Archaeological sites in Grand Canyon National Park along the Colorado River are eroding owing to six decades of Glen Canyon Dam operations

The archaeological record documenting human history in deserts is commonly concentrated along rivers in terraces or other landforms built by river sediment deposits. Today that record is at risk in many river valleys owing to human resource and infrastructure development activities, including the construction and operation of dams. We assessed the effects of the operations of Glen Canyon Dam - which, since its closure in 1963, has imposed drastic changes to flow, sediment supply and distribution, and riparian vegetation - on a population of 362 archaeological sites in the Colorado River corridor through Grand Canyon National Park, Arizona, USA. We leverage 50 years of evidence from aerial photographs and more than 30 years of field observations and measurements of archaeological-site topography and wind patterns to evaluate changes in the physical integrity of archaeological sites using two geomorphology-based site classification systems. We find that most archaeological sites are eroding; moreover, most are at increased risk of continuing to erode, due to six decades of operations of Glen Canyon Dam. Results show that the wind-driven (aeolian) supply of river-sourced sand, essential for covering archaeological sites and protecting them from erosion, has decreased for most sites since 1973 owing to effects of long-term dam operations on river sediment supply and riparian vegetation expansion on sandbars. Results show that the proportion of sites affected by erosion from gullies controlled by the local base-level of the Colorado River has increased since 2000. These changes to landscape processes affecting archaeological site integrity limit the ability of the National Park Service and Grand Canyon-affiliated Native American Tribes to achieve environmental management goals to maintain or improve site integrity in situ. We identify three environmental management opportunities that could be used to a greater extent to decrease the risk of erosion and increase the potential for in-situ preservation of archaeological sites. Environmental management opportunities are: 1) sediment-rich controlled river floods to increase the aeolian supply of river-sourced sand, 2) extended periods of low river flow to increase the aeolian supply of river-sourced sand, 3) the removal of riparian vegetation barriers to the aeolian transport of river-sourced sand.

Health-related quality of life in women after colposcopy: results from a longitudinal patient survey

BACKGROUND

Information concerning the health-related quality-of-life (HRQoL) consequences of colposcopy is limited, particularly over time. In a longitudinal study, we investigated women's HRQoL at 4, 8 and 12 months post colposcopy and the factors associated with this.

METHODS

Women attending colposcopy at two large hospitals affiliated with the national screening programme in Ireland were invited to complete questionnaires at 4, 8 and 12 months post colposcopy. HRQoL was measured using the EQ-5D-3L and compared across a range of socio-demographic, clinical and attitudinal variables. A mixed-effects logistic multivariable model was employed to investigate associations between these variables and low HRQoL.

RESULTS

Of 584 women initially recruited, 429, 343 and 303 completed questionnaires at 4, 8 and 12 months, respectively. The mean overall HRQoL score for the sample across all time points was 0.90 (SD 0.16). Approximately 18% of women experienced low HRQoL at each of the three time points. In multivariable testing, over the entire 12-month follow-up period, non-Irish nationals (OR 8.99, 95% CI 2.35-34.43) and women with high-grade referral cytology (OR 2.78, 95% CI 1.08-7.13) were at higher odds of low HRQoL. Women who were past (OR 0.20, 95% CI 0.07-0.58) or never (OR 0.42, 95% CI 0.16-1.12) smokers were at lower odds of low HRQoL than current smokers. As women's satisfaction with their healthcare increased their odds of experiencing low HRQoL fell (OR per unit increase 0.51, 95% CI 0.34-0.75).

CONCLUSIONS

Women's HRQoL did not change over the 12 months post colposcopy, but some subgroups of women were at higher risk of experiencing low HRQoL. These subgroups may benefit from additional support.

Physical after-effects of colposcopy and related procedures, and their inter-relationship with psychological distress: a longitudinal survey

OBJECTIVE

To estimate prevalence of post-colposcopy physical after-effects and investigate associations between these and subsequent psychological distress.

DESIGN

Longitudinal survey.

SETTING

Two hospital-based colposcopy clinics.

POPULATION

Women with abnormal cytology who underwent colposcopy (±related procedures).

METHODS

Questionnaires were mailed to women 4, 8 and 12 months post-colposcopy. Details of physical after-effects (pain, bleeding and discharge) experienced post-colposcopy were collected at 4 months. Colposcopy-specific distress was measured using the Process Outcome-Specific Measure at all time-points. Linear mixed-effects regression was used to identify associations between physical after-effects and distress over 12 months, adjusting for socio-demographic and clinical variables.

MAIN OUTCOME MEASURES

Prevalence of post-colposcopy physical after-effects. Associations between the presence of any physical after-effects, awareness of after-effects, and number of after-effects and distress.

RESULTS

Five-hundred and eighty-four women were recruited (response rate = 73, 59 and 52% at 4, 8 and 12 months, respectively). Eighty-two percent of women reported one or more physical after-effect(s). Multiple physical after-effects were common (two after-effects = 25%; three after-effects = 25%). Psychological distress scores declined significantly over time. In adjusted analyses, women who experienced all three physical after-effects had on average a 4.58 (95% CI: 1.10-8.05) higher distress scored than those who experienced no after-effects. Women who were unaware of the possibility of experiencing after-effects scored significantly higher for distress during follow-up.

CONCLUSIONS

The prevalence of physical after-effects of colposcopy and related procedures is high. The novel findings of inter-relationships between awareness of the possibility of after-effects and experiencing multiple after-effects, and post-colposcopy distress may be relevant to the development of interventions to alleviate post-colposcopy distress.

TWEETABLE ABSTRACT

Experiencing multiple physical after-effects of colposcopy is associated with psychological distress.

Triage of LSIL/ASC-US with p16/Ki-67 dual staining and human papillomavirus testing: a 2-year prospective study

OBJECTIVE

To investigate human papillomavirus (HPV) DNA testing and p16/Ki-67 staining for detecting cervical intraepithelial grade 2 or worse (CIN2+) and CIN3 in women referred to colposcopy with minor abnormal cervical cytology low-grade squamous intraepithelial lesions (LSIL) and atypical squamous cells of undermined significance (ASC-US). The clinical performance of both tests was evaluated as stand-alone tests and combined, for detection CIN2+ and CIN3 over 2 years.

METHODS

ThinPrep(®) liquid-based cytology (LBC) specimens were collected from 1349 women with repeat LSIL or ASC-US. HPV DNA was performed using Hybrid Capture. Where adequate material remained (n = 471), p16/Ki-67 overexpression was assessed. Clinical performance for detection of histologically diagnosed CIN2+ and CIN3 was calculated.

RESULTS

Approximately 62.2% of the population were positive for HPV DNA, and 30.4% were positive for p16/Ki-67. p16/Ki-67 showed no significant difference in positivity between LSIL and ASC-US referrals (34.3% versus 28.6%; P = 0.189). Women under 30 years had a higher rate of p16/Ki-67 compared to those over 30 years (36.0% versus 26.6%; P = 0.029). Overall HPV DNA testing produced a high sensitivity for detection of CIN3 of 95.8% compared to 79.2% for p16/Ki-67. In contrast, p16/Ki-67 expression offered a higher specificity, 75.2% versus 40.4% for detection of CIN3. Combining p16/Ki-67 with HPV DNA improved the accuracy in distinguishing between CIN3 and <CIN3. The absolute risk of CIN3 increased from 15.6% in women who were HPV DNA positive to 27% in women positive for HPV DNA and p16/Ki-67. Those negative for HPV DNA and p16/Ki-67 had a low risk of 1.2% of CIN3.

CONCLUSION

The addition of p16/Ki-67 to HPV DNA testing leads to a more accurate stratification of CIN in women presenting with minor cytological abnormalities.

Approaches taken to the treatment of young children with carious primary teeth: a national cross-sectional survey of general dental practitioners and paediatric specialists in England

AIM

To measure the distribution of choices for the treatment of a child with differing severities of caries in a primary molar tooth among specialists in paediatric dentistry and general dental practitioners (GDPs) in England.

METHOD

Two surveys were undertaken using the same tool. The populations invited to take part in the study were confined to dentists practising in England in 2004. They were 500 GDPs selected at random from the list of all GDPs with a National Health Service (NHS) contract identified by the Dental Practice Board (DPB) and all 148 specialists in paediatric dentistry appearing on the General Dental Council specialist register. The selected dentists were sent a questionnaire containing four hypothetical clinical case scenarios in which the severity of dental caries in a single primary molar differed. Each clinical case scenario had a list of possible treatment options and participants were asked to select their single most preferred treatment option. To maximise the response rate there were three mailing rounds.

RESULTS

Of the 500 GDPs and 148 paediatric specialists sent a questionnaire, 322 (64%) GDPs and 115 (78%) specialists responded. The answers to each of the case scenarios indicate differences of opinion both between and among GDPs and specialists in the care they would recommend for a child with caries in a primary molar tooth. This variation in opinion about care was more pronounced for a single deep carious lesion than for a less severe lesion. The spread of treatment options chosen in each scenario indicates disagreement among GDPs and specialists about restorative techniques and philosophy of care.

CONCLUSION

In England there is wide variation among GDPs and specialists in paediatric dentistry about the best way to treat a young child with caries in a primary molar tooth. Well designed studies are urgently needed to provide strong evidence for the most effective way to manage the dental care of children.

General dental practitioners' views on the use of stainless steel crowns to restore primary molars

AIM

To ascertain general dental practitioners' views on the use of stainless steel (pre-formed metal) crowns to restore carious primary molars.

METHOD

Ninety-three general dental practitioners were selected at random from those practising in Lancashire, Cheshire and Greater Manchester in 2003 and interviewed separately about the clinical care they provide to the primary dentition. Before the interview participants recorded the care they would provide for a case scenario, describing a child with a carious lesion that the British Society of Paediatric Dentistry (BSPD) guidelines indicate should be treated with a stainless steel crown.

RESULTS

In answering the case scenario only six (7%) of the dentists reported that they would fit a stainless steel crown. Of the 93 dentists interviewed 71% knew of the BSPD guidelines, but only 18% had ever fitted a stainless steel crown in general practice. Reasons given for not using stainless steel crowns were they are inappropriate for many children, time consuming to fit, difficult to manipulate, expensive, and ugly.

CONCLUSION

The BSPD guidelines on the use of stainless steel crowns do not reflect the views of the majority of general dental practitioners who consider these crowns unsuitable for most children and an impractical restorative technique in busy daily practice.

Potential viral pathogenic mechanism for new variant inflammatory bowel disease

AIMS

A new form of inflammatory bowel disease (ileocolonic lymphonodular hyperplasia) has been described in a cohort of children with developmental disorder. This study investigates the presence of persistent measles virus in the intestinal tissue of these patients (new variant inflammatory bowel disease) and a series of controls by molecular analysis.

METHODS

Formalin fixed, paraffin wax embedded and fresh frozen biopsies from the terminal ileum were examined from affected children and histological normal controls. The measles virus Fusion (F) and Haemagglutinin (H) genes were detected by TaqMan reverse transcription polymerase chain reaction (RT-PCR) and the Nucleocapsid (N) gene by RT in situ PCR. Localisation of the mRNA signal was performed using a specific follicular dendritic cell antibody.

RESULTS

Seventy five of 91 patients with a histologically confirmed diagnosis of ileal lymphonodular hyperplasia and enterocolitis were positive for measles virus in their intestinal tissue compared with five of 70 control patients. Measles virus was identified within the follicular dendritic cells and some lymphocytes in foci of reactive follicular hyperplasia. The copy number of measles virus ranged from one to 300,00 copies/ng total RNA.

CONCLUSIONS

The data confirm an association between the presence of measles virus and gut pathology in children with developmental disorder.

Development of brief pictorial instruments for assessing spirituality in primary care

The relationship between spirituality and health is an emerging area of study. However, spirituality assessment instruments with clinical utility for busy health care practices are lacking. The article describes research directed at developing and validating brief pictorial measures of spirituality as instruments to measure the relationship between reported spirituality and health. The instruments presented are patterned after the Dartmouth Medical School Primary Care Cooperative (COOP) charts. The charts also provide a nonthreatening way to enhance communication between patients and physicians in this important area.

The relationship between a patient's spirituality and health experiences

BACKGROUND AND OBJECTIVES

The relationship between spirituality and health is a new frontier in medicine. This study is a preliminary investigation into the relationship between a patient's experience of overall health, physical pain, and intrinsic spirituality.

METHODS

We used a stratified, random sample of 462 patients at a family practice residency clinic. The Index of Core Spiritual Experiences (INSPIRIT) measured intrinsic spirituality, and Dartmouth Primary Care Cooperative Charts measured overall health and pain. Pearson correlations tested the association between health, pain, and spirituality. Patient scores on the INSPIRIT were then placed into three groups (high, medium, and low levels of intrinsic spirituality). ANOVA tested for significant differences in health and pain.

RESULTS

We collected information from 442 of the patients surveyed (95%). We found significant correlation between patient health and spirituality. Significant differences were also found in both overall health and physical pain, based on the three levels of spirituality. Gender differences were only significant for overall health, not for patient pain.

CONCLUSIONS

Our results suggest an association between intrinsic spirituality and a patient's experience of health and pain. Assessment of spirituality may be important for family physicians to consider as a supplement to patient interviews.