Development and validation of the brief esophageal dysphagia questionnaire

BackgroundEsophageal dysphagia is common in gastroenterology practice and has multiple etiologies. A complication for some patients with dysphagia is food impaction. A valid and reliable questionnaire to rapidly evaluate esophageal dysphagia and impaction symptoms can aid the gastroenterologist in gathering information to inform treatment approach and further evaluation, including endoscopy.Methods1638 patients participated over two study phases. 744 participants completed the Brief Esophageal Dysphagia Questionnaire (BEDQ) for phase 1; 869 completed the BEDQ, Visceral Sensitivity Index, Gastroesophageal Reflux Disease Questionnaire, and Hospital Anxiety and Depression Scale for phase 2. Demographic and clinical data were obtained via the electronic medical record. The BEDQ was evaluated for internal consistency, split‐half reliability, ceiling and floor effects, and construct validity.Key ResultsThe BEDQ demonstrated excellent internal consistency, reliability, and construct validity. The symptom frequency and severity scales scored above the standard acceptable cutoffs for reliability while the impaction subscale yielded poor internal consistency and split‐half reliability; thus the impaction items were deemed qualifiers only and removed from the total score. No significant ceiling or floor effects were found with the exception of 1 item, and inter‐item correlations fell within accepted ranges. Construct validity was supported by moderate yet significant correlations with other measures. The predictive ability of the BEDQ was small but significant.Conclusions & InferencesThe BEDQ represents a rapid, reliable, and valid assessment tool for esophageal dysphagia with food impaction for clinical practice that differentiates between patients with major motor dysfunction and mechanical obstruction.Validated, rapid clinical assessment tools for esophageal dysphagia are lacking. The brief esophageal dysphagia questionnaire aims to gauge the severity and frequency of dysphagia with additional items to gauge food impaction. The BEDQ is a reliable and valid tool to assess esophageal dysphagia.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135130/1/nmo12889.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135130/2/nmo12889_am.pd

Human plague: An old scourge that needs new answers

Yersinia pestis, the bacterial causative agent of plague, remains an important threat to human health. Plague is a rodent-borne disease that has historically shown an outstanding ability to colonize and persist across different species, habitats, and environments while provoking sporadic cases, outbreaks, and deadly global epidemics among humans. Between September and November 2017, an outbreak of urban pneumonic plague was declared in Madagascar, which refocused the attention of the scientific community on this ancient human scourge. Given recent trends and plague’s resilience to control in the wild, its high fatality rate in humans without early treatment, and its capacity to disrupt social and healthcare systems, human plague should be considered as a neglected threat. A workshop was held in Paris in July 2018 to review current knowledge about plague and to identify the scientific research priorities to eradicate plague as a human threat. It was concluded that an urgent commitment is needed to develop and fund a strong research agenda aiming to fill the current knowledge gaps structured around 4 main axes: (i) an improved understanding of the ecological interactions among the reservoir, vector, pathogen, and environment; (ii) human and societal responses; (iii) improved diagnostic tools and case management; and (iv) vaccine development. These axes should be cross-cutting, translational, and focused on delivering context-specific strategies. Results of this research should feed a global control and prevention strategy within a “One Health” approach

Mycophenolate mofetil for maintenance of remission in steroid-dependent autoimmune pancreatitis

Systemic corticosteroids represent the standard treatment for autoimmune pancreatitis with IgG4-associated cholangitis. For steroid-dependent disease, azathioprine has been used for maintenance of remission. Mycophenolate mofetil has been used for transplant immunosuppression and more recently for autoimmune hepatitis; however, there are no case reports to date on the use of mycophenolate mofetil in adult patients with autoimmune pancreatitis. A patient with IgG4-mediated autoimmune pancreatitis and IgG4-associated cholangitis refractory to steroids and intolerant of azathioprine was treated with mycophenolate mofetil, which inhibits de novo guanosine synthesis and blockade of both B and T lymphocyte production. Introduction of mycophenolate mofetil and uptitration to 1000 mg by mouth twice daily over a treatment period of 4 mo was associated with improvement in the patient’s energy level and blood glucose control and was not associated with any adverse events. The patient was managed without a biliary stent. However, there was a return of symptoms, jaundice, increase in transaminases, and hyperbilirubinemia when the prednisone dose reached 11 mg per day. In the first report of mycophenolate mofetil use in an adult patient with IgG4-associated autoimmune pancreatitis and IgG4-associated cholangitis, the introduction of mycophenolate mofetil was safe and well-tolerated without adverse events, but it did not enable discontinuation of the steroids. Mycophenolate mofetil and other immunomodulatory therapies should continue to be studied for maintenance of remission in the large subset of patients with refractory or recurrent autoimmune pancreatitis

Not Just Participation:The Rise of the Eco-Precariat in the Green Economy

Despite recent attention to “frontier” green economies and the governance of emerging ecosystem services, the specific division of labour in these economies has been little studied. As many such initiatives are in the global South, labour’s marginality potentially contributes to the existing precariousness of those who are more often identified as “participants”. This article examines the roles and vulnerabilities of these actors: the carbon counters, species identifiers, GIS mappers, tree planters and others operating in the shadows. We draw on current understandings of labour and precarity to examine the geographical contours of an apparent and emerging “eco‐precariat”: a socio‐economically diverse group of labourers that address the volatile demands of an ever‐expanding environmental service‐based economy. We illustrate our analysis drawing on examples from a Blue Carbon project in Kenya, ecosystem services project in the Philippines, and REDD+ scheme in Cambodia. We use these examples to theorise the nature of labour in these frontier economies and put forward a framework for analysing the eco‐precariat. We highlight the need to understand the precarity and marginalisation potentially created by this green division of labour in the provision of new ecosystem products and services. This framework contributes to ongoing analyses of labour as a central part of the green economy discourse and to larger discussions in the geographies of labour literature around the future of work in the global South and beyond

Inverting the impacts: Mining, conservation and sustainability claims near the Rio Tinto/QMM ilmenite mine in Southeast Madagascar

This paper traces a genealogy of land access and legitimization strategies culminating in the current convergence of mining and conservation in Southeast Madagascar, contributing to recent debates analyzing the commonalities and interdependencies between seemingly discrete types of land acquisitions. Drawing upon research carried out near the Rio Tinto/QMM ilmenite mine in 2009 (January–March), it focuses on how local Malagasy land users are incorporated into new forms of inclusion (into the neoliberal capitalist economy) and exclusion (from land-based, subsistence activities) resulting from private sector engagements in conservation and sustainability. Sustainability tropes and corporate partnerships with international conservation NGOs were found to play a part in land access, in part through the neoliberal project of commodifying, economically valuing and objectifying nature. Through a process of mimesis (of conservation NGOs) and alterity (‘othering’ land users), Rio Tinto's process of creating scarcity of biodiversity paradoxically lends support to the company's claim to be ‘saving’ biodiversity from local Malagasy people; this is described as a process of inversion, wherein actual mining impacts are abstracted and remediated as part of a broader sustainable development strategy