Construir la raza y encontrar un lugar en el Orlando puertorriqueño

This article explores the different memories of racial experience that Puerto Ricans bring to Orlando, Florida, from Puerto Rico and from northern diasporic communities. It then looks at how the black-white racial binary of Orlando history has affected how Puerto Ricans have been received and how they have used historical racial discourses to create a space for themselves in the social, political, and economic worlds of Orlando.Este artículo explora las diferentes memorias de la experiencia racial que los puertorriqueños llevan a Orlando, Florida, desde Puerto Rico y desde otras comunidades diaspóricas del norte de Estados Unidos. Posteriormente examina cómo la oposición binaria racial entre negros y blancos en la historia de Orlando ha afectado la recepción de los puertorriqueños y cómo estos han utilizado discursos raciales históricos para crear un espacio para sí mismos en los mundos sociales, políticos y económicos de Orlando

Aquatic polymers can drive pathogen transmission in coastal ecosystems.

Gelatinous polymers including extracellular polymeric substances (EPSs) are fundamental to biophysical processes in aquatic habitats, including mediating aggregation processes and functioning as the matrix of biofilms. Yet insight into the impact of these sticky molecules on the environmental transmission of pathogens in the ocean is limited. We used the zoonotic parasite Toxoplasma gondii as a model to evaluate polymer-mediated mechanisms that promote transmission of terrestrially derived pathogens to marine fauna and humans. We show that transparent exopolymer particles, a particulate form of EPS, enhance T. gondii association with marine aggregates, material consumed by organisms otherwise unable to access micrometre-sized particles. Adhesion to EPS biofilms on macroalgae also captures T. gondii from the water, enabling uptake of pathogens by invertebrates that feed on kelp surfaces. We demonstrate the acquisition, concentration and retention of T. gondii by kelp-grazing snails, which can transmit T. gondii to threatened California sea otters. Results highlight novel mechanisms whereby aquatic polymers facilitate incorporation of pathogens into food webs via association with particle aggregates and biofilms. Identifying the critical role of invisible polymers in transmission of pathogens in the ocean represents a fundamental advance in understanding and mitigating the health impacts of coastal habitat pollution with contaminated runoff

2009 Alaska Health Workforce Vacancy Study

Alaska continues to experience health professional shortages. The state has long had a deficient “supply side” characterized by insufficient numbers of key health workers whose recruitment, retention, and training have been impeded by Alaska’s remoteness, harsh climate, rural isolation, low population density, and scarce training resources. Alaska is the only state without a pharmacy school and lacks its own dental and physical therapy schools as well. Health professional shortages can be decreased through the start of new training programs, the expansion of existing programs, and the improvement of the effectiveness of recruitment and retention efforts. However, strategic planning and the execution of such programs require valid and accurate data. To this end, stakeholders such as the Alaska Mental Health Trust Authority (AMHTA) and Alaskan's For Access to Health Care (ACCESS), along with schools and departments within the University of Alaska Anchorage (UAA), funded the Alaska Center for Rural Health-Alaska’s AHEC (ACRH) and the Institute of Social and Economic Research (ISER) to conduct a comprehensive health workforce study during winter and spring of 2009. This report highlights employers’ needs for employees to fill budgeted positions. This is different from a needs assessment that would take into account population demographics and disease incidence and prevalence. This health workforce study is an assessment of health manpower shortage based on budgeted staff positions and their vacancies in organizations throughout the state. Respondents included part-time positions, which resulted in our counting full-time equivalent (FTE) rather than individuals (“bodies”). In situations where a position was divided among more than one occupation (e.g., Dental Assistant and Billing Clerk), we asked the respondent to count the position under which they considered the position’s “primary occupation.” This was a point-in-time cross-sectional study. Recently filled vacancies or imminent vacancies were not counted. Positions filled by relief/temporary/locum/contract health workers were counted as vacancies only if these workers were temporarily filling a currently vacant, budgeted position. Due to budget and time constraints, we were not able to conduct a trend analysis that is a comparison of this study’s findings and the prior 2007 study. The key questions this study sought to answer were (1) How many budgeted positions, either full- or part-time, existed in organizations providing health services in Alaska? (2) How many of these budgeted positions were currently vacant? (3) What was the vacancy rate? (4) How many of the organizations that employ these occupations hired new graduates of training programs? (5) How many of the currently vacant budgeted positions (#2) could be filled by new graduates of training programs? (6) What were the mean and maximum length of time, expressed in months, that the vacancies have existed? (7) What were the principal, underlying causes of vacancies? The study was designed in consultation with an advisory group that included AMHTA, ACCESS, and UAA. The study targeted 93 health occupations. The unit of analysis was the employment site by organization type, which allowed for the allocation of positions and vacancies by geographic region. For each employer, we identified the staff person most knowledgeable about hiring and vacancies. In large organizations this meant that one employer might provide information about multiple sites and organization types; smaller employers were responsible for only a single site.Alaska Mental Health Trust Authority. Alaskan's for Access to Health Care. University of Alaska Fairbanks, Tanana Valley campus Telemedicine program. University of Alaska Anchorage, Community and Technical College. University of Alaska Anchorage, School of Nursing.Acknowledgements / Executive Summary / Table of Contents / Problem and Rationale / Methodology / Limitations of Study / Findings / Appendix A. List of Health Occupations / Appendix B. Health Workforce Surveys / Appendix C. Cover Letter Accompanying Survey Forms / Appendix D. Confidence Intervals for Positions, Vacancies, Number of Vacancies Filled with New Graduates, and Length of Longest Vacancy in Months / Appendix E. Tables of Samples and Estimates of Positions, Vacancies, Vacancy Rates, Number of Vacancies Filled with New Graduates, Mean and Maximum Length of Longest Vacancy in Months / Appendix F. Tables of Occupations Sorted By Estimates of Positions, Vacancies, Vacancy Rates, Number of Vacancies Filled with New Graduates, Mean and Maximum Length of Longest Vacancy in Month

Effects of the 2002 Chignik Cooperative: A Survey of Chignik Salmon Permit Holders

This report presents the results of a survey of Chignik Salmon Purse Seine permit holders about management changes in the Chignik salmon fishery and the effects of the 2002 Chignik salmon cooperative. In January 2002, the Alaska Board of Fisheries passed regulations that established criteria and management measures for a cooperative fishery in the Chignik purse seine salmon fishery. Under the regulations, if 51 or more Chignik permit holders chose to join a cooperative, the cooperative would receive an allocation of a percentage of the Chignik sockeye salmon harvest. The purpose of the regulations was to allow permit holders the opportunity to fish cooperatively to reduce costs, improve quality and increase value by reducing the number of vessels fishing and slowing down the fishery. Permit holders who chose not to join the cooperative could fish in an “open” or “independent” fishery with a separate allocation. Subsequently the Chignik Seafood Producers Alliance (CSPA) formed as a cooperative in accordance with the new regulations. In 2002, 77 Chignik permit holders joined the Co-op, 22 permit holders chose to fish independently in the open fishery, and 1 permit holder did not join the cooperative and also did not fish. This report is based on the 89 survey responses that we received by January 15, 2003. (An earlier report was based on the 80 responses received by December 3, 2002.)Funding for the survey and the study was provided by University of Alaska Foundation funds made available to ISER by University of Alaska President Hamilton for a series of Alaska economic studies

Leveraging health infrastructure to optimize HPV vaccination for adolescents in Zambia: Protocol for an implementation study

BACKGROUND: Cervical cancer is the leading cause of cancer death in Zambia, where HIV prevalence is also high (11.3%). HIV heightens the risk of developing and dying from cervical cancer. The human papillomavirus (HPV) vaccine can prevent 90% of cervical cancers, and in Zambia is recommended for adolescent girls ages 14-15 years, including those with HIV. Currently they mainly deliver HPV vaccination via school-based campaigns, which may exclude the most vulnerable adolescents-those out-of-school or who irregularly attend. Adolescents living with HIV (ALHIV) are more likely to have these vulnerabilities. Further, school-based campaigns are not tailored to the WHO-recommended HPV vaccination schedule for ALHIV (3 versus 2 doses). Integrating HPV vaccination into routine care in adolescent HIV clinics may ensure that ALHIV have access to vaccine at the WHO-recommended schedule. Such integration requires a multilevel approach, stakeholder engagement, and diversified implementation strategies, given known challenges of providing the HPV vaccine in LMICs, including Zambia. METHODS: Our study aims to integrate HPV vaccination into routine care in adolescent HIV clinics. To achieve success, we will co-design a package of implementation strategies using a previously successful implementation research approach developed for cervical cancer prevention in LMICs: the Integrative Systems Praxis for Implementation Research (INSPIRE). INSPIRE is a novel, comprehensive approach to develop, implement, and evaluate implementation science efforts. Following key elements of INSPIRE, our specific aims are to: 1) Identify the unique multilevel contextual factors (barriers and facilitators) across HIV settings (rural, urban, peri-urban) that influence HPV vaccine uptake; 2) Use Implementation Mapping to translate stakeholder feedback and findings from Aim 1 into a package of implementation strategies to integrate HPV vaccine into HIV clinics; 3) Conduct a Hybrid Type 3 effectiveness-implementation trial to evaluate the package of multilevel implementation strategies for integrating HPV vaccine into HIV clinics. DISCUSSION: Our research team has strong support, technical expertise, and resources (e.g., vaccines) from the Zambian Ministry of Health; and political will for scale-up. This stakeholder-based implementation model has the potential to be transported to HIV clinics across Zambia and serve as a model to address cancer prevention priorities for those with HIV in other LMICs. TRIAL REGISTRATION: To be registered prior to Aim 3, when implementation strategies finalized

Perspectives on the INternational CLassification of Diseases, 11th Revision (ICD-11); an international qualitative study to Understand and improve mental health Diagnosis using expertise by Experience: INCLUDE Study

Developed in collaboration with the WHO Department of Mental Health and Substance Abuse, this study conducted in the UK, India, and the US, integrated feedback from mental health service users into the development of the chapter on mental, behavioural, and neurodevelopmental disorders for the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11). The ICD-11 is set for approval by the World Health Assembly in May, 2019. As a reporting standard and diagnostic classification system it will be highly influential on the policy, clinical practice, and research that affect mental health service users; yet this is the first study to systematically seek and collate service user perspectives on a major classification and diagnostic guideline. Focus groups were used to collect feedback on five diagnoses: depressive episode, generalised anxiety disorder, schizophrenia, bipolar type 1 disorder, and personality disorder. Participants were given the official draft diagnostic guidelines and a parallel lay translation. Data were thematically analysed. This formed the basis of co-produced recommendations for the WHO, which included features that could be added or revised to better reflect lived experience and changes to language that was confusing or objectionable to service users. The findings also indicated that an accessible lay language version of the ICD-11 could be beneficial for service users and their supporters

Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial.

BACKGROUND: Preterm birth remains a common cause of neonatal mortality, with a disproportionately high burden in low-income and middle-income countries. Meta-analyses of low-dose aspirin to prevent pre-eclampsia suggest that the incidence of preterm birth might also be decreased, particularly if initiated before 16 weeks of gestation. METHODS: ASPIRIN was a randomised, multicountry, double-masked, placebo-controlled trial of low-dose aspirin (81 mg daily) initiated between 6 weeks and 0 days of pregnancy, and 13 weeks and 6 days of pregnancy, in nulliparous women with an ultrasound confirming gestational age and a singleton viable pregnancy. Participants were enrolled at seven community sites in six countries (two sites in India and one site each in the Democratic Republic of the Congo, Guatemala, Kenya, Pakistan, and Zambia). Participants were randomly assigned (1:1, stratified by site) to receive aspirin or placebo tablets of identical appearance, via a sequence generated centrally by the data coordinating centre at Research Triangle Institute International (Research Triangle Park, NC, USA). Treatment was masked to research staff, health providers, and patients, and continued until 36 weeks and 7 days of gestation or delivery. The primary outcome of incidence of preterm birth, defined as the number of deliveries before 37 weeks\u27 gestational age, was analysed in randomly assigned women with pregnancy outcomes at or after 20 weeks, according to a modified intention-to-treat (mITT) protocol. Analyses of our binary primary outcome involved a Cochran-Mantel-Haenszel test stratified by site, and generalised linear models to obtain relative risk (RR) estimates and associated confidence intervals. Serious adverse events were assessed in all women who received at least one dose of drug or placebo. This study is registered with ClinicalTrials.gov, NCT02409680, and the Clinical Trial Registry-India, CTRI/2016/05/006970. FINDINGS: From March 23, 2016 to June 30, 2018, 14 361 women were screened for inclusion and 11 976 women aged 14-40 years were randomly assigned to receive low-dose aspirin (5990 women) or placebo (5986 women). 5780 women in the aspirin group and 5764 in the placebo group were evaluable for the primary outcome. Preterm birth before 37 weeks occurred in 668 (11·6%) of the women who took aspirin and 754 (13·1%) of those who took placebo (RR 0·89 [95% CI 0·81 to 0·98], p=0·012). In women taking aspirin, we also observed significant reductions in perinatal mortality (0·86 [0·73-1·00], p=0·048), fetal loss (infant death after 16 weeks\u27 gestation and before 7 days post partum; 0·86 [0·74-1·00], p=0·039), early preterm delivery (\u3c34 \u3eweeks; 0·75 [0·61-0·93], p=0·039), and the incidence of women who delivered before 34 weeks with hypertensive disorders of pregnancy (0·38 [0·17-0·85], p=0·015). Other adverse maternal and neonatal events were similar between the two groups. INTERPRETATION: In populations of nulliparous women with singleton pregnancies from low-income and middle-income countries, low-dose aspirin initiated between 6 weeks and 0 days of gestation and 13 weeks and 6 days of gestation resulted in a reduced incidence of preterm delivery before 37 weeks, and reduced perinatal mortality. FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development

Soil-derived Nature’s Contributions to People and their contribution to the UN Sustainable Development Goals

Acknowledgments The input of PS contributes to Soils-R-GRREAT (NE/P019455/1) and the input of PS and SK contributes to the European Union's Horizon 2020 Research and Innovation Programme through project CIRCASA (grant agreement no. 774378). PR acknowledges funding from UK Greenhouse Gas Removal Programme (NE/P01982X/2). GB De Deyn acknowledges FoodShot Global for its support. TKA acknowledges the support of “Towards Integrated Nitrogen Management System (INMS) funded by the Global Environment Facility (GEF), executed through the UK’s Natural Environment Research Council (NERC). The input of DG was supported by the New Zealand Ministry of Business, Innovation and Employment (MBIE) strategic science investment fund (SSIF). PMS acknowledges support from the Australian Research Council (Project FT140100610). PM’s work on ecosystem services is supported by a National Science Foundation grant #1853759, “Understanding the Use of Ecosystem Services Concepts in Environmental Policy”. LGC is funded by National Council for Scientific and Technological Development (CNPq, Brazil – grants 421668/2018-0 and 305157/2018-3) and by Lisboa2020 FCT/EU (project 028360). BS acknowledges support from the Lancaster Environment Centre Project.Peer reviewedPostprin

Immunochip analysis identifies multiple susceptibility loci for systemic sclerosis

In this study, 1,833 systemic sclerosis (SSc) cases and 3,466 controls were genotyped with the Immunochip array. Classical alleles, amino acid residues, and SNPs across the human leukocyte antigen (HLA) region were imputed and tested. These analyses resulted in a model composed of six polymorphic amino acid positions and seven SNPs that explained the observed significant associations in the region. In addition, a replication step comprising 4,017 SSc cases and 5,935 controls was carried out for several selected non-HLA variants, reaching a total of 5,850 cases and 9,401 controls of European ancestry. Following this strategy, we identified and validated three SSc risk loci, including DNASE1L3 at 3p14, the SCHIP1-IL12A locus at 3q25, and ATG5 at 6q21, as well as a suggested association of the TREH-DDX6 locus at 11q23. The associations of several previously reported SSc risk loci were validated and further refined, and the observed peak of association in PXK was related to DNASE1L3. Our study has increased the number of known genetic associations with SSc, provided further insight into the pleiotropic effects of shared autoimmune risk factors, and highlighted the power of dense mapping for detecting previously overlooked susceptibility loci

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program