Wellness from Diabetes: Community Health and Diabetes Assessment

The Republic of the Marshall Islands (RMI) is highly prevalent in type 2 diabetes mellitus (T2DM) with a prevalence rate of 37.37%, the highest in the world. T2DM dominates Majuro, the country’s capital, as a leading cause of mortality and morbidity, despite efforts of health care workers, local community organizations, and government. Income and education are social determinants of health. The correlations between good health and high income, and between good health and high education level, are positive. However, there is a continuous growth of T2DM incidence and prevalence on Majuro. Therefore, we hypothesized that there is no significant difference between healthful dietary and exercise practices of two groups of people on Majuro, RMI: those with high income and high education levels, and those with low income and low education levels. Community-based research conducted on Majuro helped test our hypothesis and gain knowledge of necessary steps to reverse this epidemic. During beginning stages of our research, related literature on diabetes, social determinants of health, and research methods were reviewed. To acquire qualitative data, focus group discussions (FGDs) and key informant interviews (KIIs) were conducted. FGDs were held with people grouped according to profession (health, education, community). With the KIIs, key members deeply involved or active in the community were interviewed one-on-one. The bulk of our quantitative data will be gathered by surveys on basic demographics, economics, and health-related perceptions. In collaboration with the Ministry of Health and local organizations, 400 surveys will be administered in Marshallese and English, and collected

Evaluation of Tumor Localization in Respiration Motion-Corrected Stereotactic Body Radiotherapy Patients Treated with TomoTherapy.

Ph.D. Thesis. University of Hawaiʻi at Mānoa 2017

Lyman-α\alpha polarization from cosmological ionization fronts: II. Implications for intensity mapping

This is the second paper in a series whose aim is to predict the power spectrum of intensity and polarized intensity from cosmic reionization fronts. After building the analytic models for intensity and polarized intensity calculations in paper I, here we apply these models to simulations of reionization. We construct a geometric model for identifying front boundaries, calculate the intensity and polarized intensity for each front, and compute a power spectrum of these results. This method was applied to different simulation sizes and resolutions, so we ensure that our results are convergent. We find that the power spectrum of fluctuations at $z=8$ in a bin of width $\Delta z=0.5$ ($\lambda/\Delta\lambda=18$) is $\Delta_\ell \equiv [\ell(\ell+1)C_\ell/2\pi]^{1/2}$ is $3.2\times 10^{-11}$ erg s$^{-1}$ cm$^{-2}$ sr$^{-1}$ for the intensity $I$, $7.6\times10^{-13}$ erg s$^{-1}$ cm$^{-2}$ sr$^{-1}$ for the $E$-mode polarization, and $5.8\times10^{-13}$ erg s$^{-1}$ cm$^{-2}$ sr$^{-1}$ for the $B$-mode polarization at $\ell=1.5\times10^4$. After computing the power spectrum, we compare results to detectable scales and discuss implications for observing this signal based on a proposed experiment. We find that, while fundamental physics does not exclude this kind of mapping from being attainable, an experiment would need to be highly ambitious and require significant advances to make mapping Lyman-$\alpha$ polarization from cosmic reionization fronts a feasible goal.Comment: 18 pages, 9 figures, to be submitted to JCA

Lyman-{\alpha} polarization from cosmological ionization fronts: I. Radiative transfer simulations

In this paper, we present the formalism of simulating Lyman-$\alpha$ emission and polarization around reionization ($z$ = 8) from a plane-parallel ionization front. We accomplish this by using a Monte Carlo method to simulate the production of a Lyman-$\alpha$ photon, its propagation through an ionization front, and the eventual escape of this photon. This paper focuses on the relation of the input parameters of ionization front speed $U$, blackbody temperature $T_{\rm bb}$, and neutral hydrogen density $n_{\rm HI}$, on intensity $I$ and polarized intensity $P$ as seen by a distant observer. The resulting values of intensity range from $3.18\times 10^{-14}$ erg/cm$^{2}$/s/sr to $1.96 \times 10^{-9}$ erg/cm$^{2}$/s/sr , and the polarized intensity ranges from $5.73\times 10^{-17}$ erg/cm$^{2}$/s/sr to $5.31 \times 10^{-12}$ erg/cm$^{2}$/s/sr. We found that higher $T_{\rm bb}$, higher $U$, and higher $n_{\rm HI}$ contribute to higher intensity, as well as polarized intensity, though the strongest dependence was on the hydrogen density. The dependence of viewing angle of the front is also explored. We present tests to support the validity model, which makes the model suitable for further use in a following paper where we will calculate the intensity and polarized intensity power spectrum on a full reionization simulation.Comment: 29 pages, 13 figures, to be submitted to JCA

The WiggleZ Dark Energy Survey: Direct constraints on blue galaxy intrinsic alignments at intermediate redshifts

Correlations between the intrinsic shapes of galaxy pairs, and between the intrinsic shapes of galaxies and the large-scale density field, may be induced by tidal fields. These correlations, which have been detected at low redshifts (z<0.35) for bright red galaxies in the Sloan Digital Sky Survey (SDSS), and for which upper limits exist for blue galaxies at z~0.1, provide a window into galaxy formation and evolution, and are also an important contaminant for current and future weak lensing surveys. Measurements of these alignments at intermediate redshifts (z~0.6) that are more relevant for cosmic shear observations are very important for understanding the origin and redshift evolution of these alignments, and for minimising their impact on weak lensing measurements. We present the first such intermediate-redshift measurement for blue galaxies, using galaxy shape measurements from SDSS and spectroscopic redshifts from the WiggleZ Dark Energy Survey. Our null detection allows us to place upper limits on the contamination of weak lensing measurements by blue galaxy intrinsic alignments that, for the first time, do not require significant model-dependent extrapolation from the z~0.1 SDSS observations. Also, combining the SDSS and WiggleZ constraints gives us a long redshift baseline with which to constrain intrinsic alignment models and contamination of the cosmic shear power spectrum. Assuming that the alignments can be explained by linear alignment with the smoothed local density field, we find that a measurement of \sigma_8 in a blue-galaxy dominated, CFHTLS-like survey would be contaminated by at most +/-0.02 (95% confidence level, SDSS and WiggleZ) or +/-0.03 (WiggleZ alone) due to intrinsic alignments. [Abridged]Comment: 18 pages, 12 figures, accepted to MNRAS; v2 has correction to one author's name, NO other changes; v3 has minor changes in explanation and calculations, no significant difference in results or conclusions; v4 has an additional footnote about model interpretation, no changes to data/calculations/result

Recognition of and care-seeking for maternal and newborn complications in Jayawijaya district, Papua province, Indonesia: a qualitative study

Background: Indonesia\u2019s progress on reducing maternal and newborn mortality rates has slowed in recent years, predominantly in rural areas. To reduce maternal and newborn mortality, access to quality and skilled care, particularly at the facility level, is crucial. Yet, accessing such care is often delayed when maternal and newborn complications arise. Using the \u201cThree Delays\u201d model originated by Thaddeus and Maine (1994), investigation into reasons for delaying the decision to seek care, delaying arrival at a health facility, and delaying the receiving of adequate care, may help in establishing more focused interventions to improve maternal and newborn health in this region. Methods: This qualitative study focused on identifying, analyzing, and describing illness recognition and care-seeking patterns related to maternal and newborn complications in the Jayawijaya district of Papua province, Indonesia. Group interviews were conducted with families and other caregivers from within 15 villages of Jayawijaya who had either experienced a maternal or newborn illness or maternal or newborn death. Results: For maternal cases, excessive bleeding after delivery was recognized as a danger sign, and the process to decide to seek care was relatively quick. The decision-making process was mostly dominated by the husband. Most care was started at home by birth attendants, but the majority sought care outside of the home within the public health system. For newborn cases, most of the caregivers could not easily recognize newborn danger signs. Parents acted as the main decision-makers for seeking care. Decisions to seek care from a facility, such as the clinic or hospital, were only made when healthcare workers could not handle the case within the home. All newborn deaths were associated with delays in seeking care due to caretaker limitations in danger sign identification, whereas all maternal deaths were associated with delays in receiving appropriate care at facility level. Conclusions: For maternal health, emphasis needs to be placed on supply side solutions, and for newborn health, emphasis needs to be placed on demand and supply side solutions, probably including community-based interventions. Contextualized information for the design of programs aimed to affect maternal and newborn health is a prerequisite

An adaptive signaling network in melanoma inflammatory niches confers tolerance to MAPK signaling inhibition

Mitogen-activated protein kinase (MAPK) pathway antagonists induce profound clinical responses in advanced cutaneous melanoma, but complete remissions are frustrated by the development of acquired resistance. Before resistance emerges, adaptive responses establish a mutation-independent drug tolerance. Antagonizing these adaptive responses could improve drug effects, thereby thwarting the emergence of acquired resistance. In this study, we reveal that inflammatory niches consisting of tumor-associated macrophages and fibroblasts contribute to treatment tolerance through a cytokine-signaling network that involves macrophage-derived IL-1β and fibroblast-derived CXCR2 ligands. Fibroblasts require IL-1β to produce CXCR2 ligands, and loss of host IL-1R signaling in vivo reduces melanoma growth. In tumors from patients on treatment, signaling from inflammatory niches is amplified in the presence of MAPK inhibitors. Signaling from inflammatory niches counteracts combined BRAF/MEK (MAPK/extracellular signal–regulated kinase kinase) inhibitor treatment, and consequently, inhibiting IL-1R or CXCR2 signaling in vivo enhanced the efficacy of MAPK inhibitors. We conclude that melanoma inflammatory niches adapt to and confer drug tolerance toward BRAF and MEK inhibitors early during treatmen

Medical Physics Leadership Academy Journal Club (Leadership Club) program: Two-year review in building a community of leaders.

The American Association of Physicists in Medicine began the Medical Physics Leadership Academy Journal Club in the fall of 2020. The initiative was launched to provide a forum for medical physicists to learn about leadership topics using published material, discuss and reflect on the material, and consider incorporating the discussed skills into their professional practice. This report presents the framework for the MPLA Journal Club program, describes the lessons learned over the last 2&nbsp;years, summarizes the data collected from attendees, and highlights the roadmap for the program moving forward