Persons with disabilities in Robeson County, North Carolina : an action-oriented community diagnosis : findings and next steps of action

The following document is a detailed report of an Action Oriented Community Diagnosis (AOCD) completed by a five-member team of graduate students at University of North Carolina at Chapel Hill, School of Public Health, Department of Health Behavior and Health Education. This AOCD was conducted in order to gain an understanding of the cultural, social, economic, and health experiences of persons with disabilities and their families in Robeson County, North Carolina. Through the AOCD process, the team and community participants identified resources, strengths, and challenges that exist in Robeson County for persons with disabilities and their families, and developed action steps to address several of the challenges. Over the course of seven months from October 2007 to April 2008, the team worked to learn more about the community. Through conducting secondary data, attending community events, and conducting 28 in-depth interviews with 20 service providers and eight community members and three focus groups with 13 community members, team members gained valuable insight into everyday life in this community. The team developed a coding system to analyze the data collected and to identify recurring themes related to living with disabilities in Robeson County. In April 2008, the team organized a community forum at the O.P. Owens Building in Lumberton, the county seat, to present findings from the AOCD process to over 43 community members and service providers. At the forum, participants had the opportunity to discuss major themes that emerged from the team‘s data analysis, and to work together in small groups to create specific action steps to address those themes. The themes and action steps discussed at the forum were: 1. Transportation: There is a lack of accessible, reliable, and affordable transportation options in Robeson County. This limits quality of life, access to services, and employment for people living with disabilities. Attend County Commissioner meetings. Attend Mayor‘s Committee for the Disabled meetings. Call SEATS to ask about safety procedures, weight limits, and wheelchair accessible vans. Research how other communities with similar demographics and geographies have addressed transportation for persons with disabilities. Look into recreating the voucher program. Create an education campaign for service providers, wheelchair vendors, persons with disabilities, and the general community about transportation issues faced by persons with disabilities. Talk to physicians and physical therapists about transportation issues faced by persons with disabilities, including how selection of wheelchair can affect opportunities for public transportation. 2. Services Communication and Information: Although many services exist for persons with disabilities in Robeson County, there is a lack of a centralized information system accessible to people with low literacy and without access to computer technology. There is also a lack of partnership between service providers. This causes confusion and limited knowledge about services for service providers, persons with disabilities and their families. Contacting the Healing Lodge in the county to facilitate a discussion with those members and connect them to disability resources. Service providers presenting at healthcare to educate the community about services available. Finding out more about the 211 telephone information service provided by United Way. Collaborate with other agencies on the Partnership for Community Health booklet by letting Partnership know about more providers. 3. Recreation: There is an interest among persons with disabilities to become physically active. There is a lack of recreational opportunities and facilities for persons with disabilities in Robeson County. This limits social and recreational interaction and creates barriers for physical fitness. Advertise and increase awareness of disabilities and recreational opportunities for persons with disabilities in the local newspapers. Form a support group for persons with disabilities to increase awareness of the need for recreation for persons with disabilities. Hold first meeting of support group where the ADA laws that ensure persons with disabilities access to accessible public recreational opportunities are explained. Organize monthly activities for persons with disabilities. 4. Awareness: There is limited awareness among community members and service providers about persons with disabilities, especially “invisible disabilities,” such as chronic illness and substance abuse. This contributes to feelings of isolation and disrespect that diminish the quality of life for persons with disabilities and caregivers. Train healthcare workers in disability awareness by having them use different assistance devices, such as wheelchairs, for a day. Be vocal as persons with disabilities and share experiences and perspectives with others. Advocate for disability awareness by integrating discussions of disability in other venues. Educate employers about ADA rights. 5. Paying for services: Although many people living with disabilities in Robeson County are supported by Medicaid, many others are uninsured and have difficulty paying for medical services. This causes people to delay seeking medical help and decreases the reach and effectiveness of existing resources. Action steps were not developed for this group as there were not enough attendees who participated in developing action steps around this theme. Following the forum, the team completed this final report with recommendations for the community based on their experiences throughout the process and the outcomes from the community forum. The final recommendations are summarized below: 1. Service providers for persons with disabilities in Robeson County should continue to update the resource list that the team has compiled and included in this document and should make it available in multiple formats designed for the those with vision loss, low literacy, and without access to computer technology. 2. Service providers for persons with disabilities in Robeson County should create a centralized referral system that could direct its users to different services, including medical and social services, as suggested by several service providers and community members. This could be started by further publicizing the existing 211 telephone directory. 3. Community members and service providers should advocate for the expansion of the county transit program (SEATS), including more accessible vans and drivers, affordable fares, and weekend routes. 4. Service providers should hold annual public events such as a community forum or health fair to increase awareness of disabilities and services and resources available to persons with disabilities in Robeson County. This can be hosted by a local health agency or an advocacy organization such as the Mayor‘s Committee for the Disabled. 5. Community members and service providers should advocate for the perspectives of persons with disabilities in public meetings about county development, including new and existing projects. Persons with disabilities and their supporters should be aware of local news, attend town, city or county meetings whenever possible, and share their views and ideas with the larger community. The Mayor‘s Committee for the Disabled should support persons with disabilities in these efforts by publicizing their meeting times and by helping persons with disabilities access schedules of other local government meetings and public hearings. The team hopes that this report, the action steps, community member and service provider connections, and the strong sense of initiative for change that emerged from this project and the community forum will continue to build on the strengths of this community. Ultimately, the team also hopes that the entire AOCD process and this final report contribute to future improvements not only for persons with disabilities, but for all residents of Robeson County.Master of Public Healt

Optical detection of the Pictor A jet and tidal tail : evidence against an IC/CMB jet

Date of Acceptance: 12/06/2015New images of the FR II radio galaxy Pictor A from the Hubble Space Telescope reveal a previously undiscovered tidal tail, as well as a number of jet knots coinciding with a known X-ray and radio jet. The tidal tail is approximately 5″ wide (3 kpc projected), starting 18″ (12 kpc) from the center of Pictor A, and extends more than 90″ (60 kpc). The knots are part of a jet observed to be about 4′ (160 kpc) long, extending to a bright hotspot. These images are the first optical detections of this jet, and by extracting knot flux densities through three filters, we set constraints on emission models. While the radio and optical flux densities are usually explained by synchrotron emission, there are several emission mechanisms that might be used to explain the X-ray flux densities. Our data rule out Doppler-boosted inverse Compton scattering as a source of the high-energy emission. Instead, we find that the observed emission can be well described by synchrotron emission from electrons with a low-energy index (p ∼ 2) that dominates the radio band, while a high-energy index (p ∼ 3) is needed for the X-ray band and the transition occurs in the optical/infrared band. This model is consistent with a continuous electron injection scenario.Peer reviewedFinal Accepted Versio

Immunofluorescent spectral analysis reveals the intrathecal cannabinoid agonist, AM1241, produces spinal anti-inflammatory cytokine responses in neuropathic rats exhibiting relief from allodynia

During pathological pain, the actions of the endocannabinoid system, including the cannabinoid 2 receptor (CB2R), leads to effective anti-allodynia and modifies a variety of spinal microglial and astrocyte responses. Here, following spinal administration of the CB2R compound, AM1241, we examined immunoreactive alterations in markers for activated p38 mitogen-activated protein kinase, interleukin-1β (IL-1β), the anti-inflammatory cytokine, interleukin-10 (IL-10) as well as degradative endocannabinoid enzymes, and markers for altered glial responses in neuropathic rats. In these studies, the dorsal horn of the spinal cord and dorsal root ganglia were examined. AM1241 produced profound anti-allodynia with corresponding immunoreactive levels of p38 mitogen-activated kinase, IL-1β, IL-10, the endocannabinoid enzyme monoacylglycerol lipase, and astrocyte activation markers that were similar to nonneuropathic controls. In contrast, spinal AM1241 did not suppress the increased microglial responses observed in neuropathic rats. The differences in fluorescent markers were determined within discrete anatomical regions by applying spectral analysis methods, which virtually eliminated nonspecific signal during the quantification of specific immunofluorescent intensity. These data reveal expression profiles that support the actions of intrathecal AM1241 control pathological pain through anti-inflammatory mechanisms by modulating critical glial factors, and additionally decrease expression levels of endocannabinoid degradative enzymes

Mathematical model insights into arsenic detoxification

<p>Abstract</p> <p>Background</p> <p>Arsenic in drinking water, a major health hazard to millions of people in South and East Asia and in other parts of the world, is ingested primarily as trivalent inorganic arsenic (iAs), which then undergoes hepatic methylation to methylarsonic acid (MMAs) and a second methylation to dimethylarsinic acid (DMAs). Although MMAs and DMAs are also known to be toxic, DMAs is more easily excreted in the urine and therefore methylation has generally been considered a detoxification pathway. A collaborative modeling project between epidemiologists, biologists, and mathematicians has the purpose of explaining existing data on methylation in human studies in Bangladesh and also testing, by mathematical modeling, effects of nutritional supplements that could increase As methylation.</p> <p>Methods</p> <p>We develop a whole body mathematical model of arsenic metabolism including arsenic absorption, storage, methylation, and excretion. The parameters for arsenic methylation in the liver were taken from the biochemical literature. The transport parameters between compartments are largely unknown, so we adjust them so that the model accurately predicts the urine excretion rates of time for the iAs, MMAs, and DMAs in single dose experiments on human subjects.</p> <p>Results</p> <p>We test the model by showing that, with no changes in parameters, it predicts accurately the time courses of urinary excretion in mutiple dose experiments conducted on human subjects. Our main purpose is to use the model to study and interpret the data on the effects of folate supplementation on arsenic methylation and excretion in clinical trials in Bangladesh. Folate supplementation of folate-deficient individuals resulted in a 14% decrease in arsenicals in the blood. This is confirmed by the model and the model predicts that arsenicals in the liver will decrease by 19% and arsenicals in other body stores by 26% in these same individuals. In addition, the model predicts that arsenic methyltransferase has been upregulated by a factor of two in this population. Finally, we also show that a modification of the model gives excellent fits to the data on arsenic metabolism in human cultured hepatocytes.</p> <p>Conclusions</p> <p>The analysis of the Bangladesh data using the model suggests that folate supplementation may be more effective at reducing whole body arsenic than previously expected. There is almost no data on the upregulation of arsenic methyltransferase in populations chronically exposed to arsenic. Our model predicts upregulation by a factor of two in the Bangladesh population studied. This prediction should be verified since it could have important public health consequences both for treatment strategies and for setting appropriate limits on arsenic in drinking water. Our model has compartments for the binding of arsenicals to proteins inside of cells and we show that these comparments are necessary to obtain good fits to data. Protein-binding of arsenicals should be explored in future biochemical studies.</p

A sensorimotor control framework for understanding emotional communication and regulation

JHGW and CFH are supported by the Northwood Trust. TEVR was supported by a National Health and Medical Research Council (NHMRC) Early Career Fellowship (1088785). RP and MW were supported by the the Australian Research Council (ARC) Centre of Excellence for Cognition and its Disorders (CE110001021)Peer reviewedPublisher PD

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline