Cultural and Linguistic Adaptation of Stop the Bleed: Saving Lives in a Multi-ethnic Refugee Resettlement Community

Background Research and practice show an urgent need for health interventions to be adapted in culturally and linguistically responsive ways for limited English proficient (LEP) communities where cultural and language discordance exacerbate challenges in accessing healthcare. Stop the Bleed (STB), an evidence-based life-saving bleeding control intervention training for lay community members is available in English and Spanish and does not reach members of other culturally and linguistically diverse US communities. Aims Our aim was to culturally and linguistically adapt STB materials and training to serve six language communities (Arabic, Burmese, Dari, Pashto, Somali, Swahili) in a two-phase project by following health literacy (HL) guidelines and Culturally and Linguistically Appropriate Services (CLAS) standards in materials development and training implementation. Methods Using a convenience and snowball sample of community residents contacted through face-to-face conversations and a flyer, a semi-structured focus group of eight participants with interpreters and two interviews were held to understand emergency medical services, emergency healthcare in home countries, and interest in STB training. The focus groups and interviews were completed before materials adaptation. Materials were adapted using focus guide/interview data and HL guidelines and shared with members of the targeted language groups to ensure cultural and linguistic responsiveness and understanding of terminology. Community members were recruited for a STB training through face-to-face and in-language flyers. STB training was delivered by certified instructors with interpreters. Results A total of 144 community members were trained over a two-year period. In the first phase (n = 46) we assessed knowledge and self-efficacy pre- and post-training; results indicate that there was a statistically significant increase in knowledge about life saving techniques and a significant increase in self-efficacy to use STB. Qualitative survey results indicated that in-language training was critical for skills improvement and appreciated by attendees. In the second phase (n = 98), we trained community and business leaders of a local elementary school and resettlement agency who live among and serve the broad refugee community in Clarkston. Discussion Culturally and linguistically responsive adaptations of health-related materials and training that follow HL and CLAS guidelines must include community members’ perspectives, cultural knowledge, and linguistic expertise. Adapted STB is a low cost feasible way to disseminate life-saving bleeding intervention training to diverse LEP communities

The downward spiral of chronic pain, prescription opioid misuse, and addiction: Cognitive, affective, and neuropsychopharmacologic pathways

Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed; multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction

Restructuring of colloidal aggregates in shear flow: Coupling interparticle contact models with Stokesian dynamics

A method to couple interparticle contact models with Stokesian dynamics (SD) is introduced to simulate colloidal aggregates under flow conditions. The contact model mimics both the elastic and plastic behavior of the cohesive connections between particles within clusters. Owing to this, clusters can maintain their structures under low stress while restructuring or even breakage may occur under sufficiently high stress conditions. SD is an efficient method to deal with the long-ranged and many-body nature of hydrodynamic interactions for low Reynolds number flows. By using such a coupled model, the restructuring of colloidal aggregates under stepwise increasing shear flows was studied. Irreversible compaction occurs due to the increase of hydrodynamic stress on clusters. Results show that the greater part of the fractal clusters are compacted to rod-shaped packed structures, while the others show isotropic compaction.Comment: A simulation movie be found at http://www-levich.engr.ccny.cuny.edu/~seto/sites/colloidal_aggregates_shearflow.htm

High-spin States in \u3csup\u3e191, 193\u3c/sup\u3eAu and \u3csup\u3e192\u3c/sup\u3ePt: Evidence for Oblate Deformation and Triaxial Shapes

High-spin states of 191, 193Au and 192Pt have been populated in the 186W(11B, xn) and 186W(11B, p4n) reactions, respectively, at a beam energy of 68 MeV and their γ decay was studied using the YRAST Ball detector array at the Wright Nuclear Structure Laboratory at Yale University. The level scheme of 193Au has been extended up to Iπ = 55/2+. New transitions were observed also in 191Au and 192Pt. Particle-plus-Triaxial-Rotor (PTR) and Total Routhian Surface (TRS) calculations were performed to determine the equilibrium deformations of the Au isotopes. The predictions for oblate deformations in these nuclei are in agreement with the experimental data. Development of nonaxial shapes is discussed within the framework of the PTR model

Triaxial Deformation and Nuclear Shape Transition in \u3csup\u3e192\u3c/sup\u3eAu

Background: Nuclei in the A≈190 mass region show gradual shape changes from prolate through nonaxial deformed shapes and ultimately towards spherical shapes as the Pb region is approached. Exploring how this shape evolution occurs will help us understand the evolution of collectivity in this region. Purpose: The level scheme of the 192Au nucleus in A ≈ 190 region was studied in order to deduce its deformations. Methods: High-spin states of 192Au have been populated in the 186W(11B, 5n) reaction at a beam energy of 68 MeV and their γ decay was studied using the YRAST Ball detector array at the Wright Nuclear Structure Laboratory (WNSL), Yale University. Results: Based on double and triple γ-ray coincidence data the level scheme of 192Au has been extended up to Iπ = 32+ at an excitation energy of ∼6 MeV. Conclusion: The results are discussed in the framework of pairing and deformation self-consistent total Routhian surface (TRS) and cranked shell model (CSM) calculations. The comparison of the experimental observations with the calculations indicates that this nucleus takes a nonaxial shape similar to other Au nuclei in this region

Design and Development of a Novel Force-Sensing Robotic System for the Transseptal Puncture in Left Atrial Catheter Ablation

Transseptal puncture (TSP) is a prerequisite for left atrial catheter ablation for atrial fibrillation, requiring access from the right side of the heart. It is a demanding procedural step associated with complications, including inadvertent puncturing and application of large forces on the tissue wall. Robotic systems have shown great potential to overcome such challenges by introducing force-sensing capabilities and increased precision and localization accuracy. Therefore, this work introduces the design and development of a novel robotic system developed to perform TSP. We integrated optoelectronic sensors into the tools' fixtures, measuring tissue contact and puncture forces along one axis. The novelty of this design is in the system's ability to manipulate a Brockenbrough (BRK) needle and dilator-sheath simultaneously and measure tissue contact and puncture forces. In performing puncture experiments on anthropomorphic tissue models, an average puncture force of 3.97 ± 0.45 N (1SD) was established - similar to the force reported in literature on the manual procedure. This research highlights the potential for improving patient safety by enforcing force constraints, paving the way to more automated and safer TSP

Structure of high-spin states in 91Sr and 92Sr

The nuclei 91Sr and 92Sr were produced at high spin as fission fragments following the fusion reaction 36S+ 159Tb at 165 MeV. γ rays were detected with the Gammasphere array. The level schemes of 91Sr and 92Sr were extended up to E≈6 MeV and E≈8 MeV, respectively. Level structures in 91Sr and 92Sr were interpreted in shell-model calculations performed in the configuration space (0f5/2, 1p3/2, 1p1/2, 0g9/2) for the protons and (1p1/2, 0g9/2, 1d5/2) for the neutrons. Negative-parity states in the yrast sequences are described in these calculations by coupling 3- proton excitations to the unpaired 1d5/2 neutrons. A possible reduction of the gap between the proton 1p3/2 and 1p1/2 orbitals in 92Sr is discussed

Rotational structures near 40ℏ in 123La

The neutron-deficient nucleus 123La was studied via the 92Mo(40Ca,2ap) reaction at a beam energy of 184 MeV. Previously known bands were extended to a much higher spin, and in two cases the structures are now observed near 40ℏ. In addition, three new sequences were identified and linked into previously known bands. The lowest (π,α)=(+,-1/2) structure displays characteristics similar to those of analogous bands in 127,129La, which have been proposed as examples of smooth band termination. Cranked Nilsson-Strutinsky calculations were compared with the experimental data in 123La to determine whether this band is approaching a terminating state as well