Impact of Gender on Separation-Reunification Experiences of Latino Adolescent Immigrants

Many Latino immigrants who enter the US in late childhood or adolescence are reunifying with parents after lengthy separations, and yet there is limited research on this process from their point of view. This article discusses the impact of gender relations on family re-engagement and immigrant adaptation of young men and young women. Young people were interviewed as part of a grounded theory study exploring the process of family separation and reunification for Latino immigrant adolescents who have been separated from their parents for at least four years during immigration. Focus groups, individual interviews and participant observation were used to gather data from 20 Mexican and Central American immigrant adolescents, 12 young men and 8 young women. Participants reported a range of personal and family beliefs about gender roles and their impact on separation and reunification, Young men reported greater exposure to violence, generally had less access to health care, and reported more emotional isolation from families and peers than young women. Fathers and adult male role models were missing from most of their lives, and this absence was particularly difficult for young men. Young women reported greater skills and persistence in emotional re-engagement with their families in the United States.Beaucoup d'immigrés latinos entrés aux Etats-Unis à la fin de l'enfance ou au début de l'adolescence retrouvent leurs parents après une longue période de séparation, et pourtant il n'existe que très peu d'études sur ce sujet relatant leur point de vue. Cet article traite de l'impact des rapports de genre sur le regroupement familial et l'adaptation des jeunes hommes et femmes immigrés. Des jeunes ont été interrogés dans le cadre d'une étude basée sur la théorie ancrée qui analysait le processus de séparation et de regroupement familial chez les adolescents immigrés latinos qui avaient été séparés de leurs parents pendant au moins quatre ans durant la période d'immigration. Des groupes cibles, des entretiens individuels et l'observation des participants ont permis de recueillir des données auprès de 20 adolescents immigrés originaires du Mexique et d'Amérique Centrale, dont 12 jeunes hommes et 8 jeunes femmes. Les participants ont décrit un ensemble de croyances personnelles et familiales sur les rôles sexuels, et leur impact sur la séparation et le regroupement familial. Les jeunes hommes ont ainsi déclaré être plus exposés à la violence, avoir généralement un accès aux soins plus limité, et souffrir d'une plus grande isolation émotionnelle vis-à-vis de leurs familles et de leurs pairs que les jeunes femmes. Les pères et les modèles adultes masculins étaient pour la plupart absents de leur vie, et cette absence était particulièrement difficile à vivre pour les jeunes hommes. Les jeunes femmes ont quant à elles montré plus de capacités et de persévérance dans le réengagement émotionnel avec leurs familles aux Etats-Unis.Muchos inmigrantes latinos que entran en Estados Unidos al final de su infancia o en su adolescencia  se reunifican con sus padres después de largos periodos de separación. Sin embargo, existen muy pocos estudios sobre este proceso desde su punto de vista. Este artículo analiza el impacto de las relaciones de género en la reunificación familiar y la adaptación como inmigrantes de hombres y mujeres jóvenes. Se entrevistó a chicos y chicas en el marco de un estudio de teoría fundamentada que explora el proceso de la separación familiar y su posterior reunificación en el caso de inmigrantes latinos adolescentes que han sido separados de sus padres durante al menos cuatro años en el transcurso de la inmigración. Se utilizaron reuniones de grupo, entrevistas individuales y observaciones para recabar datos de 20 inmigrantes adolescentes mexicanos y centroamericanos, 12 chicos y 8 chicas. Los participantes reflejaban diversas creencias personales y familiares sobre los roles de género y su impacto en la separación y reunificación. Los chicos reflejaron una mayor exposición a la violencia, un acceso más limitado en general a la asistencia sanitaria y un mayor aislamiento emocional de sus familias y compañeros que las chicas. En sus familias no había referencias paternas o de adultos masculinos y esta ausencia resultaba especialmente difícil para los chicos. Las chicas, en cambio, mostraron mayores habilidades y persistencia en la reunificación emocional con sus familias en suelo estadounidense

Impact of Gender on Separation-Reunification Experiences of Latino Adolescent Immigrants

Many Latino immigrants who enter the US in late childhood or adolescence are reunifying with parents after lengthy separations, and yet there is limited research on this process from their point of view. This article discusses the impact of gender relations on family re-engagement and immigrant adaptation of young men and young women. Young people were interviewed as part of a grounded theory study exploring the process of family separation and reunification for Latino immigrant adolescents who have been separated from their parents for at least four years during immigration. Focus groups, individual interviews and participant observation were used to gather data from 20 Mexican and Central American immigrant adolescents, 12 young men and 8 young women. Participants reported a range of personal and family beliefs about gender roles and their impact on separation and reunification, Young men reported greater exposure to violence, generally had less access to health care, and reported more emotional isolation from families and peers than young women. Fathers and adult male role models were missing from most of their lives, and this absence was particularly difficult for young men. Young women reported greater skills and persistence in emotional re-engagement with their families in the United States.Beaucoup d'immigrés latinos entrés aux Etats-Unis à la fin de l'enfance ou au début de l'adolescence retrouvent leurs parents après une longue période de séparation, et pourtant il n'existe que très peu d'études sur ce sujet relatant leur point de vue. Cet article traite de l'impact des rapports de genre sur le regroupement familial et l'adaptation des jeunes hommes et femmes immigrés. Des jeunes ont été interrogés dans le cadre d'une étude basée sur la théorie ancrée qui analysait le processus de séparation et de regroupement familial chez les adolescents immigrés latinos qui avaient été séparés de leurs parents pendant au moins quatre ans durant la période d'immigration. Des groupes cibles, des entretiens individuels et l'observation des participants ont permis de recueillir des données auprès de 20 adolescents immigrés originaires du Mexique et d'Amérique Centrale, dont 12 jeunes hommes et 8 jeunes femmes. Les participants ont décrit un ensemble de croyances personnelles et familiales sur les rôles sexuels, et leur impact sur la séparation et le regroupement familial. Les jeunes hommes ont ainsi déclaré être plus exposés à la violence, avoir généralement un accès aux soins plus limité, et souffrir d'une plus grande isolation émotionnelle vis-à-vis de leurs familles et de leurs pairs que les jeunes femmes. Les pères et les modèles adultes masculins étaient pour la plupart absents de leur vie, et cette absence était particulièrement difficile à vivre pour les jeunes hommes. Les jeunes femmes ont quant à elles montré plus de capacités et de persévérance dans le réengagement émotionnel avec leurs familles aux Etats-Unis.Muchos inmigrantes latinos que entran en Estados Unidos al final de su infancia o en su adolescencia  se reunifican con sus padres después de largos periodos de separación. Sin embargo, existen muy pocos estudios sobre este proceso desde su punto de vista. Este artículo analiza el impacto de las relaciones de género en la reunificación familiar y la adaptación como inmigrantes de hombres y mujeres jóvenes. Se entrevistó a chicos y chicas en el marco de un estudio de teoría fundamentada que explora el proceso de la separación familiar y su posterior reunificación en el caso de inmigrantes latinos adolescentes que han sido separados de sus padres durante al menos cuatro años en el transcurso de la inmigración. Se utilizaron reuniones de grupo, entrevistas individuales y observaciones para recabar datos de 20 inmigrantes adolescentes mexicanos y centroamericanos, 12 chicos y 8 chicas. Los participantes reflejaban diversas creencias personales y familiares sobre los roles de género y su impacto en la separación y reunificación. Los chicos reflejaron una mayor exposición a la violencia, un acceso más limitado en general a la asistencia sanitaria y un mayor aislamiento emocional de sus familias y compañeros que las chicas. En sus familias no había referencias paternas o de adultos masculinos y esta ausencia resultaba especialmente difícil para los chicos. Las chicas, en cambio, mostraron mayores habilidades y persistencia en la reunificación emocional con sus familias en suelo estadounidense

Psychological and physiological stress and burnout among maternity providers in a rural county in Kenya: individual and situational predictors

Background: Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported stress and burnout levels as well as stress-related physiologic measures of these providers, along with their potential predictors. Methods: Participants included 101 maternity providers (62 nurses/midwives, 16 clinical officers/doctors, and 23 support staff) in western Kenya. Respondents completed Cohen’s Perceived Stress Scale, the Shirom-Melamed Burnout scale, and other sociodemographic, health, and work-related items. We also collected data on heart rate variability (HRV) and hair cortisol levels to assess stress-related physiologic responses to acute and chronic stress respectively. Multilevel linear regression models were computed to examine individual and work-related factors associated with stress, burnout, HRV, and cortisol level. Results: 85% of providers reported moderate stress and 11.5% high stress. 65% experienced low burnout and 19.6% high burnout. Average HRV (measured as the root mean square of differences in intervals between successive heart beats: RMSSD) was 60.5 (SD = 33.0) and mean cortisol was mean cortisol was 44.2 pg/mg (SD = 60.88). Greater satisfaction with life accomplishments was associated with reduced stress (β = − 2.83; CI = -5.47; − 0.18), while motivation to work excessively (over commitment) was associated with both increased stress (β = 0.61 CI: 0.19, 1.03) and burnout (β = 2.05, CI = 0.91, 3.19). Female providers had higher burnout scores compared to male providers. Support staff had higher HRV than other providers and providers under 30 years of age had higher HRV than those 30 and above. Although no association between cortisol and any predictor was statistically significant, the direction of associations was consistent with those found for stress and burnout. Conclusions: Most providers experienced moderate to high levels of stress and burnout. Individuals who were more driven to work excessively were particularly at risk for higher stress and burnout. Higher HRV of support staff and providers under age 30 suggest their more adaptive autonomic nervous system response to stress. Given its impact on provider wellbeing and quality of care, interventions to help providers manage stress are critical

Animal models for investigating chronic pancreatitis

Chronic pancreatitis is defined as a continuous or recurrent inflammatory disease of the pancreas characterized by progressive and irreversible morphological changes. It typically causes pain and permanent impairment of pancreatic function. In chronic pancreatitis areas of focal necrosis are followed by perilobular and intralobular fibrosis of the parenchyma, by stone formation in the pancreatic duct, calcifications in the parenchyma as well as the formation of pseudocysts. Late in the course of the disease a progressive loss of endocrine and exocrine function occurs. Despite advances in understanding the pathogenesis no causal treatment for chronic pancreatitis is presently available. Thus, there is a need for well characterized animal models for further investigations that allow translation to the human situation. This review summarizes existing experimental models and distinguishes them according to the type of pathological stimulus used for induction of pancreatitis. There is a special focus on pancreatic duct ligation, repetitive overstimulation with caerulein and chronic alcohol feeding. Secondly, attention is drawn to genetic models that have recently been generated and which mimic features of chronic pancreatitis in man. Each technique will be supplemented with data on the pathophysiological background of the model and their limitations will be discussed

Bimodal coupling of ripples and slower oscillations during sleep in patients with focal epilepsy.

OBJECTIVE: Differentiating pathologic and physiologic high-frequency oscillations (HFOs) is challenging. In patients with focal epilepsy, HFOs occur during the transitional periods between the up and down state of slow waves. The preferred phase angles of this form of phase-event amplitude coupling are bimodally distributed, and the ripples (80-150 Hz) that occur during the up-down transition more often occur in the seizure-onset zone (SOZ). We investigated if bimodal ripple coupling was also evident for faster sleep oscillations, and could identify the SOZ. METHODS: Using an automated ripple detector, we identified ripple events in 40-60 min intracranial electroencephalography (iEEG) recordings from 23 patients with medically refractory mesial temporal lobe or neocortical epilepsy. The detector quantified epochs of sleep oscillations and computed instantaneous phase. We utilized a ripple phasor transform, ripple-triggered averaging, and circular statistics to investigate phase event-amplitude coupling. RESULTS: We found that at some individual recording sites, ripple event amplitude was coupled with the sleep oscillatory phase and the preferred phase angles exhibited two distinct clusters (p \u3c 0.05). The distribution of the pooled mean preferred phase angle, defined by combining the means from each cluster at each individual recording site, also exhibited two distinct clusters (p \u3c 0.05). Based on the range of preferred phase angles defined by these two clusters, we partitioned each ripple event at each recording site into two groups: depth iEEG peak-trough and trough-peak. The mean ripple rates of the two groups in the SOZ and non-SOZ (NSOZ) were compared. We found that in the frontal (spindle, p = 0.009; theta, p = 0.006, slow, p = 0.004) and parietal lobe (theta, p = 0.007, delta, p = 0.002, slow, p = 0.001) the SOZ incidence rate for the ripples occurring during the trough-peak transition was significantly increased. SIGNIFICANCE: Phase-event amplitude coupling between ripples and sleep oscillations may be useful to distinguish pathologic and physiologic events in patients with frontal and parietal SOZ

Physician Clinical Alignment and Integration: A Community Academic Hospital Approach

An overwhelming need for change in the U.S. healthcare delivery system, coupled with the need to improve clinical and financial outcomes, has prompted hospitals to direct renewed efforts toward achieving high quality and cost-effectiveness. Additionally, with the dawn of accountable care organizations and increasing focus on patient expectations, hospitals have begun to seek physician partners through clinical alignment. Contrary to the unsuccessful alignment strategies of the 1990s, today\u27s efforts are more mutually beneficial, driven by the need to achieve better care coordination, increased access to infrastructure, improved quality, and lower costs. In this article, we describe a large, academic, tertiary care hospital\u27s approach to developing and implementing alignment and integration models with its collaboration-ready physicians and physician groups. We developed four models--short of physicians\u27 employment with the organization--tailored to meet the needs of both the physician group and the hospital: (1) medical directorship (group physicians are appointed to serve as medical directors of a clinical area), (2) professional services agreement (specific clinical services, such as overnight admissions help, are contracted), (3) co-management services agreement (one specialty group co-manages all services within the specialty service lines), and (4) lease arrangement (closest in scope to employment, in which the hospital pays all expenses and receives all revenue). Successful hospital-physician alignment requires careful planning and the early engagement of legal counsel to ensure compliance with federal statutes. Establishing an integrated system with mutually identified goals better positions hospitals to deliver cost-effective and high-quality care under the new paradigm of healthcare reform

Dorsal Anterior Cingulate Cortices Differentially Lateralize Prediction Errors and Outcome Valence in a Decision-Making Task.

The dorsal anterior cingulate cortex (dACC) is proposed to facilitate learning by signaling mismatches between the expected outcome of decisions and the actual outcomes in the form of prediction errors. The dACC is also proposed to discriminate outcome valence—whether a result has positive (either expected or desirable) or negative (either unexpected or undesirable) value. However, direct electrophysiological recordings from human dACC to validate these separate, but integrated, dimensions have not been previously performed. We hypothesized that local field potentials (LFPs) would reveal changes in the dACC related to prediction error and valence and used the unique opportunity offered by deep brain stimulation (DBS) surgery in the dACC of three human subjects to test this hypothesis. We used a cognitive task that involved the presentation of object pairs, a motor response, and audiovisual feedback to guide future object selection choices. The dACC displayed distinctly lateralized theta frequency (3–8 Hz) event-related potential responses—the left hemisphere dACC signaled outcome valence and prediction errors while the right hemisphere dACC was involved in prediction formation. Multivariate analyses provided evidence that the human dACC response to decision outcomes reflects two spatiotemporally distinct early and late systems that are consistent with both our lateralized electrophysiological results and the involvement of the theta frequency oscillatory activity in dACC cognitive processing. Further findings suggested that dACC does not respond to other phases of action-outcome-feedback tasks such as the motor response which supports the notion that dACC primarily signals information that is crucial for behavioral monitoring and not for motor control

Functional Characterization of Rare Variants in the SHOX2 Gene Identified in Sinus Node Dysfunction and Atrial Fibrillation

Sinus node dysfunction (SND) and atrial fibrillation (AF) often coexist; however, the molecular mechanisms linking both conditions remain elusive. Mutations in the homeobox-containing SHOX2 gene have been recently associated with early-onset and familial AF. Shox2 is a key regulator of sinus node development, and its deficiency leads to bradycardia, as demonstrated in animal models. To provide an extended SHOX2 gene analysis in patients with distinct arrhythmias, we investigated SHOX2 as a susceptibility gene for SND and AF by screening 98 SND patients and 450 individuals with AF. The functional relevance of the novel mutations was investigated in vivo and in vitro, together with the previously reported p.H283Q variant. A heterozygous missense mutation (p.P33R) was identified in the SND cohort and four heterozygous variants (p.G77D, p.L129=, p.L130F, p.A293=) in the AF cohort. Overexpression of the pathogenic predicted mutations in zebrafish revealed pericardial edema for p.G77D and the positive control p.H283Q, whereas the p.P33R and p.A293= variants showed no effect. In addition, a dominant-negative effect with reduced heart rates was detected for p.G77D and p.H283Q. In vitro reporter assays demonstrated for both missense variants p.P33R and p.G77D significantly impaired transactivation activity, similar to the described p.H283Q variant. Also, a reduced Bmp4 target gene expression was revealed in zebrafish hearts upon overexpression of the p.P33R mutant. This study associates additional rare variants in the SHOX2 gene implicated in the susceptibility to distinct arrhythmias and allows frequency estimations in the AF cohort (3/990). We also demonstrate for the first time a genetic link between SND and AF involving SHOX2. Moreover, our data highlight the importance of functional investigations of rare variants