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For over fifty years, minorities in Burma have faced severe persecution and violence, forcing them to flee their homeland. In the past ten years there has been an influx in the number of refugees resettled in Denver, Colorado. Refugees often struggle to navigate the complexities of the American health care system and adapt to life in a foreign culture. The development of programs and partnerships to assist refugees in their pursuit of health and integration is essential to building stronger communities.
Objectives
This community based participatory research (CBPR) project was developed in collaboration with the refugee community from Burma living in the Denver area. After regular meetings with a group of motivated teenagers and young adults from this community to form our Youth Advisory Board (YAB), they identified alcohol use and misuse as a health concern within their community. With this identified issue, the project aimed to gather data from community members that could be leveraged to create, implement, and evaluate a culturally competent intervention to effectively address risky alcohol use in this community.
Methods
Data collection involved formal one-on-one, semi-structured, audio-recorded interviews with community members. Participants were recruited voluntarily at health information nights held by the student researchers at their local apartment complex. The interviews were conducted by one medical student researcher with one translator present and were transcribed afterward. The interview data was analyzed using Immersion Crystallization methodology.
Results
Initial results from the community meetings with the YAB, local organizations, formative community surveys, and key informant interviews highlighted the vulnerability of the refugee population, scarcity of culturally appropriate resources for alcohol abuse, and urgency of addressing problematic alcohol use. The analysis of the ten audio-recorded surveys showed several themes including negative consequences of alcohol use, specifically negative impacts on familial relationships, employment, and financial resources, and a perceived personal responsibility for managing one’s own alcohol consumption.
Conclusions
This project corroborates current literature regarding the scope and breadth of hazardous alcohol use within the community of refugees from Burma. Our data has expanded our understanding of the values of community members including the influence of religion and family on behaviors, and the negative impact on employment as the most impactful negative consequence. These findings need to be shared with the community to move forward in mapping the most effective and appropriate interventions.
The advancement of technology on the modern commercial flight deck has allowed flight crew members to utilise multiple sources of information to maintain the safety of their flight. Having multiple sources of flight deck information, capable of displaying the same type of information, can lead to a situation in which a pilot encounters conflicting information. Understanding how a pilot makes a decision when faced with an information conflict on the flight deck is important to ensure appropriate design of flight-deck information systems and effective pilot training. This effort utilised data collected from 25 airline pilots who experienced information conflicts on a simulated B-737 flight deck, in conjunction with a theoretical review of how information conflicts impact decision making, to develop a theoretical model of pilot decision-making in the presence of an information conflict. This manuscript describes the model, along with the theory-driven and data-driven approaches utilised to develop the model.
Nebular Heii emission implies the presence of energetic photons (E≽54 eV). Despite the great deal of effort dedicated to understanding Heii ionization, its origin has remained mysterious, particularly in metal-deficient star-forming galaxies. Unfolding Heii-emitting, metal-poor starbursts at z∼0 can yield insight into the powerful ionization processes occurring in the primordial universe. Here we present a study on the origin of the extended nebular Heii emission in SBS 0335-052E, one of the most metal-poor (Z ∼ 3% Z⊙ Heii-emitter starbursts known locally. Based on optical VLT/MUSE spectroscopic and Chandra X-ray observations, and current stellar models we found that the Heii-ionization budget of SBS 0335-052E can only be produced by peculiar, nearly metal-free ionizing stars (called here “PopIII-like” stars) with a top-heavy initial mass function. This result is in line with recent simulations for PopIII star formation down to z=0.
OBJECTIVES/GOALS: Using the covariate-rich Veteran Health Administration data, estimate the association between Proton Pump Inhibitor (PPI) use and severe COVID-19, rigorously adjusting for confounding using propensity score (PS)-weighting. METHODS/STUDY POPULATION: We assembled a national retrospective cohort of United States veterans who tested positive for SARS-CoV-2, with information on 33 covariates including comorbidity diagnoses, lab values, and medications. Current outpatient PPI use was compared to non-use (two or more fills and pills on hand at admission vs no PPI prescription fill in prior year). The primary composite outcome was mechanical ventilation use or death within 60 days; the secondary composite outcome included ICU admission. PS-weighting mimicked a 1:1 matching cohort, allowing inclusion of all patients while achieving good covariate balance. The weighted cohort was analyzed using logistic regression. RESULTS/ANTICIPATED RESULTS: Our analytic cohort included 97,674 veterans with SARS-CoV-2 testing, of whom 14,958 (15.3%) tested positive (6,262 [41.9%] current PPI-users, 8,696 [58.1%] non-users). After weighting, all covariates were well-balanced with standardized mean differences less than a threshold of 0.1. Prior to PS-weighting (no covariate adjustment), we observed higher odds of the primary (9.3% vs 7.5%; OR 1.27, 95% CI 1.13-1.43) and secondary (25.8% vs 21.4%; OR 1.27, 95% CI 1.18-1.37) outcomes among PPI users vs non-users. After PS-weighting, PPI use vs non-use was not associated with the primary (8.2% vs 8.0%; OR 1.03, 95% CI 0.91-1.16) or secondary (23.4% vs 22.9%;OR 1.03, 95% CI 0.95-1.12) outcomes. DISCUSSION/SIGNIFICANCE: The associations between PPI use and severe COVID-19 outcomes that have been previously reported may be due to limitations in the covariates available for adjustment. With respect to COVID-19, our robust PS-weighted analysis provides patients and providers with further evidence for PPI safety.
Alcohol, cannabis, and nicotine use are highly comorbid and alarmingly prevalent in young adults. The hippocampus may be particularly sensitive to substance exposure. This remains largely untested in humans and familial risk may confound exposure effects. We extend prior work on alcohol and hippocampal volume in women by testing common and unique substance use effects and the potential moderating role of sex on hippocampal volume during emerging adulthood. A quasi-experimental cotwin control (CTC) design was used to separate familial risk from exposure consequences.
Methods
In a population-based sample of 435 24-year-old same-sex twins (58% women), dimensional measures (e.g. frequency, amount) of alcohol, cannabis, and nicotine use across emerging adulthood were assessed. Hippocampal volume was assessed using MRI.
Results
Greater substance use was significantly associated with lower hippocampal volume for women but not men. The same pattern was observed for alcohol, cannabis, and nicotine. CTC analyses provided evidence that hippocampal effects likely reflected familial risk and the consequence of substance use in general and alcohol and nicotine in particular; cannabis effects were in the expected direction but not significant. Within-pair mediation analyses suggested that the effect of alcohol use on the hippocampus may reflect, in part, comorbid nicotine use.
Conclusions
The observed hippocampal volume deviations in women likely reflected substance-related premorbid familial risk and the consequences of smoking and, to a lesser degree, drinking. Findings contribute to a growing body of work suggesting heightened risk among women toward experiencing deleterious effects of substance exposure on the still-developing young adult hippocampus.
The objective of this study was to investigate changes in serum biomarkers of acute brain injury, including white matter and astrocyte injury during chronic foetal hypoxaemia. We have previously shown histopathological changes in myelination and neuronal density in fetuses with chronic foetal hypoxaemia at a level consistent with CHD.
Methods:
Mid-gestation foetal sheep (110 ± 3 days gestation) were cannulated and attached to a pumpless, low-resistance oxygenator circuit, and incubated in a sterile fluid environment mimicking the intrauterine environment. Fetuses were maintained with an oxygen delivery of 20–25 ml/kg/min (normoxemia) or 14–16 ml/kg/min (hypoxaemia). Myelin Basic Protein and Glial Fibrillary Acidic Protein serum levels in the two groups were assessed by ELISA at baseline and at 7, 14, and 21 days of support.
Results:
Based on overlapping 95% confidence intervals, there were no statistically significant differences in either Myelin Basic Protein or Glial Fibrillary Acidic Protein serum levels between the normoxemic and hypoxemic groups, at any time point. No statistically significant correlations were observed between oxygen delivery and levels of Myelin Basic Protein and Glial Fibrillary Acidic Protein.
Conclusion:
Chronic foetal hypoxaemia during mid-gestation is not associated with elevated serum levels of acute white matter (Myelin Basic Protein) or astrocyte injury (Glial Fibrillary Acidic Protein), in this model. In conjunction with our previously reported findings, our data support the hypothesis that the brain dysmaturity with impaired myelination found in fetuses with chronic hypoxaemia is caused by disruption of normal developmental pathways rather than by direct cellular injury.
There is growing recognition of the importance of increasing preparedness for and the provision of palliative care in humanitarian crises. The primary objective of this review is to interpret the existing literature on culture and palliative care to query the recommendation that humanitarian healthcare providers, teams, and organizations integrate palliative care into their practice in ways that are attentive to and respectful of cultural differences.
Methods
A critical interpretive synthesis was applied to a systematic literature review guided by the PRISMA framework. Analysis was based on directed data extraction and was team based, to ensure rigor and consistency.
Results
In total, 112 articles covering 51 countries and 9 major worldviews met inclusion criteria. This literature describes culture as it influences perspectives on death and dying, expectations of palliative care, and challenges to providing culturally sensitive care. A key pattern highlighted in articles with respect to the culture and palliative care literature is that culture is invoked in this literature as a sort of catch-all for non-white, non-Christian, indigenous practices, and preferences for palliative care. It is important that humanitarian healthcare providers and organizations aiming to enact their commitment of respect for all persons through attention to potential culturally specific approaches to pain management, suffering, and dying in specific crisis settings do so without reproducing Othering and reductionistic understandings of what culturally sensitive care in humanitarian crises settings involves.
Significance of results
This paper clarifies and unpacks the diverse influences of culture in palliative care with the goal of supporting the preparedness and capacity of humanitarian healthcare providers to provide palliative care. In doing so, it aids in thinking through what constitutes culturally sensitive practice when it comes to palliative care needs in humanitarian crises. Providing such care is particularly challenging but also tremendously important given that healthcare providers from diverse cultures are brought together under high stress conditions.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Exposure to childhood maltreatment (CM) may disrupt typical development of neural systems underlying impulse control and emotion regulation. Yet resilient outcomes are observed in some individuals exposed to CM. Individual differences in adult functioning may result from variation in inhibitory control in the context of emotional distractions, underpinned by cognitive–affective brain circuits. Thirty-eight healthy adults with a history of substantiated CM and 34 nonmaltreated adults from the same longitudinal sample performed a Go/No-Go task in which task-relevant stimuli (letters) were presented at the center of task-irrelevant, negative, or neutral images, while undergoing functional magnetic resonance imaging. The comparison group, but not the maltreated group, made increased inhibitory control errors in the context of negative, but not neutral, distractor images. In addition, the comparison group had greater right inferior frontal gyrus and bilateral frontal pole activation during inhibitory control blocks with negative compared to neutral background images relative to the CM group. Across the full sample, greater adaptive functioning in everyday contexts was associated with superior inhibitory control and greater right frontal pole activation. Results suggest that resilience following early adversity is associated with enhanced attention and behavioral regulation in the context of task-irrelevant negative emotional stimuli in a laboratory setting.
Access to cutting-edge technologies is essential for investigators to advance translational research. The Indiana Clinical and Translational Sciences Institute (CTSI) spans three major and preeminent universities, four large academic campuses across the state of Indiana, and is mandate to provide best practices to a whole state.
Methods:
To address the need to facilitate the availability of innovative technologies to its investigators, the Indiana CTSI implemented the Access Technology Program (ATP). The activities of the ATP, or any program of the Indiana CTSI, are challenged to connect technologies and investigators on the multiple Indiana CTSI campuses by the geographical distances between campuses (1–4 hr driving time).
Results:
Herein, we describe the initiatives developed by the ATP to increase the availability of state-of-the-art technologies to its investigators on all Indiana CTSI campuses, and the methods developed by the ATP to bridge the distance between campuses, technologies, and investigators for the advancement of clinical translational research.
Conclusions:
The methods and practices described in this publication may inform other approaches to enhance translational research, dissemination, and usage of innovative technologies by translational investigators, especially when distance or multi-campus cultural differences are factors to efficient application.
The release of buoyant harmful gases within enclosed spaces, such as tunnels and corridors, may engender specific health, industrial and transportation risks. For safety, a simple ventilation strategy for these spaces is to impose a flow along the tunnel, whose velocity is defined as ‘critical’, that confines the front of harmful buoyant gases immediately downstream of the source of emission. Determining the critical velocity as a function of the geometrical and dynamical conditions at the source is a fundamental fluid mechanics problem which has yet to be elucidated; this problem concerns the dynamics of non-Boussinesq releases relating to large differences between the densities of the buoyant and the ambient fluids. We have investigated this problem theoretically, by means of a simplified model of a top-hat plume in a cross-flow, and in complementary experiments by means of tests in a reduced-scale ventilated tunnel, examining releases from circular sources. Experimental results reveal: (i) the existence of two flow regimes depending on the plume Richardson number at the source $\unicode[STIX]{x1D6E4}_{i}$, one for momentum-dominated releases, $\unicode[STIX]{x1D6E4}_{i}\ll 1$, and a second for buoyancy-dominated releases, $\unicode[STIX]{x1D6E4}_{i}\gg 1$, with a smooth transition between the two; and (ii) the presence of relevant non-Boussinesq effects only for momentum-dominated releases. All these features can be conveniently predicted by the plume-based model, whose validity is, strictly speaking, limited to releases issuing from ‘small’ sources in ‘weak’ ventilation flows. Analytical solutions of the model are generally in good agreement with the experimental data, even for values of the governing parameters that are beyond the range of validity for the model. The solutions aid to clarify the effect of the source radius, and reveal interesting behaviours in the limits $\unicode[STIX]{x1D6E4}_{i}\rightarrow 0$ and $\unicode[STIX]{x1D6E4}_{i}\rightarrow \infty$. These findings support the adoption of simplified models to simulate light gas releases in confined ventilated spaces.
Stable perovskite and metastable post-perovskite NaCoF3 were deformed in pure-shear geometry in a deformation-DIA press with radiographic monitoring of the sample strain. In isothermal experiments where there was no transformation, post-perovskite was found to be 5 timesweaker than perovskite. In temperature-ramping experiments where post-perovskite transformed to perovskite during the deformation experiment the initial post-perovskite sample was 5–10 times weaker than perovskite under comparable conditions and their strengths converged during the transformation,being equal on completion of the transformation. These results confirm recent findings which show that postperovskite is weaker than perovskite, regardless of the prior history of the sample.
The thermal diffusivity of diopside, jadeite and enstatite were measured at simultaneous pressures and temperatures of up to 7 GPa and 1200 K using the X-radiographic Ångström method. The measurements herein show that the pressure dependency of thermal diffusivity in pyroxenes is significantly greater than in olivine or garnet and that in the MORB-layer of a subducting slab the thermal diffusivity of pyroxenes are a factor of 1.5 greater than that of olivine. The temperature dependence of all the data sets is well described by a low-order polynomial fit to 1/K and the pressure dependence is exponential in 1/K, formulations which are consistent with the damped harmonic oscillator model for thermal properties.
This review aimed to critically analyse data pertaining to the clinical presentation and treatment of neuroendocrine carcinomas of the larynx.
Method
A PubMed search was performed using the term ‘neuroendocrine carcinoma’. English-language articles on neuroendocrine carcinoma of the larynx were reviewed in detail.
Results and conclusion
While many historical classifications have been proposed, in contemporary practice these tumours are sub-classified into four subtypes: carcinoid, atypical carcinoid, small cell neuroendocrine carcinoma and large cell neuroendocrine carcinoma. These tumours exhibit a wide range of biological behaviour, ranging from the extremely aggressive nature of small and large cell neuroendocrine carcinomas, which usually have a fatal prognosis, to the less aggressive course of carcinoid tumours. In small and large cell neuroendocrine carcinomas, a combination of irradiation and chemotherapy is indicated, while carcinoid and atypical carcinoid tumour management entails conservation surgery.
Now in its third edition, this outstanding textbook explains everything you need to get started using MATLAB®. It contains concise explanations of essential MATLAB commands, as well as easily understood instructions for using MATLAB's programming features, graphical capabilities, simulation models, and rich desktop interface. MATLAB 8 and its new user interface is treated extensively in the book. New features in this edition include: a complete treatment of MATLAB's publish feature; new material on MATLAB graphics, enabling the user to master quickly the various symbolic and numerical plotting routines; and a robust presentation of MuPAD® and how to use it as a stand-alone platform. The authors have also updated the text throughout, reworking examples and exploring new applications. The book is essential reading for beginners, occasional users and experienced users wishing to brush up their skills. Further resources are available from the authors' website at www-math.umd.edu/schol/a-guide-to-matlab.html.
Aerospace designers are increasingly interested in predicting unsteady flowfields such as those associated with store release, rotating propellers etc. However, the cost of performing fully unsteady calculations is usually prohibitively expensive. In order to address this problem for unsteady flows driven by a moving surface, a novel method is presented which calculates the time derivates as an analytic function of the instantaneous flowfield. This allows an accurate solution of the unsteady flow equations to be calculated using a quasi-unsteady approach. The validity of this approach is demonstrated for a store release and a propeller test case. Possible extensions to this method for more complex unsteady flows are presented.
During 1990 we surveyed the southern sky using a multi-beam receiver at frequencies of 4850 and 843 MHz. The half-power beamwidths were 4 and 25 arcmin respectively. The finished surveys cover the declination range between +10 and −90 degrees declination, essentially complete in right ascension, an area of 7.30 steradians. Preliminary analysis of the 4850 MHz data indicates that we will achieve a five sigma flux density limit of about 30 mJy. We estimate that we will find between 80 000 and 90 000 new sources above this limit. This is a revised version of the paper presented at the Regional Meeting by the first four authors; the surveys now have been completed.
Childhood maltreatment is a serious individual, familial, and societal threat that compromises healthy development and is associated with lasting alterations to emotion perception, processing, and regulation (Cicchetti & Curtis, 2005; Pollak, Cicchetti, Hornung, & Reed, 2000; Pollak & Tolley-Schell, 2003). Individuals with a history of maltreatment show altered structural and functional brain development in both frontal and limbic structures (Hart & Rubia, 2012). In particular, previous research has identified hyperactive amygdala responsivity associated with childhood maltreatment (e.g., Dannlowski et al., 2012). However, less is known about the impact of maltreatment on the relationship between the amygdala and other brain regions. The present study employed an emotion processing functional magnetic resonance imaging task to examine task-based activation and functional connectivity in adults who experienced maltreatment as children. The sample included adults with a history of substantiated childhood maltreatment (n = 33) and comparison adults (n = 38) who were well matched on demographic variables, all of whom have been studied prospectively since childhood. The maltreated group exhibited greater activation than comparison participants in the prefrontal cortex and basal ganglia. In addition, maltreated adults showed increased amygdala connectivity with the hippocampus and prefrontal cortex. The results suggest that the intense early stress of childhood maltreatment is associated with lasting alterations to frontolimbic circuitry.
Gamma-ray burst host galaxies are deficient in molecular gas, and show anomalous metal-poor regions close to GRB positions. Using recent Australia Telescope Compact Array (ATCA) Hi observations we show that they have substantial atomic gas reservoirs. This suggests that star formation in these galaxies may be fuelled by recent inflow of metal-poor atomic gas. While this process is debated, it can happen in low-metallicity gas near the onset of star formation because gas cooling (necessary for star formation) is faster than the Hi-to-H2 conversion.