The Levant versus the Horn of Africa: evidence for bidirectional corridors of human migrations

Paleoanthropological evidence indicates that both the Levantine corridor and the Horn of Africa served, repeatedly, as migratory corridors between Africa and Eurasia. We have begun investigating the roles of these passageways in bidirectional migrations of anatomically modern humans, by analyzing 45 informative biallelic markers as well as 10 microsatellite loci on the nonrecombining region of the Y chromosome (NRY) in 121 and 147 extant males from Oman and northern Egypt, respectively. The present study uncovers three important points concerning these demic movements: (1) The E3b1-M78 and E3b3-M123 lineages, as well as the R1*-M173 lineages, mark gene flow between Egypt and the Levant during the Upper Paleolithic and Mesolithic. (2) In contrast, the Horn of Africa appears to be of minor importance in the human migratory movements between Africa and Eurasia represented by these chromosomes, an observation based on the frequency distributions of E3b*-M35 (no known downstream mutations) and M173. (3) The areal diffusion patterns of G-M201, J-12f2, the derivative M173 haplogroups, and M2 suggest more recent genetic associations between the Middle East and Africa, involving the Levantine corridor and/or Arab slave routes. Affinities to African groups were also evaluated by determining the NRY haplogroup composition in 434 samples from seven sub-Saharan African populations. Oman and Egypt's NRY frequency distributions appear to be much more similar to those of the Middle East than to any sub-Saharan African population, suggesting a much larger Eurasian genetic component. Finally, the overall phylogeographic profile reveals several clinal patterns and genetic partitions that may indicate source, direction, and relative timing of different waves of dispersals and expansions involving these nine populations.

A seasonal pattern of hospital medication errors in Alaska

Specific behavioral consequences of seasonal affective disorder have not been closely examined. Length of daylight is evaluated in relation to medication errors in a medical center located in the far north. Factors such as numbers of patient admissions, discharges, and deaths were controlled with data collected in Anchorage, Alaska, over 5 consecutive years, 1985-89. These data revealed that 58% of all medication errors occurred during the first quarter of the year. Medication errors were 1.95 times more likely in December than September. The best statistical prediction was for errors associated with levels of darkness 2 months earlier. There may be not only an impairment of work performance among hospital nursing staff that reaches a peak in late winter but, more importantly, medication errors appear to follow a pattern that is closely associated with the annual cycle of daylight and darkness.

Health care technology in Australia and New Zealand: contrasts and cooperation

Australia and New Zealand are neighbouring countries with similarities due to their settlement by Europeans, but with major differences in their economies, populations, geography and political systems. These differences have led to contrasting approaches to the introduction and control of health care technologies. New Zealand has historically had greater success in limiting the use of health technologies which have often been adopted more widely and rapidly in Australia. Recent initiatives in health technology assessment have involved participation by both countries, giving the potential for a joint approach to policy formulation on use of some medical devices and procedures.

Geographically diverse canid sampling provides novel insights into pre-industrial microbiomes

Canine microbiome studies are often limited in the geographic and temporal scope of samples studied. This results in a paucity of data on the canine microbiome around the world, especially in contexts where dogs may not be pets or human associated. Here, we present the shotgun sequences of fecal microbiomes of pet dogs from South Africa, shelter and stray dogs from India, and stray village dogs in Laos. We additionally performed a dietary experiment with dogs housed in a veterinary medical school, attempting to replicate the diet of the sampled dogs from Laos. We analyse the taxonomic diversity in these populations and identify the underlying functional redundancy of these microbiomes. Our results show that diet alone is not sufficient to recapitulate the higher diversity seen in the microbiome of dogs from Laos. Comparisons to previous studies and ancient dog fecal microbiomes highlight the need for greater population diversity in studies of canine microbiomes, as modern analogues can provide better comparisons to ancient microbiomes. We identify trends in microbial diversity and industrialization in dogs that mirror results of human studies, suggesting future research can make use of these companion animals as substitutes for humans in studying the effects of industrialization on the microbiome.

Is a national model for health planning appropriate?

In this article, a "point-counterpoint" format is used to discuss a fundamental issue concerned with the design and implementation of P.L. 93-641. Dr. Cyril Roseman first examines some implementation obstacles and argues that basic forces are at work militating against effective implementation of an implicit national model, and he argues that multiple models for planning should be formulated under the existing law. Boyd Palmer then counters with a view that the existing national model is flexible enough to accommodate the basic forces without undertaking the drastic changes implied by Dr. Roseman.

The planner as public health resource allocator: post-Proposition 13 county health services in California and the role of the HSAs in budget review and public hearings

Immediately following adoption of Proposition 13 in California in June of 1978, the state legislature adopted a Bail-Out program which included procedures for monitoring the detrimental effects of disproportionate reductions in public health, inpatient and outpatient county budgets. For a variety of reasons, the methodology and procedures employed failed to reveal the adverse effects of Proposition 13 on health services. This paper deals with the actual and potential role of health systems agencies (HSAs) in monitoring such effects, commenting in public hearings on budget review and, in general, playing a policy analysis role that links local government with the citizenry on the one hand and the state government on the other. In addition to identifying the weakness of the State's monitoring effort in identifying negative effects in program analysis and staffing reductions, the findings point out the limited role of HSAs. Specific recommendations are offered for improvement of HSA involvement in future resource allocation planning in California and the United States as a whole.

Persistent pain and its predictors after starting anti-tumour necrosis factor therapy in psoriatic arthritis: what is the role of inflammation control?

OBJECTIVE

While considerable focus has been placed on pain due to inflammation in psoriatic arthritis (PsA), less is reported on pain despite inflammation control. Here, we aimed to investigate the occurrence/predictors of persistent pain, including non-inflammatory components, after starting anti-tumour necrosis factor (anti-TNF) therapy.

METHOD

Bionaïve PsA patients starting a first anti-TNF therapy 2004-2010 were identified (South Swedish Arthritis Treatment Group register; N = 351). Outcomes included unacceptable pain [visual analogue scale (VAS) pain > 40 mm], and unacceptable pain despite inflammation control (refractory pain; VAS pain > 40 mm + C-reactive protein < 10 mg/L + ≤ 1 swollen joint of 28), assessed at 0, 3, 6, and 12 months. Baseline predictors were estimated by logistic regression.

RESULTS

Upon starting anti-TNF therapy, 85% of patients reported unacceptable pain, falling to 43% at 3 months and then remaining stable. After 12 months, refractory pain constituted 63% of all unacceptable pain. Higher baseline VAS pain/global, worse physical function and lower health-related quality-of-life were associated with a higher risk of unacceptable/refractory pain at 12 months. More swollen joints and higher evaluator's global assessment were associated with a lower risk of 12-month refractory pain.

CONCLUSIONS

A substantial proportion of PsA patients reported unacceptable pain throughout the first anti-TNF treatment year. At 12 months, refractory pain constituted about two-thirds of this remaining pain load. More objective signs of inflammation at anti-TNF initiation were associated with less future refractory pain. This highlights insufficient effect of biologics in patients with inflammation-independent pain, warranting alternative treatments.

Learning from the Aloha State

Since 1974, Hawaii has required its employers to provide health insurance to all employees working at least 20 hours a week. More recently, the state created a new program to cover the "gap group" of 50,000 uninsured residents, along with a new program to create a "seamless system of health care" for all Aloha State residents. And Hawaii has managed to insure nearly all of its citizens while keeping the annual price of health insurance at nearly half of that paid in many mainland states ($1,300 per person and $4,000 per family). At the same time, life expectancy is the highest in the nation and infant mortality is among the lowest. In seeking to reform a dysfunctional national insurance system, policymakers should learn from the Hawaiian experience, which shows that small business can live with an employer mandate, universal coverage can cut costs by encouraging early preventive care, and a dominant payer can reduce administrative expenses.

Workload and environmental factors in hospital medication errors

Nine hospital workload factors and seasonal changes in daylight and darkness were examined over a 5-year period in relation to nurse medication errors at a medical center in Anchorage, Alaska. Three workload factors, along with darkness, were found to be significant predictors of the risk of medication error. Errors increased with the number of patient days per month (OR/250 patient days = 1.61) and the number of shifts worked by temporary nursing staff (OR/10 shifts = 1.15); errors decreased with more overtime worked by permanent nursing staff members (OR/10 shifts = .85). Medication errors were 95% more likely in midwinter than in the fall, but the effect of increasing darkness was strongest; a 2-month delay was found between the level of darkness and the rate of errors. More than half of all medication errors occurred during the first 3 months of the year.

Joint venture acquisition of expensive medical technology by Oahu hospitals. Planning, operations and impact of lithotripsy and magnetic resonance imaging

Expensive diagnostic and treatment services and equipment are naturally suited to large, populous medical market areas, with sufficient forecasted service demand to justify the large investment in capital, construction and staffing. Only major tertiary or secondary medical centers with shared resources can justify the first-generation investment in the multimillion-dollar purchases of magnetic resonance imaging (MRI), megavoltage linear accelerators, or lithotripters. The regional referral system in most nations accommodates the outlying population in the less developed rural sectors.