Homophobia and Patriarchy in Nicaragua: A Few Ideas to Start a Debate

Reflecting on a 25?year?old study on cultural constructions of same?sex sexual relations between men in Nicaragua, which described a submissive–dominant – or cochón–cochonero – model, this article contrasts this notion with more recent gay identities that have emerged in urban Nicaragua in particular, and which now coexist alongside the more traditional model. Despite many LGBT (lesbian, gay, bisexual, and transgender) groups having emerged in the country, patriarchy is proving resilient and adaptive in surprising ways. Although important victories have been achieved on a global and national scale, culturally and legislatively, in relation to equal rights for LGBT people, this article argues that such advances do not necessarily mean that the intensely andocentric character of patriarchy itself has been significantly challenged or altered. In the struggle for equal rights for all, the models and dynamics of patriarchal power and how they manifest themselves within LGBT organisations, families and relations must also be addressed … and undressed

Examining KY HB8 for 2022: What Can We Learn from Other States’ Experiences?

Currently, Kentucky levies an individual income tax on all income earned by Kentucky residents at a rate of 5%. A bill approved in 2022 by the Kentucky legislature, KY HB8 for 2022 will phase down the individual income tax rate from 5% to 0% and expand the sales tax to 39 additional classes of services. Incremental decreases in the individual income tax rate depend on meeting General Fund receipts thresholds established in the bill after an initial reduction of one percentage point. Kentucky will join the ranks of 9 other states that do not impose an individual income tax including Alaska, Florida, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington, and Wyoming with this change. The purpose of this paper is to provide a general overview of KY HB8 and to examine how other states have performed under similar tax strategies. The short and long-term economic impact on Kentucky was not examined which is a limitation of the paper. State level financial information was reviewed to determine revenue generating strategies in Kentucky and several states with a no individual income tax model. States for this analysis included New Hampshire, Tennessee, and Florida for comparison to Kentucky. Comparison states were selected based on these characteristics: 1. New Hampshire provides examples of potential business tax strategies, 2. Tennessee provides information from a state that is geographically parallel and proximal to Kentucky and 3. Florida exemplifies a state with a prolonged omission of individual income taxes. The literature review describes critical public services and fiscal factors linked to the revenue sources for these states. A more comprehensive examination of the strategies used by other states may be useful to Kentucky as the elements of KY HB8 for 2022 are implemented. Examining revenue generating strategies used by other states without an individual income tax can identify additional approaches for achieving threshold attainment with KY HB8 for 2022. Research Questions 1. What are the potential fiscal implications of KY HB for 2022? 2. How do revenue collections for Kentucky compare to collections in other states without an individual income tax? 3. Are there revenue generating strategies in other states that have the potential to contribute to revenue collections in Kentucky

The At-Risk Mental State (ARMS) for Psychosis in Children and Adolescents.

Introduction In the last decade it has been proposed that individuals who are at an elevated future risk of developing psychosis compared to the general population can be identified using operationalised criteria. Those who fulfil these criteria are labelled as having an At-Risk Mental State (ARMS) for psychosis. Research in working-age adults has reported a lowering of the short-term rate of transition of such individuals to psychosis over successive cohorts. Nevertheless, such individuals report poor psychosocial functioning and high distress levels. To date, there has been a dearth of research specifically focussed on the concept of the ARMS in adolescents. Thus it is not established how these young people present to mental health services, what mental health diagnostic categories, if any, they would fulfil and what their short-term outcomes are in terms of mental health and psychosocial functioning. Moreover, it is unknown how this group may experience the label of being ‘at-risk’ and whether these individuals would benefit from the ARMS criteria being made an official diagnostic category. The aim of this study was to investigate how young people fulfilling the ARMS criteria present to services, to characterise them and report the short-term outcomes, in terms of mental health and functioning. The views and experiences of young people with the ARMS label and mental health professionals potentially working with this client group were also explored. Methods Two separate projects were completed: Project 1; The Follow-up of the At-Risk Mental State (FARMS) project and Project 2; The Professional Attitudes towards the At-Risk Mental State (PAARMS) project. Study 1 of the FARMS project involved a prospective longitudinal cohort study and investigated how adolescents categorised as having an ARMS initially present to mental health services and fared over a six month follow-up period. Study 2 involved recruiting a purposive sample of participants fulfilling the ARMS criteria from Study 1, into a qualitative study. An Interpretative Phenomenological Analysis (IPA) framework was then used to explore the personal understanding and experiences of these young people in relation to the ARMS concept. The PAARMS project used a mixed methods approach in order to evaluate the attitudes and experience of Child and Adolescent Mental Health Service (CAMHS) professionals in relation to the ARMS concept. Firstly, in-depth interviews were conducted with a purposive sample of six CAMHS clinicians who work in Early Intervention in Psychosis (EIP) services regarding their experience and attitudes in relation to working with young mental health service-users who have the ARMS label. Secondly, a survey involving 180 CAMHS clinicians was conducted. Results Study 1 of the FARMS project confirmed that adolescents fulfilling the ARMS criteria present to services with significant levels of reported psychopathology and functional impairment. Auditory perceptual disturbance was the most frequently reported ‘positive’ symptom whilst 70% of participants met the threshold for at least one current ICD-10 Axis I psychiatric diagnosis. In terms of short term outcomes, transition rates to psychosis were low (1/29; 3%) with a handful of individuals (7/29; 24%) demonstrating significant remission of symptoms and/or significant improvements in psychosocial functioning. The findings from Study 2 indicate that young people wish to be told about their condition upon identification and do not report experiencing significantly negative or distressing instances of stigma, though this was a voiced initial concern. Talking to mental health professionals and possibly peers, who also experience similar symptoms, are perceived as the most beneficial elements of support offered by services. Finally, CAMHS professionals participating in the PAARMS project reported being reluctant to recommend medication as a first-line treatment strategy. However, monitoring, psycho-education and psychological therapies were widely endorsed. Identification and management of adolescents with the ARMS label was viewed as challenging and complicated by a variety of factors including maturational process and a lack of official guidelines and protocols. Discussion The results of this study not only characterise how adolescents fulfilling the ARMS criteria present to services but also inform future debates regarding the ARMS concept as a distinct diagnosis. These findings should therefore facilitate the development of new policies for the identification and management of the condition in young people and address areas of clinical practice that require immediate attention. Future research is required to establish whether these initial findings are generalisable to services elsewhere and to evaluate plausible interventional approaches that target distressing symptoms and functioning

Wraith Work

Pages 102-10

Response by Welsh et al to letter regarding article “Urinary sodium excretion, blood pressure, and risk of future cardiovascular disease and mortality in subjects without prior cardiovascular disease”

No abstract available

Evaluation of the impact of Patient-Centered Medical Home adoption among primary care providers in the Mid-west

Background. Primary care transformation, or activities undertaken at the practice site level that are designed to strengthen the delivery of care, has been advanced as a vehicle for achieving improved population health outcomes, particularly among chronically ill patients. The patient-centered medical home (PCMH) model has been established as an important mechanism for preventing acute episodes requiring high-cost interventions yet there remains uncertainty about the conditions that best contribute to the model’s success. Objectives. To compare the probability that at least one patient on a physician’s panel had an emergency department (ED) visit in the year between physicians who adopted the PCMH model and non-adopting physicians, and to determine if the model’s effectiveness differed amongst primary care practice types and disease groups. Research Design. We used a quasi-experimental design leveraging secondary claims data from calendar years 2011-2017 linked with PCMH adoption events to create adopter and non-adopter physician cohorts between 2008-2017. The sample included commercial beneficiaries 18-64 years of age with one of three aggregated chronic disease categories based on 3M risk adjustment methodologies. Generalized estimating equations with an exchangeable working correlation structure was used to estimate associations between PCMH adoption and subsequent ED utilization at the physician-panel level using inverse-probability-oftreatment weighting to address confounding from an endogenous treatment. Subjects. 6,421,772 non-unique patients were attributed to 6,467 unique physicians based on where they received a majority of their care during the year. All physicians were affiliated with a commercial health plan operating in five contiguous states in the Midwest with the majority of claims coming from a single state. Measures. The primary outcome of interest was an indicator variable that at least one patient on a physician’s panel had an ED visit during the year. A binary treatment variable delineated PCMH adopting physician-practices from non-adopting physician-practices. Results. Adoption of the PCMH model was associated with 2.1 percentage point increase in the probability of at least one ED visit during the year using a propensity weighted control group. Conclusions. Health plans should thoughtfully weigh the decision to incentivize PCMH adoption within their physician networks. While reductions in overall ED utilization may be limited relative to non-adopters, understanding the differences in how primary care provider types and their staff work together will be important for identifying where the model can be most advantageous.Master of Science in Public Healt

The Orbital Light Curve of Aquila X-1

We obtained R- and I-band CCD photometry of the soft X-ray transient/neutron- star binary Aql X-1 in 1998 June while it was at quiescence. We find that its light curve is dominated by ellipsoidal variations, although the ellipsoidal variations are severely distorted and have unequal maxima. After we correct for the contaminating flux from a field star located only 0.46" away, the peak-to-peak amplitude of the modulation is ~0.25 mag in the R band, which requires the orbital inclination to be greater than 36 degrees. The orbital period we measure is consistent with the 18.95 h period measured by Chevalier & Ilovaisky (1998). During its outbursts the light curve of Aql X-1 becomes single humped. The outburst light curve observed by Garcia et al. (1999) agrees in phase with our quiescent light curve. We show that the single humped variation is caused by a ``reflection effect,'' that is, by heating of the side of the secondary star facing towards the neutron star.Comment: 18 manuscript pages, 7 figures; accepted by A

The White Dwarf in EM Cygni: Beyond The Veil

We present a spectral analysis of the FUSE spectra of EM Cygni, a Z Cam DN system. The FUSE spectrum, obtained in quiescence, consists of 4 individual exposures (orbits): two exposures, at orbital phases phi ~ 0.65 and phi ~ 0.90, have a lower flux; and two exposures, at orbital phases phi =0.15 and 0.45, have a relatively higher flux. The change of flux level as a function of the orbital phase is consistent with the stream material (flowing over and below the disk from the hot spot region to smaller radii) partially masking the white dwarf. We carry out a spectral analysis of the FUSE data, obtained at phase 0.45 (when the flux is maximual, using the codes TLUSTY and SYNSPEC. Using a single white dwarf spectral component, we obtain a white dwarf temperature of 40,000K, rotating at 100km/s. The white dwarf, or conceivably, the material overflowing the disk rim, shows suprasolar abundances of silicon, sulphur and possibly nitrogen. Using a white dwarf+disk composite model, we obtain that the white dwarf temperature could be even as high as 50,000K, contributing more than 90% of the FUV flux, and the disk contributing less than 10% must have a mass accretion rate reaching 1.E-10 Msun/yr.In both cases, however, we obtain that the white dwarf temperature is much higher than previously estimated.Comment: accepted for publication in ApJ, 3 Tables, 12 Figures (including color figures), 33 pages in present format (possibly 10 pages in ApJ format

Abnormal small heat shock protein interactions involving neuropathy-associated HSP22 (HSPB8) mutants

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154632/1/fsb2fj065911fje.pd