decisions: Connecting Interest and Identity Negotiation with Plural Valuation

Issues of interest, identity and values intertwine in environmental conflicts, creating challenges that cannot generally be overcome using rationalities grounded in generalised argumentation and abstraction. To address the growing need to engage interests and identities along with plural values in the conservation of biodiversity and ecological systems, we introduce the concept of ‘appropriateness of actions’ and ground it in a relational understanding of environmental ethics. A determination of appropriateness for actions comes from combining outputs from value elicitation with those of interest and identity negotiation in ways that are salient to specific people and their relationships to specific places. Drawing on the Blue Mountain Forest Partnership in the Pacific Northwest, we propose factors of success for supporting appropriate actions: 1) understanding context and identifying key stakeholders; 2) surfacing a diversity of interests and building system-level trust; 3) building empathy for different identities grounded in specific places; 4) eliciting diverse values and seeking to understand their links to worldviews and knowledge systems and; 5) seeking out appropriate actions

A Quasi-Experimental Evaluation of High Emitter Non-Compliance and its Impact on Vehicular Tailpipe Emissions in Atlanta, 1997-2001

A quasi-experimental evaluation is employed to assess the compliance behavior of high emitters in response to Atlanta’s Inspection and Maintenance program between 1997 and 2001 and to predict the impact of compliance behavior on vehicular tailpipe emissions of ozone precursors, such as carbon monoxide, hydrocarbons and nitrogen oxide. Remote sensing data of a sample of approximately 0.8 million observations of on-road vehicles are matched with IM program data and vehicle registration data to identify the compliant and non-compliant high emitters. A mixed-pool time-series regression analysis is carried out to predict changes in the vehicular tailpipe emissions due to the compliance and non-compliance of the high emitters in the Atlanta airshed

Common peroneal nerve palsy following total hip arthroplasty: prognostic factors for recovery.

BACKGROUND: Common peroneal nerve palsy, although rare, is a serious complication of total hip arthroplasty. Although several publications have dealt with the risk factors for peroneal nerve palsy, there is little literature regarding the time it takes for the nerve to recover and the factors that influence its recovery. The purpose of this study was to elucidate the clinical course of this injury and identify prognostic factors for recovery. METHODS: From January 2000 to December 2007, 7969 primary and 1601 revision total hip arthroplasties were performed at our institution. Common peroneal nerve palsy developed following thirty-one (0.32%) of these procedures. Thirty of these patients were evaluated by a neurologist at the time of diagnosis and at regular intervals thereafter. Univariate and multivariate regression analyses were performed to identify risk factors and prognostic factors for recovery. RESULTS: On average, patients who developed common peroneal nerve palsy were significantly younger (fifty-six years) than those who did not develop palsy (sixty-three years, p \u3c 0.05). Higher body mass index (BMI) was a negative prognostic factor for recovery from palsy (p \u3c 0.05). The palsy was incomplete in twenty-five of the thirty patients, and fourteen of these recovered fully at a mean of 10.3 months (range, 1.0 to 50.0 months). Three of the five patients with complete nerve palsy recovered fully at a mean of 14.5 months (range, 8.0 to 21.0 months). CONCLUSIONS: Only one-half of the patients in the study who developed common peroneal nerve palsy following total hip arthroplasty recovered fully. The mean time to recovery was approximately one year for partial peroneal palsy and one and one-half years for complete palsy. Obesity adversely influenced the nerve recovery

Contributions to the Science of Environmental Impact Assessment: Three Papers on the Arctic Cisco (Coregonus autumnalis) of Northern Alaska

Editor's Introduction -- D. W. Norton; An Assessment of the Colville River Delta Stock of Arctic Cisco--Migrants from Canada? -- B. J. Gallaway, W. B. Griffiths, P. C. Craig, W. J. Gazey, and J. W. Helmericks; Temperature Preference of Juvenile Arctic Cisco (Coregonus autumnalis) From the Alaskan Beaufort Sea -- R. G. Fechhelm, W. H. Neill, and B. J. Gallaway; Modeling Movements and Distribution of Arctic Cisco (Coregonus autumnalis) Relative to Temperature-Salinity Regimes of the Beaufort Sea Near the Waterflood Causeway, Prudhoe Bay, Alaska. -- W. H. Neill, R. G. Fechhelm, B. J. Gallaway, J. D. Bryan, and S. W. Anderson; Notice to Author

Cross-scale value trade-offs in managing social-ecological systems: The politics of scale in Ruaha National Park, Tanzania

Management of social-ecological systems takes place amidst complex governance processes and cross-scale institutional arrangements that are mediated through politics of scale. Each management scenario generates distinct cross-scale trade-offs in the distribution of pluralistic values. This study explores the hypothesis that conservation-oriented management scenarios generate higher value for international and national scale social organizations, whereas mixed or more balanced management scenarios generate higher value for local scale social organizations. This hypothesis is explored in the management context of Ruaha National Park (RNP), Tanzania, especially the 2006 expansion of RNP that led to the eviction of many pastoralists and farmers. Five management scenarios for RNP, i.e., national park, game reserve, game control area, multiple use area, and open area, are evaluated in a multicriteria decision analytical framework on six valuation criteria: economic welfare; good governance; socio-cultural values; social equity; ecosystem services; and biodiversity protection; and at three spatial scales: local, national, and international. Based upon this evaluation, we discuss the politics of scale that ensue from the implementation of management alternatives with different mixes of conservation and development goals in social-ecological systems. Copyright © 2011 by the author(s)