The Medical Evaluation of the Newly Resettled Female Refugee: A Narrative Review

The number of forcibly displaced individuals worldwide is increasing each year, reaching 65 million persons by the end of 2015, half of which were women and children. As the population of displaced persons grows, it is every physician’s responsibility to understand these patients and their health needs. Refugee patients and the providers who care for them face many barriers to effective patient care, including language barriers, cultural differences, and systematic inequalities. Female refugees commonly experience gender-based violence, repetitive trauma, stigmatized mental illness, and cultural barriers to women’s healthcare. This review is intended to be a comprehensive guide for the provider caring for the recently resettled female refugee patient. It addresses general considerations for working with refugee patients, initial medical evaluation guidelines, specific women’s health issues, and mental health care of female refugee patients

The vascular smooth muscle T-type Ca2+ channel: An anti-proliferative target for heme oxygenase-1

Pathological proliferation of vascular smooth muscle cells (VSMC) is a central feature of vascular disorders such as atherosclerosis and restenosis. During such proliferative conditions the expression of the T-type Ca2+ channel is increased, providing an important route for Ca2+ entry. The inducible stress-response protein, heme oxygenase-1 (HO-1), is also up-regulated during vascular disorders. This enzyme confers cytoprotective effects via the breakdown of free heme to produce iron, biliverdin, and carbon monoxide (CO). CO has been shown to be anti-inflammatory, anti-apoptotic, and anti-proliferative at low concentrations. Furthermore, CO is emerging as a modulator of various ion channels, and our research group has recently found that CO inhibits the T-type Ca2+ current via whole-cell patch clamp recordings. Therefore, the aim of this thesis was to investigate whether the VSMC T-type Ca2+ channel could act as an anti-proliferative target for HO-1-derived CO. HEK293 cells over-expressing the Cav3.2 T-type Ca2+ channel produced higher basal [Ca2+]i and displayed an augmented proliferative response. [Ca2+]i and proliferation were both reduced by T-type Ca2+ channel inhibition, CO exposure, and HO-1 induction. T-type Ca2+ channel inhibition and HO-1 induction reduced [Ca2+]i and proliferation in the rat aortic VSMC line, A7r5. Exogenous CO exposure decreased [Ca2+]i in A7r5 cells, but conferred insignificant anti-proliferative effects, which correlated to a relatively low expression of the T-type Ca2+ channel. T-type Ca2+ channel inhibition, CO exposure, and HO-1 induction all have anti-proliferative effects in human VSMCs, yet simultaneous HO-1 induction and T-type Ca2+ channel inhibition do not cause additive inhibitory effects on proliferation. These data provide evidence that CO is anti-proliferative, and that CO potentially acts via the T-type Ca2+ channel. This pathway could be a novel therapeutic target for vascular disorders involving excessive smooth muscle cell proliferation

Genomic and non-genomic regulation of PGC1 isoforms by estrogen to increase cerebral vascular mitochondrial biogenesis and reactive oxygen species protection

We previously found that estrogen exerts a novel protective effect on mitochondria in brain vasculature. Here we demonstrate in rat cerebral blood vessels that 17beta-estradiol (estrogen), both in vivo and ex vivo, affects key transcriptional coactivators responsible for mitochondrial regulation. Treatment of ovariectomized rats with estrogen in vivo lowered mRNA levels of peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (PGC-1alpha) but increased levels of the other PGC-1 isoforms: PGC-1beta and PGC-1 related coactivator (PRC). In vessels ex vivo, estrogen decreased protein levels of PGC-1alpha via activation of phosphatidylinositol 3-kinase (PI3K). Estrogen treatment also increased phosphorylation of forkhead transcription factor, FoxO1, a known pathway for PGC-1alpha downregulation. In contrast to the decrease in PGC-1alpha, estrogen increased protein levels of nuclear respiratory factor 1, a known PGC target and mediator of mitochondrial biogenesis. The latter effect of estrogen was independent of PI3K, suggesting a separate mechanism consistent with increased expression of PGC-1beta and PRC. We demonstrated increased mitochondrial biogenesis following estrogen treatment in vivo; cerebrovascular levels of mitochondrial transcription factor A and electron transport chain subunits as well as the mitochondrial/nuclear DNA ratio were increased. We examined a downstream target of PGC-1beta, glutamate-cysteine ligase (GCL), the rate-limiting enzyme for glutathione synthesis. In vivo estrogen increased protein levels of both GCL subunits and total glutathione levels. Together these data show estrogen differentially regulates PGC-1 isoforms in brain vasculature, underscoring the importance of these coactivators in adapting mitochondria in specific tissues. By upregulating PGC-1beta and/or PRC, estrogen appears to enhance mitochondrial biogenesis, function and reactive oxygen species protection

Caregivers\u27 Social Capital and Satisfaction with their Children\u27s Service Providers

The authors examine children\u27s access to and caregiver\u27s satisfaction with organizations that provide leisure time activities for children on Saturdays. The authors argue that access and satisfaction are a function of familie\u27s financial, cultural and social capital. Using data on 1,036 households in the Phoenix metropolitan area in 2003-04, the authors found that families\u27 financial and cultural capital affected whether or not children participate din activities organized by organizations, but family ties to the organization directly (e.g., either worked there, volunteered, donated) resulted in caregivers being more satisfied with the services. The authors also found that the benefits of network closure (caregivers knowing the parents of other children on site) were greater the riskier the activities of the child (e.g., sports or cheerleading). Contrary to the authors expectations, having family or friends in the area did not affect caregiver\u27s satisfaction with the child\u27s provider

Using peer review to support development of community resources for research data management

This work is licensed under a Creative Commons 1.0 Public Domain Dedication. The definitive version was published in Journal of eScience Librarianship 6 (2017): e1114, doi:10.7191/jeslib.2017.1114.To ensure that resources designed to teach skills and best practices for scientific research data sharing and management are useful, the maintainers of those materials need to evaluate and update them to ensure their accuracy, currency, and quality. This paper advances the use and process of outside peer review for community resources in addressing ongoing accuracy, quality, and currency issues. It further describes the next step of moving the updated materials to an online collaborative community platform for future iterative review in order to build upon mechanisms for open science, ongoing iteration, participation, and transparent community engagement.DataONE is supported by US National Science Foundation Awards 08- 30944 and 14-30508, William Michener, Principal Investigator; Matthew Jones, Patricia Cruse, David Vieglais, and Suzanne Allard, Co-Principal Investigators

Perceptions of Cardiovascular Health in Underserved Communities

Introduction: Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions. Methods: Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences. Results: Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials. Conclusion: Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions

Autoradiographic localization of [delta] opioid receptors in the rat brain using a highly selective bis-penicillamine cyclic enkephalin analog

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25669/1/0000221.pd