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Most clinical microbiology laboratories have replaced toxin immunoassay (EIA) alone with multistep testing (MST) protocols or nucleic acid amplification testing (NAAT) alone for the detection of C. difficile.
Study the effect of changing testing strategies on C. difficile detection and strain diversity.
A Veterans’ Affairs hospital.
Initially, toxin EIA testing was replaced by an MST approach utilizing a glutamate dehydrogenase (GDH) and toxin EIA followed by tcdB NAAT for discordant results. After 18 months, MST was replaced by a NAAT-only strategy. Available patient stool specimens were cultured for C. difficile. Restriction endonuclease analysis (REA) strain typing and quantitative in vitro toxin testing were performed on recovered isolates.
Before MST (toxin EIA), 79 of 708 specimens (11%) were positive, and after MST (MST-A), 121 of 517 specimens (23%) were positive (P < .0001). Prior to NAAT-only testing (MST-B), 80 of the 490 specimens (16%) were positive by MST, and after NAAT-only testing was implemented, 67 of the 368 specimens (18%) were positive (P = nonsignificant). After replacing toxin EIA testing, REA strain group diversity increased (8, 13, 13, and 10 REA groups in the toxin EIA, MST-A, MST-B, and NAAT-only periods, respectively) and in vitro toxin concentration decreased. The average log10 toxin concentration of the isolates were 2.08, 1.88, 1.20 and 1.55 ng/mL for the same periods, respectively.
MST and NAAT had similar detection rates for C. difficile. Compared to toxin testing alone, they detected increased diversity of C. difficile strains, many of which were low toxin producing.
WHEN THE CANADIAN Confederation Group poet William Wilfred Campbell turned to the Matter of Britain in his medievalist verse-drama Mordred, composed 1893–94, he was embarking upon politically fraught aesthetic terrain that was just beginning to be explored by writers of the new Dominion. Prior to 1892 – the year Campbell published his Arthurian poem, “Sir Lancelot” – the principal texts in this nascent tradition of Canadian Arthuriana were Irish emigrant and Anglican clergyman John Reade's “The Prophecy of Merlin” (1870) and Charles G.D. Roberts's “Launcelot and the Four Queens” (1880). In both of these early works, much of what D.M.R. Bentley aptly refers to as “the politically complex … habitus” of post-Confederation Canadian literature is made apparent by their authors’ self-conscious engagements with a tradition of British medievalism whose availability as a site of national self-recognition was no longer self-evident. Reade, for instance, in his reprising of Alfred Tennyson's “The Passing of Arthur,” feels compelled to justify his ex-centric (post?)colonial site of enunciation by inscribing Canada directly into Arthurian history in the form of a consoling prophecy, spoken by Merlin to Bedivere, about the founding of a new kingdom “In a far land beneath the setting sun / Now and long hence undreamed of… / … a land of stately woods, / Of swift broad rivers, and of ocean lakes,” that Queen Victoria and Prince Albert's son, a new Arthur, will visit and eventually oversee as Governor-General. In this way, Reade “celebrate[s] the British Empire's high destiny,” includes Canada in that destiny, and secures his own poetic authority in a single stroke.
Roberts's participation in the Victorian Medieval Revival in Canada was more straightforward than Reade's but no less significant: his poem's dramatization of Morgan le Fay's machinations and Launcelot's guilty conscience simply present no contradiction to him as subjects for Canadian poetry. As a self-described “cosmopolitan nationalist” Roberts was to argue in “The Beginnings of Canadian Literature” (1883) that a Canadian literary tradition should not require works exclusively based on “Canadian themes” to be considered authentic; Canadians were inheritors of “the whole heritage of English song,” and “the domain of English letters knows no boundaries of Canadian Dominion, of American Commonwealth, nor yet of British Empire.”
To examine the relationship between protein intake and the risk of incident premenstrual syndrome (PMS).
Nested case–control study. FFQ were completed every 4 years during follow-up. Our main analysis assessed protein intake 2–4 years before PMS diagnosis (for cases) or reference year (for controls). Baseline (1991) protein intake was also assessed.
Nurses’ Health Study II (NHS2), a large prospective cohort study of registered female nurses in the USA.
Participants were premenopausal women between the ages of 27 and 44 years (mean: 34 years), without diagnosis of PMS at baseline, without a history of cancer, endometriosis, infertility, irregular menstrual cycles or hysterectomy. Incident cases of PMS (n 1234) were identified by self-reported diagnosis during 14 years of follow-up and validated by questionnaire. Controls (n 2426) were women who did not report a diagnosis of PMS during follow-up and confirmed experiencing minimal premenstrual symptoms.
In logistic regression models adjusting for smoking, BMI, B-vitamins and other factors, total protein intake was not associated with PMS development. For example, the OR for women with the highest intake of total protein 2–4 years before their reference year (median: 103·6 g/d) v. those with the lowest (median: 66·6 g/d) was 0·94 (95 % CI 0·70, 1·27). Additionally, intakes of specific protein sources and amino acids were not associated with PMS. Furthermore, results substituting carbohydrates and fats for protein were also null.
Overall, protein consumption was not associated with risk of developing PMS.
The growing prevalence of non-communicable diseases, combined with greater recognition of the effectiveness of lipid lowering agents (LLAs), has fuelled their increasing use in recent years. Similarly, increasing recognition of mental health and, arguably, societal expectations and pressures, has driven appreciable growth in antidepressant prescribing in recent years. Concurrent with this, growing resource pressures enhanced by the continual launch of new premium priced medicines necessitates reforms and initiatives within finite budgets. Scotland has introduced multiple measures in recent years to improve both the quality and efficiency of prescribing. There is a need to document these initiatives and outcomes to provide future direction.
Assessment of the utilization (items dispensed) and expenditure of key LLAs (mainly statins) and SSRIs between 2001 and 2017 in Scotland alongside initiatives.
Multiple interventions have increased international non-proprietary name (INN) prescribing (99% for statins and up to 99.9% for SSRIs). They have also increased preferential prescribing of generic versus patented statins with low costs for generics, reduced inappropriate prescribing of ezetimibe due to effectiveness concerns, and increased the prescribing of higher dose statins (71% in 2015). These measures have resulted in a 50% reduction in LLA expenditure between 2001 and 2015 despite a 412% increase in utilization. Initiatives to reduce the prescribing of escitalopram as lack of evidence demonstrating cost-benefits over generic citalopram, along with high INN prescribing, achieved a 73.7% reduction in SSRI expenditure between 2001 and 2017 despite a 2.34-fold increase in utilisation. Concerns with paroxetine, and more recently citalopram and escitalopram following safety warnings, resulted in a considerable reduction in their use alongside a significant increase in sertraline.
Generic availability coupled with multiple measures has resulted in appreciable shifts in statin and SSRI prescribing behavior and reduced ezetimibe prescribing, resulting in improvements in both the quality and efficiency of prescribing to provide future direction.
In response to concerns about acetolactate synthase (ALS) inhibitor–resistant weeds in wheat production systems, we explored the efficacy of managing Bromus spp., downy and Japanese bromes, in a winter wheat system using alternative herbicide treatments applied in either fall or spring. Trials were established at Lethbridge and Kipp, Alberta, and Scott, Saskatchewan, Canada over three growing seasons (2012–2014) to compare the efficacy of pyroxasulfone (a soil-applied very-long-chain fatty acid elongase inhibitor; WSSA Group 15) and flumioxazin (a protoporphyrinogen oxidase inhibitor; WSSA Group 14) against industry-standard ALS-inhibiting herbicides for downy and Japanese brome control. Winter wheat injury from herbicide application was minor, with the exception of flucarbazone application at Scott. Bromus spp. control was greatest with pyroxsulam and all herbicide treatments containing pyroxasulfone. Downy and Japanese bromes were controlled least by thiencarbazone and flumioxazin, respectively, whereas Bromus spp. had intermediate responses to the other herbicides tested. Herbicides applied in fall resulted in reduced winter wheat yield relative to the spring applications. Overall, pyroxasulfone or pyroxsulam provided the most efficacious Bromus spp. control compared with the other herbicides and consistently maintained optimal winter wheat yields. Therefore, pyroxasulfone could facilitate management of Bromus spp. resistant to ALS inhibitors in winter wheat in the southern growing regions of western Canada. Improved weed control and delayed herbicide resistance may be achieved when pyroxasulfone is applied in combination with flumioxazin.
Approximately 8–20 % of reproductive-aged women experience premenstrual syndrome (PMS), substantially impacting quality of life. Women with PMS are encouraged to reduce fat intake to alleviate symptoms; however, its role in PMS development is unclear. We evaluated the association between dietary fat intake and PMS development among a subset of the prospective Nurses’ Health Study II cohort. We compared 1257 women reporting clinician-diagnosed PMS, confirmed by premenstrual symptom questionnaire and 2463 matched controls with no or minimal premenstrual symptoms. Intakes of total fat, subtypes and fatty acids were assessed via FFQ. After adjustment for age, BMI, smoking, Ca and other factors, intakes of total fat, MUFA, PUFA and trans-fat measured 2–4 years before were not associated with PMS. High SFA intake was associated with lower PMS risk (relative risk (RR) quintile 5 (median=28·1 g/d) v. quintile 1 (median=15·1 g/d)=0·75; 95 % CI 0·58, 0·98; Ptrend=0·07). This association was largely attributable to stearic acid intake, with women in the highest quintile (median=7·4 g/d) having a RR of 0·75 v. those with the lowest intake (median=3·7 g/d) (95 % CI 0·57, 0·97; Ptrend=0·03). Individual PUFA and MUFA, including n-3 fatty acids, were not associated with risk. Overall, fat intake was not associated with higher PMS risk. High intake of stearic acid may be associated with a lower risk of developing PMS. Additional prospective research is needed to confirm this finding.
A qualitative ranking method, Q methodology, was used to assess stakeholder priorities for socioecological services derived from coastal marshes and communities. The goal was to reveal strength of concerns for and tradeoffs among effects of coastal resilience strategies. Factor analysis identified three perspectives that formed a spectrum from high to low priorities on intangible services. Academic and government stakeholders were more likely than local residents to prioritize intangible services, but stakeholder views were diverse. A collaborative learning process promoted some alignment of views and academics showed the most movement – towards residents’ perspectives. Q-sort appeared effective at efficiently synthesizing broad concerns.
To assess the effects of aripiprazole once-monthly 400 mg (AOM 400) on clinical symptoms and global improvement in schizophrenia after switching from an oral antipsychotic.
In a multicenter, open-label, mirror-image, naturalistic study in patients with schizophrenia (>1 year, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR] criteria), changes in efficacy measures were assessed during prospective treatment (6 months) with AOM 400 after switching from standard-of-care oral antipsychotics. During prospective treatment, patients were cross-titrated to oral aripiprazole monotherapy (1–4) weeks followed by open-label AOM 400 (24 weeks). Mean change from baseline of the open-label AOM 400 phase in Positive and Negative Syndrome Scale (PANSS) scores (total, positive and negative subscales) and Clinical Global Impression–Severity (CGI-S) scores; mean CGI–Improvement (CGI-I) score; and proportion of responders (≥30% decrease from baseline in PANSS total score or CGI-I score of 1 [very much improved] or 2 [much improved]) were assessed.
PANSS and CGI-S scores improved from baseline (P<0.0001) and CGI-I demonstrated improvement at all time points. By the end of the study, 49.0% of patients were PANSS or CGI-I responders.
In a community setting, patients with schizophrenia who were stabilized at baseline and switched to AOM 400 from oral antipsychotics showed clear improvements in clinical symptoms.
Giant ragweed has been increasing as a major weed of row crops in the last
30 yr, but quantitative data regarding its pattern and mechanisms of spread
in crop fields are lacking. To address this gap, we conducted a Web-based
survey of certified crop advisors in the U.S. Corn Belt and Ontario, Canada.
Participants were asked questions regarding giant ragweed and crop
production practices for the county of their choice. Responses were mapped
and correlation analyses were conducted among the responses to determine
factors associated with giant ragweed populations. Respondents rated giant
ragweed as the most or one of the most difficult weeds to manage in 45% of
421 U.S. counties responding, and 57% of responding counties reported giant
ragweed populations with herbicide resistance to acetolactate synthase
inhibitors, glyphosate, or both herbicides. Results suggest that giant
ragweed is increasing in crop fields outward from the east-central U.S. Corn
Belt in most directions. Crop production practices associated with giant
ragweed populations included minimum tillage, continuous soybean, and
multiple-application herbicide programs; ecological factors included giant
ragweed presence in noncrop edge habitats, early and prolonged emergence,
and presence of the seed-burying common earthworm in crop fields. Managing
giant ragweed in noncrop areas could reduce giant ragweed migration from
noncrop habitats into crop fields and slow its spread. Where giant ragweed
is already established in crop fields, including a more diverse combination
of crop species, tillage practices, and herbicide sites of action will be
critical to reduce populations, disrupt emergence patterns, and select
against herbicide-resistant giant ragweed genotypes. Incorporation of a
cereal grain into the crop rotation may help suppress early giant ragweed
emergence and provide chemical or mechanical control options for
late-emerging giant ragweed.
The fact that crime and disorder are concentrated at a few places is interesting and deserves an explanation. It is also interesting that places show up in other criminological theories and in other disciplines. And it is useful to understand the methods for studying places. However, a primary reason we are interested in high-crime places is that it might be possible to do something about crime by addressing these places. We are convinced that focusing on places can substantially reduce crime and disorder. Our conviction is not a matter of faith, but is based on over twenty-five years of accumulating evidence.
This chapter summarizes the research evidence examining whether focusing on crime places reduces crime. We first discuss a broad range of place-based prevention strategies examined by Eck and Guerrette (2012). This review provides strong evidence for a place-based approach to crime prevention. We then turn to a specific form of place-based crime prevention – hot spots policing (Sherman and Weisburd 1995). Again, we have a strong body of evidence supporting a place-based approach. Having reviewed hot spots policing, we turn to the importance of place managers and third parties in controlling problem places. We then examine an extension of the third-party approach to argue that a place-based approach to crime may free crime control policy from the police monopoly. Then we describe how a place-based approach to crime could be incorporated in community corrections to improve probation and parole outcomes. Finally, we review the larger body of research on the potential threat of crime displacement, and its opposite, the diffusion of crime control benefits. Consistently, the evidence described in this chapter clearly shows the substantial utility of a place-based approach for reducing crime.
SITUATIONAL CRIME PREVENTION AT PLACES
In Chapter 3 we argued for the importance of social disorganization theories for understanding crime places. This is an area where basic research suggests promise (e.g., see Weisburd et al. 2012; Weisburd et al. 2014), but where there is little evidence of effectiveness of specific practices. Such evidence is beginning to be developed, but we can say little at this juncture. In contrast, the evidence regarding opportunity reduction and crime has grown systematically over the last few decades.
Take a moment to imagine a crime occurring – perhaps a street robbery or a bag snatch. When you do this, it is difficult not to visualize the crime occurring in a particular setting or place. So, you might imagine a dark street corner with dim street lighting or seating in the outside area of a public bar. It seems intuitively sensible to analyze and understand crime at this unit of analysis – in other words, to investigate how criminals behave and crime concentrates at small microplaces. However, engaging in such microlevel analysis has tended to be a more recent criminological undertaking, and there are still many fruitful avenues to explore in terms of advancing both our knowledge and the sophistication of the methods that we use in this research area.
In this chapter, we raise and endeavor to answer a number of questions concerning the appropriate scale of analysis of criminological enquiry. To do this, we will start by defining what we mean by place and how this differs from other geographic concepts. Next, we highlight what has become the key catalyst for the criminology of place – the tremendous concentration of crime at microgeographic units of analysis. The strong and consistent concentration of crime at addresses, street segments, and other microgeographic units across cities is key to understanding why it is important to study the criminology of place and why it has such strong policy implications. We then turn to some additional statistical benefits of studying crime at microgeographic units that have to do with what is often termed “spatial interaction effects.” Finally, we examine problems that crime and place researchers will need to consider, and recommend some future directions for research exploring crime concentration at places.
PLACE AND SPACE
Geographic concepts are sometimes used in criminological research without a clear understanding of their meaning. Place and space are two such concepts. The subtle difference between them is important to keep in mind, as they can be a guide to establishing a carefully constructed study and influence the interpretation of findings. Furthermore, as will become apparent later in this chapter, a confusion of these concepts can mislead the reader in the interpretation of an argument. For example, it is important to keep in mind that place does not necessarily mean small units of analysis, nor does space necessarily refer to large areas.
Over the last two decades, there has been increased interest in the distribution of crime and other antisocial behavior at lower levels of geography. The focus on micro geography and its contribution to the understanding and prevention of crime has been called the 'criminology of place'. It pushes scholars to examine small geographic areas within cities, often as small as addresses or street segments, for their contribution to crime. Here, the authors describe what is known about crime and place, providing the most up-to-date and comprehensive review available. Place Matters shows that the study of criminology of place should be a central focus of criminology in the twenty-first century. It creates a tremendous opportunity for advancing our understanding of crime, and for addressing it. The book brings together eighteen top scholars in criminology and place to provide comprehensive research expanding across different themes.
This chapter explores the importance of place in theory and research in both mainstream criminology and other disciplines. As we noted in earlier chapters, traditional criminology has focused primarily on understanding why people commit crime. This focus on criminality has generally inhibited study of microgeographies and their role in producing crime. However, more recently there has been a trend toward integrating microgeographic places into traditional theorizing about criminality. In the first part of the chapter we discuss this trend, focusing on some recent innovations in understanding criminality that have incorporated place-based perspectives. In the second part of the chapter we focus on how other disciplines have influenced thinking in this area, focusing in particular on contributions in psychology, economics, and public health. Finally, we explore how trends in other disciplines might influence future directions of study in the criminology of place.
THE GROWING ROLE OF MICROGEOGRAPHIC PLACES IN TRADITIONAL THEORIZING OF CRIMINALITY
As we noted in Chapter 1, places, at least at a macro level, played a key part in the development of criminology in the nineteenth and early twentieth centuries. But despite the role of place in crime in empirical study in Europe and theoretical development in the Chicago School through social disorganization theory, microgeographic places were mostly ignored. This was not because early criminologists failed to recognize the role of place in crime. Crime occurs in specific environments, and this was apparent to observers of the crime problem. Nonetheless, as we noted in Chapter 1, early criminologists did not see “crime places” – small discrete areas within communities – as a relevant focus of criminological study. This was the case, in part, because crime opportunities provided by places were assumed to be so numerous as to make concentration on specific places of little utility for theory or policy. What is the point of focusing theory or research on the opportunities offered by specific places if such opportunities can be found throughout the urban context?
Moreover, criminologists did not see the utility in focusing in on situational opportunities when criminal motivation was the key to understanding crime rates. Criminologists traditionally assumed that situational factors played a relatively minor role in explaining crime as compared with the “driving force of criminal dispositions” (Clarke and Felson 1993, 4; Trasler 1993).
In the previous chapter, we showed that crime is concentrated at very small geographic units, substantially smaller than neighborhoods, and that these concentrations, on average, are relatively stable. This is true whether examining high- or low-crime neighborhoods. Although high-crime places do cluster, they seldom form a homogeneous block of high-crime places. Rather, interspersed within concentrations of high-crime places are many low- and modest-crime places.
Why is crime concentrated in a relatively small number of places? Standard criminology has not asked this question, largely because standard criminology focuses on criminality and implicitly assumes that the density of offenders explains crime density. Recognition that place characteristics matter is the starting point for this chapter. We look at two perspectives on crime place characteristics. We use the term “perspective” because each type of explanation is comprised of multiple theories linked by a common orientation. The first perspective arises from opportunity theories of crime. The second perspective arises from social disorganization theories of crime.
We begin by contrasting two ways of thinking about how a place becomes a crime hot spot and suggest that the process by which high-crime places evolve must involve place characteristics. In the next sections, we examine opportunity and social disorganization explanations. In the final section of the chapter, we examine possible ways researchers might link these two perspectives.
PROCESSES THAT CREATE CRIME PLACES
Before we look for explanations of why places become hot spots of crime it is important to consider two processes that might lead to such an outcome. Criminologists have generally proposed two generic models to account for the processes that lead to variation in place susceptibility to crime. One model suggests that places may start with reasonably similar risks of an initial criminal attack, but once attacked the risk of a subsequent attack on the place rises. Over time, places diverge in their crime risk, and consequently in their crime counts. This temporal contagion model is also known as a boost model (see Chapter 2) or a state-dependence model. It puts the emphasis on offenders’ willingness to return to a previously successful crime site (Johnson et al. 2007; Townsley et al. 2000). It suggests that irrespective of initial crime risk the occurrence of a crime will lead to changes in risk of crime at a place.
We began this book by noting that criminologists have largely ignored the involvement of microgeographic places in crime. Mainstream criminologists have focused on “who done it?” and not “where done it?” (Sherman 1995). At least for the last century the key inquiries of crime and the key prevention approaches have looked to doing something about criminal motivation (Sutherland 1947; Reiss 1981). Why people commit crime has been the main focus of criminology (Brantingham and Brantingham 1990; Weisburd 2002), and catching and processing offenders has been the main focus of crime prevention (Weisburd 2008). In contrast, the criminology of place (Sherman et al. 1989; Weisburd et al. 2012), which began to develop in the 1980s and 1990s (Brantingham and Brantingham 1981; 1984; Eck 1994; Eck and Weisburd 1995; Roncek and Bell 1981; Weisburd and Green 1995a), provides an alternative vision of how we can understand crime and the crime problem. Like the emergence of community criminology during the same period (Bursik 1988; Morenoff et al. 2001; Sampson 2008; Sampson et al. 1997) the criminology of place has offered a new set of mechanisms for crime study and a new set of methods for doing something about the crime problem.
Theory has been a driving force in criminological study, and as we note below, we think that more not less attention to theory is important for advancing the criminology of place. However, theories are about something and try to explain something. When we change the unit of analysis, we are changing the target for theory. The criminology of place proposes a new target. It focuses on places, rather than people. Its goal is to explain the criminal involvement of microgeographic units rather than trying to explain the criminal involvement of people. This does not mean we ignore the role of individuals in the crime problem. But it does mean that we begin our inquiries with the place and see the individuals as only one part of the crime equation at places.
We have illustrated in the preceding chapters the extent to which theory, method, and empirical evidence about crime places have been developing over the last three decades. In this concluding chapter, we want to draw from our review of what is known some key themes that we think our work has identified, and key questions that still need to be answered.