Syrian Refugee Health: A Qualitative Analysis Of Experiences With The U.s. Healthcare System

SYRIAN REFUGEE HEALTH: A QUALITATIVE ANALYSIS OF EXPERIENCES WITH HEALTHCARE IN THE UNITED STATES. Eunice M. M. DeFilippo, Amer Abdullah, Tracy L. Rabin. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT. As refugee populations worldwide increase exponentially, there is growing concern for the health needs of these displaced individuals. This qualitative study examines the illness experiences of newly arrived Syrian refugees as they navigate the complex U.S. healthcare system, in an attempt to identify and characterize potential barriers to care that can be addressed. The specific aims of this study are to understand the experiences, beliefs, and practices regarding general health and healthcare delivery amongst newly arrived Syrian refugees obtaining care at Yale New Haven Hospital. Twenty individuals were recruited to participate in semi-structured interviews. An Arabic language interpreter was present. Interviews were audio-taped, transcribed, and coded by a multidisciplinary team using grounded theory and analyzed for emergent themes. Participant ages ranged from 20-64; nine were female. Preliminary analysis of five transcripts revealed the following major theme: Unmet expectations for healthcare delivery and patient-provider interactions leads to experiences of perceived healthcare system inaccessibility and insufficiency. Participants described frustration with: 1) Lengthy Wait Times for Care, 2) Prescription Requirements, 3) Delayed Access to Specialists, 4) Dismissed Chronic Complaints, and 5) Language Barriers. Unexpected shifts in care delivery also contributed, such as a lack of knowledge to understand the 1) Referral System, 2) Prescription Drug System, or their 3) Insurance Limitations. As a result, participants experienced delays in care leading to 1) Frustration, 2) Mistrust, and the 3) Reliance on Traditional Medicines. This preliminary analysis reveals key challenges to accessing the U.S. healthcare system and limitations in refugee-provider interactions that may contribute to patients disengaging from care, and are critical to address in efforts to improve care for this population

Fate of Salmonella enterica Typhimurium and Listeria monocytogenes in Black Soldier Fly (Hermetia illucens) Larvae Reared on Two Artificial Diets

Ensuring food security is one of the main challenges facing the world over the next 30 years. There is, thus, an urgent need to significantly increase the supply of sustainable protein that can be transformed into animal feed. Proteins from insects offer a valuable alternative. This article presents the results of challenge tests conducted to investigate the dynamics of the microbial load of Salmonella enterica Typhimurium and Listeria monocytogenes in black soldier fly (Hermetia illucens) larvae grown on contaminated substrates. Four separate challenge tests were performed on two substrates: the Gainesville diet and a homemade diet. The challenge test procedure was carried out in accordance with ISO/DIS 20976-2 (under development). The results of this study show that, when grown on contaminated substrates, BSF larvae do not eliminate Salmonella Typhimurium or L. monocytogenes, but can reduce their microbial load. Sanitation processes downstream of the breeding of BSF larvae are, however, required to reduce the microbiological risks of this novel food

Characterization of necrophagus entomofauna in a typical agricultural area in Emilia-Romagna region (Northern Italy)

This study presents a checklist of Dipterans and Coleopterans accountable for carrion decay in the Po Valley (Italy), a contribution to the Forensic Entomology knowledge in Italy. Insects colonizing two pig carcasses in an agricultural area in Mezzani municipality (Parma, Northern Italy) were sampled by pitfall traps and original Malaise-like traps, which allowed the sampling of a very relevant number of flying insects. A checklist of 57 taxa was obtained, of which 26 were considered of forensic importance. For the latter the arrival time of adult specimens on the carcasses was recorded, as an important parameter in minimum post mortem interval estimation. Dipterans (6141 specimens) were the most common insects; the fastest specimens to detect and colonize the carcass belonged to the Calliphoridae family, while Fanniidae and Muscidae infested the carrion until completion of the skeletal stage. Coleopterans appeared later (308 adult specimens and 114 larvae were captured). Staphylinidae, Dermestidae, and Histeridae were the most common coleopterans sampled in this study

Técnica para Calibração Primária em Campo Livre de Microfones de Medição

Este artigo apresenta a técnica de medição, desenvolvida e implementada no Inmetro, para a calibração primária em campo livre de microfones de medição. Nesta técnica, a diafonia (crosstalk) é removida por subtração e o interespalhamento (multiple backscattering) e as demais reflexões são removidos por um procedimento de seleção no tempo

Calendar time as an instrumental variable in assessing the risk of heart failure with antihyperglycemic drugs

Objective: In recent years, second-line diabetes treatment with dipeptidyl peptidase–4 inhibitors (DPP-4i) increased with a corresponding decrease in thiazolidinediones (TZDs). Using hospitalization for heart failure (HF) as a positive control outcome, we explored the use of calendar time as an instrumental variable (IV) and compared this approach to an active comparator new-user study. Methods: We identified DPP-4i or TZD initiators after a 6-month washout using Medicare claims 2006–2013. The IV was defined as a binary variable comparing initiators during October 2010 to December 2013 (postperiod) versus January 2008 to May 2010 (preperiod). We examined IV strength and estimated risk differences (RDs) for HF using Kaplan-Meier curves, which were compared with propensity score (PS)–weighted RD for DPP-4i versus TZD. Results: The IV compared 22 696 initiators (78% DPP-4i) in the postperiod versus 20 283 initiators (38% DPP-4i) in the preperiod, resulting in 40% compliance. The active-comparator (PS-weighted) approach compared 26 198 DPP-4i and 18 842 TZD initiators. Covariate balance across IV levels was slightly better than across treatments (standardized difference, 3% vs 4.5%). The 1- and 2-year local average treatment effects of RD of HF per 100 patients in the “compliers” (95% confidence intervals) were −0.62 (−0.99 to −0.25) and −0.88 (−1.46 to −0.25). Corresponding PS-weighted results were −0.20 (−0.33 to −0.05) and −0.18 (−0.30 to 0.03). Conclusion: Both approaches indicated lesser risk of HF hospitalizations among DPP-4i vs TZD initiators. The magnitude of the estimated effects may differ due to differences in the target populations and assumptions. Calendar time can be leveraged as an IV when market dynamics lead to profound changes in treatments

The COVID-related mental health load of neonatal healthcare professionals: a multicenter study in Italy

Background: The COVID-19 pandemic has dramatically affected healthcare professionals’ lives. We investigated the potential mental health risk faced by healthcare professionals working in neonatal units in a multicentre cross-sectional observational study. Methods: We included all healthcare personnel of seven level-3 and six level-2 neonatal units in Tuscany, Italy. We measured the level of physical exposure to COVID-19 risk, self-reported pandemic-related stress, and mental health load outcomes (anxiety, depression, burnout, psychosomatic symptoms, and post-traumatic symptoms) using validated, self-administered, online questionnaires during the second pandemic wave in Italy (October 2020 to March 2021). Results: We analyzed 314 complete answers. Scores above the clinical cutoff were reported by 91% of participants for symptoms of anxiety, 29% for post-traumatic symptoms, 13% for burnout, and 3% for symptoms of depression. Moreover, 50% of the participants reported at least one psychosomatic symptom. Pandemic-related stress was significantly associated with all the measured mental health load outcomes, with an Odds Ratio of 3.31 (95% confidence interval: 1.87, 5.88) for clinically relevant anxiety, 2.46 (1.73, 3.49) for post-traumatic symptoms, 1.80 (1.17, 2.79) for emotional exhaustion, and 2.75 (1.05, 7.19) for depression. Female health care professionals displayed a greater risk of anxiety, and male health care professionals and nurses, of depressive symptoms. Conclusions: Despite the low direct clinical impact of COVID-19 in newborns, neonatal professionals, due to both living in a situation of uncertainty and personal exposure to contacts with parents and other relatives of the newborns, and having to carry out activities once routine and now fraught with uncertainty, displayed clear signs of mental health load outcomes. They must be considered a specific population at risk for psychological consequences during the pandemic

High-Resolution In-situ Synchrotron X-ray Studies of Inorganic Perovskite CsPbBr3_3: New Symmetry Assignments and Structural Phase Transitions

Perovskite photovoltaic ABX$_3$ systems are being studied due to their high energy-conversion efficiencies with current emphasis placed on pure inorganic systems. In this work, synchrotron single-crystal diffraction measurements combined with second harmonic generation measurements reveal the absence of inversion symmetry below room temperature in CsPbBr$_3$. Local structural analysis by pair distribution function and X-ray absorption fine structure methods are performed to ascertain the local ordering, atomic pair correlations, and phase evolution in a broad range of temperatures. The currently accepted space group assignments for CsPbBr$_3$ are found to be incorrect in a manner that profoundly impacts physical properties. New assignments are obtained for the bulk structure: $Im$$\bar{3}$ (above $\sim$ 410 K), $P$2$_1$/$m$ (between $\sim$ 300 K and $\sim$ 410 K), and the polar group $Pm$ (below $\sim$ 300 K), respectively. The newly observed structural distortions exist in the bulk structure consistent with the expectation of previous photoluminescence and Raman measurements. High-pressure measurements reveal multiple low-pressure phases, one of which exists as a metastable phase at ambient pressure. This work should help guide research in the perovskite photovoltaic community to better control the structure under operational conditions and further improve transport and optical properties.Comment: 7 Figures in main text (20 pages), 18 Figure groups and 10 Table groups in supplementary documentation (42 pages

Modeling the Fuel Spray and Combustion Process of the Ignition Quality Tester with KIVA-3V

Discusses the use of KIVA-3V to develop a model that reproduces ignition behavior inside the Ignition Quality Tester, which measures the ignition delay of low-volatility fuels

Comparative Effectiveness of Oxaliplatin Versus 5-flourouricil in Older Adults: An Instrumental Variable Analysis

Oxaliplatin was rapidly adopted for treatment of stage III colon cancer after FDA approval in November 2004, thus providing an opportunity to use calendar time as an instrumental variable (IV) in nonexperimental comparative effectiveness research. Assuming instrument validity, IV analyses account for unmeasured confounding and are particularly valuable in sub-populations of unresolved effectiveness such as older individuals