COVID-19 contagion across remote communities in tropical forests.

Understanding COVID-19 contagion among poor populations is hampered by a paucity of data, and especially so in remote rural communities with limited access to transportation, communication, and health services. We report on the first study on COVID-19 contagion across rural communities without road access. We conducted telephone surveys with over 400 riverine communities in the Peruvian Amazon in the early phase of the pandemic. During the first wave (April-June, 2020), COVID-19 spread from cities to most communities through public and private river transportation according to their remoteness. The initial spread was delayed by transportation restrictions but at the same time was driven in unintended ways by government social assistance. During the second wave (August, 2020), although people's self-protective behaviors (promoted through communication access) helped to suppress the contagion, people responded to transportation restrictions and social assistance in distinct ways, leading to greater contagion among Indigenous communities than mestizo communities. As such, the spatial contagion during the early phase of the pandemic in tropical forests was shaped by river transportation and social behaviors. These novel findings have important implications for research and policies on pandemics in rural areas.

Landscape-scale concordance between local ecological knowledge for tropical wild species and remote sensing of land cover.

Monitoring the status of species is crucial for biodiversity conservation and sustainable resource management in tropical forests, but conventional in situ monitoring methods are impractical over large scales. Scientists have resorted to two potentially complementary approaches: local ecological knowledge (LEK) and remote sensing. To gauge the potential of combining LEK and remote sensing for assessing species status at landscape scales, a large-scale assessment of the reliability of both measures is critical but hampered by the lack of ground-level data. We conducted a landscape-scale assessment of LEK and remote sensing, using a survey of over 900 communities (a near census in our study area) and nearly 4,000 households in 235 randomly selected communities in the Peruvian Amazon-the largest LEK survey as yet undertaken in tropical forests. The survey collected LEK data on the presence of 20 indicator species from both community leaders/elders and randomly sampled households. We assessed LEK and remotely sensed land cover-forest cover and nonmain channel open water-as proxies for species habitat, across species (game, fish, and timber), over time (current and historical), and by indigeneity (Indigenous peoples and mestizos). Overall, LEK and remotely sensed land cover corroborate each other well. Concordance is highest for the current status of game species reported by sampled households, as is the concordance of historical LEK from Indigenous community leaders/elders. The results point to the promise of combining LEK and remote sensing in monitoring the status of species in data-poor tropical forests.

COVID-19 information and self-protective behaviors among rural communities in tropical forests.

BACKGROUND: Health risk communication plays a key role in promoting self-protective measures, which are critical in suppressing COVID-19 contagion. Relatively little is known about the communication channels used by rural poor populations to learn novel measures and their effectiveness in promoting self-protective behaviors. Behavioral change can be shaped by people's trust in government institutions which may be differentiated by social identity, including indigeneity. METHODS: During an early phase of the pandemic, we conducted two telephone surveys with over 460 communities - both Indigenous and mestizo - without road access and limited communication access in the Peruvian Amazon. This is the first report on the association of information sources about self-protective measures against COVID-19 with the adoption of self-protective behaviors in remote rural areas in developing countries. RESULTS: People mainly relied on mass media (radio, television, newspapers) and interpersonal sources (local authorities, health workers, neighbors/relatives) for information and adopted handwashing, mask-wearing, social distancing, and social restrictions to varying degrees. Overall, self-protective behaviors were largely positively and negatively associated with mass media and interpersonal sources, respectively, depending on the source-measure combination. Mistrust of the government seems to have shaped how Indigenous and mestizo peoples distinctively responded to interpersonal information sources and relied on mass media. CONCLUSIONS: Our findings call for improved media access to better manage pandemics in rural areas, especially among remote Indigenous communities.

Geolocation of unpublished archaeological sites in the Peruvian Amazon.

Published maps identifying archaeological sites in the Amazon basin show a paucity of sites in western Amazonia compared to the Brazilian Amazon. Whereas fewer than two dozen are identified for the Peruvian Amazon on basin-wide maps, a thorough review of unpublished archival material held by the Ministry of Culture of Peru and other sources revealed more than 400 known but unpublished sites in the Department of Loreto, challenging the notion that the region was sparsely occupied in prehistory. Our database provides the geolocation of each site and corresponding references for use by scientists seeking to better understand regional Pre-Columbian human occupation and settlement, cultural change, resource use and their landscape legacies. These data are foundational not only to the development of a richer understanding of prehistory and historical ecology of the Amazon basin but importantly for informing current land use, forest conservation and development policies as well as initiatives to support indigenous land and cultural rights in Amazonia.

Vaccine Hesitancy and Refusal: Behavioral Evidence from Rural Northern Nigeria.

It is widely believed that vaccine hesitancy is prevalent in African countries, although this belief is without rigorous evidence. Our field experiment in rural northern Nigeria behaviorally measured the prevalence of vaccine hesitancy-the non-uptake of vaccines despite their availability due to non-monetary factors directly associated with vaccination. We randomly assigned two tasks to women: answering a short survey at their house vs. additionally receiving a free tetanus vaccine by submitting a voucher. The differences in their completion rates captured vaccine hesitancy, showing the rate to be about 13%. Our study reveals that absolute refusers with negative willingness to pay (WTP) for vaccines, who are likely to have strong misperceptions or a distrust of vaccines, account for about half of vaccine hesitaters, while floating refusers with zero or weakly positive WTP, who are likely to be indifferent about vaccines, account for the other half. A simple intervention, such as a door-to-door vaccination campaign, is likely to be effective for floating refusers, while interventions for absolute refusers need to effectively change their misperceptions or distrust of vaccines.

Backfire effect of salient information on vaccine take-up experimental evidence from scared-straight intervention in rural northern Nigeria.

Vaccination is the most cost-effective way to prevent mothers and infants from contracting tetanus. However, developing countries struggle with the persistent low take-up of vaccination. The low risk perceptions of disease can be one of the barriers to vaccination. One way to increase the risk perceptions of disease is to use salient loss-framed messages to highlight negative consequences of not getting vaccinated. We conducted a randomized controlled trial among 1,660 women in 80 villages in northeastern Nigeria. Respondents were randomly assigned to view one of two flipcharts: (1) control flipcharts, which contained written explanation about the severity of the disease, or (2) `scared-straight' flipcharts that contain the salient information about the disease severity in addition to the written explanation about the severity of the disease. Additionally, respondents were provided randomly assigned amounts of cash incentives. The scared-straight intervention backfired among women with no previous experience of tetanus vaccination: it decreased their vaccine take-up by 3.7-6.1 percentage points, even though it increased their perceived risk of disease and their fear level. The negative effect of the scared-straight intervention is the most prevalent among women who received the lowest amount of cash incentive. Women without experience of tetanus vaccination might have responded to the scared-straight flipcharts by denying the information provided because the flipcharts were too frightening. The use of the scared-straight tactic is not recommended to aim for the improved take-up of vaccination in developing countries where people might face budget constraints for achieving desirable behaviors.Trial Registration: The trial was registered at ISRCTN registry (ID: ISRCTN95083356).

Predictors of early postoperative pneumonia after oncologic surgery with the patients receiving professional oral health care: A prospective, multicentre, cohort study.

This study was a prospective, multicentre, cohort study on 685 patients who had undergone oncologic surgery. The patients were divided into two groups according to the presence or absence of postoperative pneumonia. The two groups were compared with respect to their background, index operation, food eaten, oral condition, contents of oral care and dental treatment, laboratory data, and bacterial flora. All postoperative pneumonias occurred in six cases within four days postoperatively. The multivariable logistic regression analysis showed that preoperative serum C-reactive protein was the strongest predictor of postoperative pneumonia. In addition, decreased postoperative Candida albicans colonies was an effective predictor of postoperative pneumonia. For patients with predictors of postoperative pneumonia, perioperative strategies for its prevention should be considered in addition to professional oral health care. This study was approved by the National Hospital Organization's Central Ethics Review Board and was also approved by the directors of the participating institutions.

An Avulsed Tooth Detected Prior to Insertion of a Laryngeal Mask Airway.

This case report describes the importance of inspecting the hypopharynx via direct laryngoscopy prior to laryngeal mask airway (LMA) insertion during induction of general anesthesia for dental patients with special needs. A 51-year-old man with cerebral palsy underwent induction of general anesthesia for dental extractions and subsequently was noted to be missing a tooth. Prompt inspection of the airway via direct laryngoscopy revealed the tooth resting within the pharynx, which was subsequently retrieved, prior to insertion of the LMA. Visual inspection of the oropharynx and hypopharynx by laryngoscopy prior to LMA insertion can be useful in preventing accidental aspiration and ingestion of foreign bodies, particularly with certain high-risk patients. Use of laryngoscopy should also be considered if an object is lost or possibly impinging upon the airway.

GIS for empirical research design: An illustration with georeferenced point data.

This paper demonstrates how Geographic Information Systems (GIS) can be utilized to study the effects of spatial phenomena. Since experimental designs such as Randomized Controlled Trials are generally not feasible for spatial problems, researchers need to rely on quasi-experimental approaches using observational data. We provide a regression-based framework of the key procedures for GIS-based empirical research design using georeferenced point data for both spatial events of interest and subjects exposed to the events. We illustrate its utility and implementation through a case study on the impacts of the Cambodian genocide under the Pol Pot regime on post-conflict education.

Genome-wide association study of sensory disturbances in the inferior alveolar nerve after bilateral sagittal split ramus osteotomy.

BACKGROUND: Bilateral sagittal split ramus osteotomy (BSSRO) is a common orthognatic surgical procedure. Sensory disturbances in the inferior alveolar nerve, including hypoesthesia and dysesthesia, are frequently observed after BSSRO, even without distinct nerve injury. The mechanisms that underlie individual differences in the vulnerability to sensory disturbances have not yet been elucidated. METHODS: The present study investigated the relationships between genetic polymorphisms and the vulnerability to sensory disturbances after BSSRO in a genome-wide association study (GWAS). A total of 304 and 303 patients who underwent BSSRO were included in the analyses of hypoesthesia and dysesthesia, respectively. Hypoesthesia was evaluated using the tactile test 1 week after surgery. Dysesthesia was evaluated by interview 4 weeks after surgery. Whole-genome genotyping was conducted using Illumina BeadChips including approximately 300,000 polymorphism markers. RESULTS: Hypoesthesia and dysesthesia occurred in 51 (16.8%) and 149 (49.2%) subjects, respectively. Significant associations were not observed between the clinical data (i.e., age, sex, body weight, body height, loss of blood volume, migration length of bone fragments, nerve exposure, duration of anesthesia, and duration of surgery) and the frequencies of hypoesthesia and dysesthesia. Significant associations were found between hypoesthesia and the rs502281 polymorphism (recessive model: combined χ² = 24.72, nominal P = 6.633 × 10⁻7), between hypoesthesia and the rs2063640 polymorphism (recessive model: combined χ² = 23.07, nominal P = 1.563 × 10⁻6), and between dysesthesia and the nonsynonymous rs2677879 polymorphism (trend model: combined χ² = 16.56, nominal P = 4.722 × 10⁻5; dominant model: combined χ² = 16.31, nominal P = 5.369 × 10⁻5). The rs502281 and rs2063640 polymorphisms were located in the flanking region of the ARID1B and ZPLD1 genes on chromosomes 6 and 3, whose official names are "AT rich interactive domain 1B (SWI1-like)" and "zona pellucida-like domain containing 1", respectively. The rs2677879 polymorphism is located in the METTL4 gene on chromosome 18, whose official name is "methyltransferase like 4". CONCLUSIONS: The GWAS of sensory disturbances after BSSRO revealed associations between genetic polymorphisms located in the flanking region of the ARID1B and ZPLD1 genes and hypoesthesia and between a nonsynonymous genetic polymorphism in the METTL4 gene and dysesthesia.

Land-use poverty traps identified in shifting cultivation systems shape long-term tropical forest cover.

In this article we illustrate how fine-grained longitudinal analyses of land holding and land use among forest peasant households in an Amazonian village can enrich our understanding of the poverty/land cover nexus. We examine the dynamic links in shifting cultivation systems among asset poverty, land use, and land cover in a community where poverty is persistent and primary forests have been replaced over time--with community enclosure--by secondary forests (i.e., fallows), orchards, and crop land. Land cover change is assessed using aerial photographs/satellite imagery from 1965 to 2007. Household and plot level data are used to track land holding, portfolios, and use as well as land cover over the past 30 y, with particular attention to forest status (type and age). Our analyses find evidence for two important types of "land-use" poverty traps--a "subsistence crop" trap and a "short fallow" trap--and indicate that the initial conditions of land holding by forest peasants have long-term effects on future forest cover and household welfare. These findings suggest a new mechanism driving poverty traps: insufficient initial land holdings induce land use patterns that trap households in low agricultural productivity. Path dependency in the evolution of household land portfolios and land use strategies strongly influences not only the wellbeing of forest people but also the dynamics of tropical deforestation and secondary forest regrowth.

Targeting cyclone relief within the village: kinship, sharing, and capture.

This article investigates the targeting of cyclone relief within villages in Fiji. It focuses on how relief allocation is linked with informal risk sharing and elite capture, both of which are directly related to kinship. The results are as follows. First, food aid is initially targeted toward kin groups according to their aggregate shocks and then shared among group members. Right after the cyclone, when aid is scarce, households with damage to their housing and with greater crop damage are allocated less aid within the group. Instead, they receive greater net private transfers in other forms, especially in labor sharing. Consistent patterns are found in village, cropping, and housing rehabilitations. Second, there is no elite capture of food aid in the kin group, and instead, traditional kin leaders share food with others; however, non-kin-based community leaders capture aid when it is allocated across kin groups. Third, distinct from food aid demanded by all, tarpaulins demanded by victims only strongly target individual housing damage at the village level­not the kin group­independent of social status. As with food aid, victims with greater crop damage are given a lower priority. Implications for relief policies are discussed.

Reconstruction of the inferior alveolar nerve by autologous graft: a retrospective study of 20 cases examining donor nerve length.

The purpose of this study was to confirm the length and kind of donor nerves used in nerve grafts for reconstruction of inferior alveolar nerve defects. The authors conducted a retrospective study of surgeries that were performed between 1977 and 1996. A total of 20 patients underwent nerve grafting procedures during this period. The greater auricular nerve was selected as the donor nerve in 16 cases, while the sural nerve was selected in 4. Mean lengths of donor nerves were 7.28 +/- 1.6 cm and 11.5 +/- 3.4 cm for the greater auricular and sural nerves, respectively. As indicated, the sural nerves were significantly longer (p < 0.01). Mean lengths of donor nerves grafted for partial resection and hemi-mandibulectomy were 7.23 +/- 1.6 cm and 10.8 +/- 3.4 cm, respectively. Statistical analysis indicated that grafts used in the hemi-mandibulectomy group were significantly longer (p < 0.05). In terms of types of donor nerve used in mandibulectomies, the greater auricular nerve was used in the majority of partial resections, and the sural nerve was employed for hemi-mandibulectomy.