Caribbean health research has overwhelmingly employed measures developed elsewhere and rarely includes evaluation of psychometric properties. Established measures are important for research and practice. Particularly, measures of stress and coping are needed. Stressors experienced by Caribbean people are multifactorial, as emerging climate threats interact with existing complex and vulnerable socioeconomic environments. In the early COVID-19 pandemic, our team developed an online survey to assess the well-being of health professions students across university campuses in four Caribbean countries. This survey included the Perceived Stress Scale, 10-item version (PSS-10) and the Brief Resilient Coping Scale (BRCS). The participants were 1,519 health professions students (1,144 females, 372 males). We evaluated the psychometric qualities of the measures, including internal consistency, concurrent validity by correlating both measures, and configural invariance using confirmatory factor analysis (CFA). Both scales had good internal consistency, with omega values of 0.91 for the PSS-10 and 0.81 for the BRCS. CFA suggested a two-factor structure of the PSS-10 and unidimensional structure of the BRCS. These findings support further use of these measures in Caribbean populations. However, the sampling strategy limits generalizability. Further research evaluating these and other measures in the Caribbean is desirable.

The Repugnant Conclusion is an implication of some approaches to population ethics. It states, in Derek Parfit's original formulation,

Background: SMA is characterized by reduced levels of survival of motor neuron (SMN) protein from deletions and/or mutations of the SMN1 gene. While SMN1 produces full-length SMN protein, a second gene, SMN2, produces low levels of functional SMN protein. Risdiplam (RG7916/RO7034067) is an investigational, orally administered, centrally and peripherally distributed small molecule that modulates pre-mRNA splicing of SMN2 to increase SMN protein levels. Methods: SUNFISH (NCT02908685) is an ongoing multicenter, double-blind, placebo-controlled, operationally seamless study (randomized 2:1, risdiplam:placebo) in patients aged 2–25 years, with Type 2/3 SMA. Part 1 (n=51) assesses safety, tolerability, pharmacokinetics and pharmacodynamics of different risdiplam dose levels. Pivotal Part 2 (n=180) assesses safety and efficacy of the risdiplam dose level selected based on Part 1 results. Results: Part 1 results showed a sustained, >2-fold increase in median SMN protein versus baseline following 1 year of treatment. Adverse events were mostly mild, resolved despite ongoing treatment and reflected underlying disease. No drug-related safety findings have led to withdrawal (data-cut 06/17/18). SUNFISH Part 1 exploratory endpoint results and Part 2 study design will also be presented. Conclusions: To date, no drug-related safety findings have led to withdrawal. Risdiplam led to sustained increases in SMN protein levels.

Background: Spinal Muscular Atrophy (SMA) is an autosomal recessive neurodegenerative disease. In June 2017, Health Canada approved Nusinersen, currently the only available drug for SMA. Since 2016, patients in Ontario have been treated clinically with Nusinersen through different access programs. Methods: Retrospective case series of patients with SMA treated clinically with Nusinersen in Ontario, describing clinical characteristics and logistics of intrathecal Nusinersen administration. Results: Twenty patients have been treated across four centres. To date, we have reviewed 8 cases at one centre (seven SMA Type I, one SMA Type II). Age at first dose ranged from 3-156 months and disease duration 9-166 months. Patients had received 4-7 doses at last evaluation. Three patients with scoliosis (2 with spinal rods) required fluoroscopy-guided radiologist administration, and 4 required general anesthesia. No complications/adverse events were reported. At last follow up, 5/8 families reported improved daily activities. Of 5 patients with baseline and follow up motor function testing, 3 demonstrated improved scores. One patient died due to respiratory decline at age 9 months, despite improved motor outcome scores. Conclusions: We describe the first Canadian post-marketing experience with Nusinersen. Timely dissemination of this information is needed to guide clinicians, hospital administrators, and policy-makers.

Background: The goal was to understand factors leading to prolonged wait times for neurological assessment of children with new onset seizures. A second objective was to develop an innovative approach to patient flow through and achieve a reduction in waiting times utilizing limited resources.

Methods:

Audit of the referrals, flow through, wait times

Identification of bottlenecks

Development of triaging strategy:

Suspected Febrile seizures and non-epileptic events;

Suspected benign and absence epilepsies;

Suspected other Focal epilepsies, generalized epilepsies, epilepsy under 2 years

Initiation of early telephone contact and support

Development of a ketogenic diet

Results: Using a triaging strategy and focusing on timely access to investigations, wait times for clinic evaluations were shortened despite larger numbers of referrals (mean wait time reductions from 179 to 91 days). Limiting factors such increase in referral numbers, attrition in support staff, interfered with sustainability of reduced wait times achieved in the initial phase of the program. Conclusions: This pilot study highlights the effectiveness of an innovative triaging strategy and improvements in patient flow through in achieving the goals of reduction in wait times for clinical evaluation and timely investigations to improve care for children with new onset seizures. Insights into limitations of such strategies and factors determining sustainability are discussed.

One of the major goals of coral reef conservation is to determine the most effective means of managing marine resources in regions where economic conditions often limit the options available. For example, no-take fishing areas can be impractical in regions where people rely heavily on reef fish for food. In this study we test whether coral reef health differed among areas with varying management practices and socio-economic conditions on Pulau Weh in the Indonesian province of Aceh. Our results show that gear restrictions, in particular prohibiting the use of nets, were successful in minimizing habitat degradation and maintaining fish biomass despite ongoing access to the fishery. Reef fish biomass and hard-coral cover were two- to eight-fold higher at sites where fishing nets were prohibited. The guiding principle of the local customary management system, Panglima Laot, is to reduce conflict among community members over access to marine resources. Consequently, conservation benefits in Aceh have arisen from a customary system that lacks a specific environmental ethic or the means for strong resource-based management. Panglima Laot includes many of the features of successful institutions, such as clearly defined membership rights and the opportunity for resource users to be involved in making, enforcing and changing the rules. Such mechanisms to reduce conflict are the key to the success of marine resource management, particularly in settings that lack resources for enforcement.

Backscattered electron microscopy provides gray-level contrast resulting from variations in atomic composition. Through the use of reference materials, quantitative backscattered electron (qBSE) imaging can be used to measure the mineral content of mineralized tissues at submicron resolution. We have developed novel tunable reference materials that can be adjusted for analysis of an individual tissue or a wide range of tissues with variable atomic density. As an alternative to conventional metallic reference materials, these amorphous materials maintain long-term stability and possess no long-range order that may induce channeling contrast. Using these reference materials, we characterized the mineral content of a broad range of mineralized tissues from immature mouse femur to whale bulla. Mineral volume fraction correlated to more traditional measurements of mineral content with microcomputed tomography and ashing techniques. Further, we demonstrate the advantage of location-matched measurements of nanomechanical properties and qBSE mineral content.

We define a hyperplane group to be a finite group generated by reflections fixing a single hyperplane pointwise. Landweber and Stong proved that the invariant ring of a hyperplane group is again a polynomial ring in any characteristic. Recently, Hartmann and Shepler gave a constructive proof of this result. By their algorithm, one can always construct generators that are additive. In this paper, we study hyperplane groups of order a power of a prime p in characteristic p and give a slightly different construction of the generators than Hartmann and Shepler. We then show that such generators have a particular form. Furthermore, we show that if the group is defined by a finite additive subgroup W ⊆ , the vanishing ideal of W is generated by polynomials obtained from a set of generators of the invariant ring that are additive. Finally, we give a shorter proof of the fact that the module of the invariant differential 1-forms is free in our situation.

Increasingly, understanding how the role of historical events and context affect present-day health inequities has become a dominant narrative among Native American communities. Historical trauma, which consists of traumatic events targeting a community (e.g., forced relocation) that cause catastrophic upheaval, has been posited by Native communities and some researchers to have pernicious effects that persist across generations through a myriad of mechanisms from biological to behavioral. Consistent with contemporary societal determinants of health approaches, the impact of historical trauma calls upon researchers to explicitly examine theoretically and empirically how historical processes and contexts become embodied. Scholarship that theoretically engages how historically traumatic events become embodied and affect the magnitude and distribution of health inequities is clearly needed. However, the scholarship on historical trauma is limited. Some scholars have focused on these events as etiological agents to social and psychological distress; others have focused on events as an outcome (e.g., historical trauma response); others still have focused on these events as mechanisms or pathways by which historical trauma is transmitted; and others have focused on historical trauma-related factors (e.g., collective loss) that interact with proximal stressors. These varied conceptualizations of historical trauma have hindered the ability to cogently theorize it and its impact on Native health. The purpose of this article is to explicate the link between historical trauma and the concept of embodiment. After an interdisciplinary review of the “state of the discipline,” we utilize ecosocial theory and the indigenist stress-coping model to argue that contemporary physical health reflects, in part, the embodiment of historical trauma. Future research directions are discussed.

SN2007gr was an ordinary type Ic supernova, with a hint of asymmetric explosion seen in the optical polarization spectrum. This type of SNe is occasionally associated with long duration gamma-ray bursts which generate ultra-relativistic jets; no relativistic outflows have yet been found by direct imaging in SNe Ib/c explosions. High resolution very long baseline interferometry (VLBI) data and simultaneous total radio flux density measurements indicated that SN2007gr has expanded mildly relativistically. We performed late time Westerbork Synthesis Radio Telescope (WSRT) observations to measure the level of the underlying extended emission. Comparison of the VLBI and the background-subtracted WSRT and independent VLA data indicate an at least partially resolved source with an average expansion velocity of ≥0.4c, although the VLBI data could be consistent with a fainter source with an expansion velocity of ~0.2c as well.