Building Integrated Mental Health and Medical Programs for Vulnerable Populations Post-Disaster: Connecting Children and Families to a Medical Home

Introduction: Hurricane Katrina, a Category 3 hurricane, made landfall in August 2005. Approximately 1,500 deaths have been directly attributed to the hurricane, primarily in Louisiana and Mississippi. In New Orleans, Louisiana, most of the healthcare infrastructure was destroyed by flooding, and >200,000 residents became homeless. Many of these internally displaced persons received transitional housing in trailer parks (“villages”) under the auspices of the [US] Federal Emergency Management Agency (FEMA). Problem: The FEMA villages are isolated from residential communities, lack access to healthcare services, and have become unsafe environments. The trailers that house families have been found to be contaminated with formaldehyde. Methods: The Children’s Health Fund, in partnership with the Mailman School of Public Health at Columbia University, began a program (“Operation Assist”) to provide health and mental health services within a medical home model. This program includes the Baton Rouge Children’s Health Project (BRCHP), which consists of two mobile medical units (one medical and one mental health). Licensed professionals at the FEMA villages and other isolated communities provide care on these mobile units. Medical and psychiatric diagnoses from the BRCHP are summarized and case vignettes presented. Results: Immediately after the hurricane, prescription medications were difficult to obtain. Complaints of headache, nosebleeds, and stomachache were observed at an unusually frequent degree for young children, and were potentially attributable to formaldehyde exposure. Dermatological conditions included eczema, impetigo, methicillin-resistant staphylococcus aureus (MRSA) abscesses, and tinea corporis and capitis. These were especially difficult to treat because of unhygienic conditions in the trailers and ongoing formaldehyde exposure. Signs of pediatric under-nutrition included anemia, failure to thrive, and obesity. Utilization of initial mental health services was low due to pressing survival needs and concern about stigma. Once the mental health service became trusted in the community, frequent diagnoses for school-age children included disruptive behavior disorders and learning problems, with underlying depression, anxiety, and stress disorders. Mood and anxiety disorders and substance abuse were prevalent among the adolescents and adults, including parents. Conclusions: There is a critical and long-term need for medical and mental health services among affected populations following a disaster due to natural hazards. Most patients required both medical and mental health care, which underscores the value of co-locating these services

The mapping of Europe and ideas of integration: in the new member countries, national meanings of European culture determine debates about the desired European Union's mission

With EU enlargement, peculiar Central European ideas and traditions of integration emerged in European politics. In the discussions on a European constitution, the representatives of the new member states surprised the “old” Europe with meanings of Europe that were situated far beyond the canonised Western concepts of pragmatic political integration. Central European politicians and political essayists discussed a canon of cultural and religious European values and the role of the nations in the European Union. Research on the contemporary history of Central Europe brings light into the traditions and the development of Central European meanings of Europe. Before 1989 and East of the “Iron curtain”, Europe rather served as a place of desire than as a concrete concept, a mechanism of integration or an institutional framework. The cases of Poland and the Czech Republic (respectively the former Czechoslovakia) show that the salient feature of their meanings of Europe in history is the high significance of the nation. In the Eastern bloc, Europe was construed along terms of culture and civilisation. Party officials, dissidents and journalists framed Europe nationally. Regarding ideas of integration, 1989 stands for continuity in Central European meanings of Europe. The historical East-West difference in the „thinking of Europe“ and former mappings of Europe in the new member countries re-shape the present new European Union. Exclusive meanings of Europe in Central Europe challenge policies of integration, migration, citizenship and governance. There is a drift towards demarcating a European self and towards defining a collective in cultural terms. This trend strengthens the paradigm of neighbourhood vis-à-vis transnationalisation and unification in the E.U. In the debates on the foreign relations of the Union, exponents of a cultural European identity address questions of self-demarcation and self-delimitation

Europäische Vorstellungswelten im Ostblock: Eine Topologie von Europanarrationen im Staatssozialismus

Sowohl der Blick nach Westeuropa als auch nationale Selbstpositionierungen bestimmten Europavorstellungen im Ostblock. Besonders in den siebziger und achtziger Jahren des 20. Jahrhunderts dynamisierten sich hier Debatten um Europa, und verschiedene Narrationen von Europa standen dabei in einer Bedeutungskonkurrenz. Die politische Integration im westlichen Teil des Kontinents strahlte in die Kreise unabhängiger Intellektueller positiv aus, doch es wurden auch Debatten um eine regionale Identität Zentraleuropas geführt. Beide Stränge traten in der bekannten „Mitteleuropa-Debatte“ in einen Widerstreit. Auch wurde die Auseinandersetzung um „Polens Platz in Europa“ über die Jahre des Staatssozialismus hinweg fortgeführt, und in den Friedensbewegungen suchte man länderübergreifend nach einer europäischen Ordnung außerhalb der Systemkonfrontation. Sogar in den Parteieliten wurde darüber nachgedacht, wie sich die westlichen Staaten des Ostblocks angesichts des schwachen Zusammenhalts im Rat für Gegenseitige Wirtschaftshilfe (RGW) wirtschaftlich neu orientieren könnten. So wurden den westeuropäischen Staaten Angebote zur wirtschaftlichen Zusammenarbeit, zu einer Verstärkung des Ost-West-Handels und gar zum politischen Dialog gemacht. Selbst in sich ideologisch stark vom Westen distanzierenden Staaten wie der DDR kam zur aus der Nachkriegszeit stammenden antikapitalistischen Rhetorik das intensive Reden über Ost-West-Kooperationen hinzu. Zwar wurde die Nachkriegspropaganda der Abgrenzung vom westlichen „Kleineuropa“ noch bis 1989 verfolgt, parallel wurde jedoch versucht, sich der Bundesrepublik und der Europäischen Gemeinschaft anzunähem, um wirtschaftliche Vorteile zu realisieren und damit die Herrschaft zu stabilisieren. Oppositionelle Vorstellungen von Europa befanden sich trotz der restriktiven Bedingungen der staatssozialistischen Diktaturen nicht allein in einem abgrenzenden Gegensatz, sondern auch in einem Austausch mit denen der offiziellen Propaganda

Communications Biophysics

Contains reports on five research projects.National Institutes of Health (Grant 5 P01 GM14940-03)National Institutes of Health (Grant 5 TOl GM01555-03)National Aeronautics and Space Administration (Grant NGL 22-009-304

A kinesin-13 mutant catalytically depolymerizes microtubules in ADP

The kinesin-13 motor protein family members drive the removal of tubulin from microtubules (MTs) to promote MT turnover. A point mutation of the kinesin-13 family member mitotic centromere-associated kinesin/Kif2C (E491A) isolates the tubulin-removal conformation of the motor, and appears distinct from all previously described kinesin-13 conformations derived from nucleotide analogues. The E491A mutant removes tubulin dimers from stabilized MTs stoichiometrically in adenosine triphosphate (ATP) but is unable to efficiently release from detached tubulin dimers to recycle catalytically. Only in adenosine diphosphate (ADP) can the mutant catalytically remove tubulin dimers from stabilized MTs because the affinity of the mutant for detached tubulin dimers in ADP is low relative to lattice-bound tubulin. Thus, the motor can regenerate for further cycles of disassembly. Using the mutant, we show that release of tubulin by kinesin-13 motors occurs at the transition state for ATP hydrolysis, which illustrates a significant divergence in their coupling to ATP turnover relative to motile kinesins

Communications Biophysics

Contains research objectives, summary of research and reports on four research projects.National Institutes of Health (Grant 5 P01 GM14940-05)National Institutes of Health (Grant 5 TOl GM01555-05)National Aeronautics and Space Administration (Grant NGL 22-009-304)B-D ElectrodyneBoston City Hospital Purchase Order 1065