Refugee Articulations of Health: A Culture-Centered Exploration of Burmese Refugees' Resettlement in the United States

Grounded in the culture-centered approach that emphasizes dialogic engagement with communities at the margins to disrupt mainstream health discourses, this article explores articulations of health by the Burmese refugee community in the United States post resettlement. Due to forced migration, often fleeing violent political regimes in their home countries and surviving itinerantly in refugee camps and host countries, they face further disenfranchisement upon resettlement as a subset of immigrants who are thrust into an unfamiliar sociocultural setting with marginal federal support. Against this backdrop, the present research explores the narratives of Burmese refugees in the United States through in-depth interviews focusing on their meaning-making practices surrounding health and displays of agency in the face of structural healthcare barriers. The participants' narratives articulate health as communal and familial safety in contrast to the mainstream discourse of disease prevention and individual lifestyle choices. They describe structural barriers to healthcare access in the form of the employment-insurance nexus, and also an intricate web of lack of access to health services resulting from linguistic isolation. Within such constraints they locate agency by utilizing community networks as mediators for infrastructural and cultural access and engage in practices seeking out providers with interpreters from within the Burmese community, as well as utilizing technology such as listservs and e-mails through informal networks often ignored by mainstream healthcare providers in the community.

Genome-wide identification and expression analysis of the plant specific LIM genes in Gossypium arboreum under phytohormone, salt and pathogen stress

Asiatic cotton (Gossypium arboreum) cultivated as ‘desi cotton’ in India, is renowned for its climate resilience and robustness against biotic and abiotic stresses. The genome of G. arboreum is therefore, considered as a valued reserve of information for discovering novel genes or gene functions for trait improvements in the present context of cotton cultivation world-wide. In the present study, we carried out genome-wide analysis of LIM gene family in desi cotton and identified twenty LIM domain proteins (GaLIMs) which include sixteen animals CRP-like GaLIMs and four plant specific GaLIMs with presence (GaDA1) or absence (GaDAR) of UIM (Ubiquitin Interacting Motifs). Among the sixteen CRP-like GaLIMs, eleven had two conventional LIM domains while, five had single LIM domain which was not reported in LIM gene family of the plant species studied, except in Brassica rapa. Phylogenetic analysis of these twenty GaLIM proteins in comparison with LIMs of Arabidopsis, chickpea and poplar categorized them into distinct αLIM1, βLIM1, γLIM2, δLIM2 groups in CRP-like LIMs, and GaDA1 and GaDAR in plant specific LIMs group. Domain analysis had revealed consensus [(C-X₂-C-X₁₇-H-X₂-C)-X₂-(C-X₂-C-X₁₇-C-X₂-H)] and [(C-X₂-C-X₁₇-H-X₂-C)-X₂-(C-X₄-C-X₁₅-C-X₂-H)] being conserved as first and/or second LIM domains of animal CRP-like GaLIMs, respectively. Interestingly, single LIM domain containing GaLIM15 was found to contain unique consensus with longer inter-zinc-motif spacer but shorter second zinc finger motif. All twenty GaLIMs showed variable spatio-temporal expression patterns and accordingly further categorized into distinct groups of αLIM1, βLIM1, γLIM2 δLIM2 and plant specific LIM (DA1/DAR). For the first time, response of GaDA1/DAR under the influence of biotic and abiotic stresses were studied in cotton, involving treatments with phytohormones (Jasmonic acid and Abscisic acid), salt (NaCl) and wilt causing pathogen (Fusarium oxysporum). Expressions patterns of GaDA1/DAR showed variable response and identified GaDA2 as a probable candidate gene for stress tolerance in G. arboreum.

Test of Lepton-Flavor Universality in B→K^{*}ℓ^{+}ℓ^{-} Decays at Belle

We present a measurement of R_{K^{*}}, the branching fraction ratio B(B→K^{*}μ^{+}μ^{-})/B(B→K^{*}e^{+}e^{-}), for both charged and neutral B mesons. The ratio for the charged case R_{K^{*+}} is the first measurement ever performed. In addition, we report absolute branching fractions for the individual modes in bins of the squared dilepton invariant mass q^{2}. The analysis is based on a data sample of 711  fb^{-1}, containing 772×10^{6}  BB[over ¯] events, recorded at the ϒ(4S) resonance with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. The obtained results are consistent with standard model expectations.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Disseminated TB in inpatient deaths at a tertiary care centre: an autopsy study over three decades

BACKGROUND: One of the most severe forms of TB, disseminated TB (dTB) is associated with significant mortality. A retrospective study was undertaken to assess the proportion of dTB among inpatient deaths and to describe the pathological spectrum of lesions. Associated comorbidities and missed dTB cases ante-mortem were also sought.METHODS: Data on autopsy-confirmed cases of dTB from over three decades (1988-2016) obtained from the departmental archives of the Post Graduate Institute of Medical Education and Research, Chandigarh, India, were reviewed for clinical details, as well as gross and histopathological findings. The proportion of autopsy-confirmed dTB were reported.RESULTS: During this period, a total of 243 autopsy-confirmed cases were retrieved. The organs most commonly involved in these cases were the lungs (90.1%), followed by the liver (72%), spleen (44%), kidneys (37%), bone marrow (17%), adrenals (12.2%), intestine (11.4%), pancreas (8.5%) and reproductive organs (6.9%). The brain was involved in 73.3% cases. In one third of cases, the diagnosis of TB was not suspected ante-mortem. Comorbid conditions were noted in 36.2% cases.CONCLUSION: A significant burden of dTB was noted among hospital inpatient deaths. Due to multi-organ involvement, dTB has atypical symptoms and may remain undiagnosed ante-mortem. Increased awareness and robust screening of TB cases are mandatory, particularly in patients with underlying comorbidities.

Evidence for X(3872)→J/ψπ^{+}π^{-} Produced in Single-Tag Two-Photon Interactions

We report the first evidence for X(3872) production in two-photon interactions by tagging either the electron or the positron in the final state, exploring the highly virtual photon region. The search is performed in e^{+}e^{-}→e^{+}e^{-}J/ψπ^{+}π^{-}, using 825  fb^{-1} of data collected by the Belle detector operated at the KEKB e^{+}e^{-} collider. We observe three X(3872) candidates, where the expected background is 0.11±0.10 events, with a significance of 3.2σ. We obtain an estimated value for Γ[over ˜]_{γγ}B(X(3872)→J/ψπ^{+}π^{-}) assuming the Q^{2} dependence predicted by a cc[over ¯] meson model, where -Q^{2} is the invariant mass squared of the virtual photon. No X(3915)→J/ψπ^{+}π^{-} candidates are found.

Effect of germanium auto-diffusion on the bond lengths of Ga and P atoms in GaP/Ge(111) investigated by using X-ray absorption spectroscopy

The germanium auto-diffusion effects on the inter-atomic distance between the nearest neighbors of the Ga atom in GaP epilayers are investigated using high-resolution X-ray diffraction (HRXRD) and X-ray absorption spectroscopy. The GaP layers grown on Ge (111) are structurally coherent and relaxed but they show the presence of residual strain which is attributed to the auto-diffusion of Ge from the results of secondary ion mass spectrometry and electrochemical capacitance voltage measurements. Subsequently, the inter-atomic distances between the nearest neighbors of Ga atom in GaP are determined from X-ray absorption fine-structure spectra performed at the Ga K-edge. The estimated local bond lengths of Ga with its first and second nearest neighbors show asymmetric variation for the in-plane and out-of-plane direction of GaP/Ge(111). The magnitude and direction of in-plane and out-of-plane microscopic residual strain present in the GaP/Ge are calculated from the difference in bond lengths which explains the presence of macroscopic residual tensile strain estimated from HRXRD. Modified nearest neighbor configurations of Ga in the auto-diffused GaP epilayer are proposed for new possibilities within the GaP/Ge hetero-structure, such as the conversion from indirect to direct band structures and engineering the tensile strain quantum dot structures on (111) surfaces.

Anti-piroplasmic activity of novobiocin as heat shock protein 90 inhibitor against in vitro cultured Theileria equi and Babesia caballi parasites

Theileria equi and Babesia caballi are the causative agents of equine piroplasmosis (EP). Currently, imidocarb dipropionate (ID) is the only available drug for treating the clinical form of EP. Serious side effects and incomplete clearance of infection is a major drawback of ID. Heat-shock proteins (Hsp) play a vital role in the life cycle of these haemoprotozoans by preventing alteration in protein conformation. These Hsp are activated during transmission of EP sporozoites from the tick vector (poikilotherm) to the natural host (homeotherm) and facilitate parasite survival. In the present study, we targeted the heat shock protein 90 (Hsp-90) pathway of T. equi and B. caballi by using its inhibitor drug - novobiocin. Dose-dependent efficacy of novobiocin on the growth of T. equi and B. caballi was observed in in vitro culture. Additionally, we examined dose-dependent cell cytotoxicity on host peripheral mononuclear cells (PBMCs) and haemolytic activity on equine red blood cells (RBC). In vivo organ toxicity of novobiocin was also assessed in a mouse model. The IC₅₀ (50 % inhibitory concentration) value of novobiocin against T. equi and B. caballi was 165 μM and 84.85 μM, respectively. Novobiocin significantly arrested the in vitro growth of T. equi and B. caballi parasites at 100 μM and 200 μM drug concentration, respectively. In vitro treated parasites had distorted nuclear material and showed no further viability. Based on the equine PBMCs and RBC, the drug was found to be safe even at 1000 μM concentration and the CC₅₀ (50 % cytotoxicity concentration) values were 11.63 mM and 261.97 mM. Very high specific selective index (SSI) values (70.47 and 1587) were observed for equine PBMCs and RBC, respectively. Organ-specific biochemical markers and histopathological examination indicated no adverse effect of the drug at a dose rate of 50 mg kg body weight in the mouse model. The results demonstrate the growth inhibitory effect of novobiocin against T. equi and B. caballi parasites and its safety for host cell lines with very high SSI. Hence, it can be inferred that the Theileria/Babesia Hsp-90 family are potential drug targets worthy of further investigation.

Identification and diagnosis of Secondary Progressive Multiple Sclerosis during the clinical encounter: Results from a physician survey

BACKGROUND

It is difficult to characterize the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive MS (SPMS), due to symptomatic variability across patients. Diagnosis of SPMS is prolonged and often established retrospectively, as it is based on patient clinical history and symptoms. This cross-sectional study aimed to identify MS neurologist reported clinical indicators deemed important in diagnosing SPMS in clinical practice.

METHODS

A web-based quantitative survey was conducted among MS-treating neurologists across the United States in January 2019. The questionnaire comprised of 17 questions evaluating primary clinical indicators used by neurologists in assessing patient progression to SPMS. Treatment approach and factors influencing treatment decision-making following SPMS diagnosis were also analyzed in the survey.

RESULTS

Overall, 300 neurologists completed the survey; most of the respondents were general MS-treating neurologists (63%) and from private care setting (58%). The overall respondents as well as MS-focused neurologists ranked patient history (45% and 42%, respectively) and patients' neurological exam (39% and 44%, respectively) as -primary clinical indicators of SPMS diagnosis. 57% of neurologists always or mostly switched disease modifying therapies after progression to SPMS, and mostly considered 3-6 months' assessment interval to diagnose SPMS.

CONCLUSION

The survey indicated that neurologists are able to recognize signs of SPMS within six months of symptomatic assessment. The diagnosis is primarily based on patient history among MS-treating neurologists. Therefore, continued education to neurologists may facilitate early diagnosis and timely introduction of effective treatment to manage the progression of SPMS.

Genomic sequence analysis of lung infections using artificial intelligence technique

Attributable to the modernization of Artificial Intelligence (AI) procedures in healthcare services, various developments including Support Vector Machine (SVM), and profound learning. For example, Convolutional Neural systems (CNN) have prevalently engaged in a significant job of various classificational investigation in lung malignant growth, and different infections. In this paper, Parallel based SVM (P-SVM) and IoT has been utilized to examine the ideal order of lung infections caused by genomic sequence. The proposed method develops a new methodology to locate the ideal characterization of lung sicknesses and determine its growth in its early stages, to control the growth and prevent lung sickness. Further, in the investigation, the P-SVM calculation has been created for arranging high-dimensional distinctive lung ailment datasets. The data used in the assessment has been fetched from real-time data through cloud and IoT. The acquired outcome demonstrates that the developed P-SVM calculation has 83% higher accuracy and 88% precision in characterization with ideal informational collections when contrasted with other learning methods.

Complete genome sequence and genetic organization of a Garlic virus D infecting garlic (Allium sativum) from northern India

The present paper describes first full genome sequence of the Garlic virus D (GarV-D) from northern India with a genome size of 8425 bp long ssRNA. The infected leaves and bulbs of garlic variety Yamuna Safed (G-282) plants suspected for GarV-D infection were collected with the aim to identify contagion virus during March, 2018. The total RNA was extracted from the pooled garlic plants using TRIzol reagent and sequenced using an Illumina HiSeq 2000 platform. BLASTn search in the NCBI database identified contagion as GarV-D (MK518067). It shared 83.63-85.83% nucleotide sequence identities with other (GarV-D) isolates from Argentina (KF550407, KF555653, KR819505) and 83.15% with isolates from China (MF795136, MF363012). Keywords: Allium sativum; Allexivirus; Garlic virus D; India.

Protocol for a feasibility and early efficacy study of the Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2)

Background

Although androgen deprivation therapy (ADT) for prostate cancer demonstrates improved overall and disease-free survival, it is associated with adverse effects such as obesity and metabolic syndrome that increase risk of cardiometabolic disease and diabetes type 2. ADT also leads to fatigue, depression and erectile dysfunction, which reduce quality of life (QoL). Lifestyle modification has shown promise in reducing obesity, metabolic syndrome and diabetes type 2 in other disease types. However, there is a paucity of data regarding the utility of lifestyle modification in men receiving ADT for prostate cancer.

Methods

The primary aim of the Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2) is to test the feasibility of conducting a 24-week lifestyle modification intervention in men on ADT for prostate cancer. Additionally, it will also determine the effect of this intervention on weight loss, cardiometabolic markers (secondary aim and markers of interest: serum glucose, insulin resistance, hemoglobin A1C and lipid panel), and QoL (tertiary aim). The intervention will be delivered weekly via telephone for the first 10 weeks and bi-weekly for the remaining 14 weeks. Questionnaires and serum samples will be collected at baseline, week 12, and week 24. Anthropometric measurements will be collected at baseline, week 6, week 12, week 18 and week 24.

Results

We hypothesize that the CLIPP2 intervention will produce a 7% weight loss that will result in improved markers associated with cardiometabolic disease and type 2 diabetes in the study population.

Conclusion

Results will provide insight into the role of lifestyle modification in addressing ADT adverse effects as well as provide preliminary data to inform the development of future lifestyle interventions in this area.

Trial registration

NCT04228055 Clinicaltrials. gov.

Clinical and vital sign changes associated with late-onset sepsis in very low birth weight infants at 3 NICUs

BACKGROUND

In premature infants, clinical changes frequently occur due to sepsis or non-infectious conditions, and distinguishing between these is challenging. Baseline risk factors, vital signs, and clinical signs guide decisions to culture and start antibiotics. We sought to compare heart rate (HR) and oxygenation (SpO2) patterns as well as baseline variables and clinical signs prompting sepsis work-ups ultimately determined to be late-onset sepsis (LOS) and sepsis ruled out (SRO).

METHODS

At three NICUs, we reviewed records of very low birth weight (VLBW) infants around their first sepsis work-up diagnosed as LOS or SRO. Clinical signs prompting the evaluation were determined from clinician documentation. HR-SpO2 data, when available, were analyzed for mean, standard deviation, skewness, kurtosis, and cross-correlation. We used LASSO and logistic regression to assess variable importance and associations with LOS compared to SRO.

RESULTS

We analyzed sepsis work-ups in 408 infants (173 LOS, 235 SRO). Compared to infants with SRO, those with LOS were of lower GA and BW, and more likely to have a central catheter and mechanical ventilation. Clinical signs cited more often in LOS included hypotension, acidosis, abdominal distension, lethargy, oliguria, and abnormal CBC or CRP(p <  0.05). HR-SpO2 data were available in 266 events. Cross-correlation HR-SpO2 before the event was associated with LOS after adjusting for GA, BW, and postnatal age. A model combining baseline, clinical and HR-SpO2 variables had AUC 0.821.

CONCLUSION

In VLBW infants at 3-NICUs, we describe the baseline, clinical, and HR-SpO2 variables associated with LOS versus SRO.

Cropland trees need to be included for accurate model simulations of land-atmosphere heat fluxes, temperature, boundary layer height, and ozone

Trees significantly impact land-atmosphere feedbacks through evapotranspiration, photosynthesis and isoprene emissions. These processes influence the local microclimate, air quality and can mitigate temperature extremes and sequester carbon dioxide. Despite such importance, currently only 5 out of 15 atmospheric chemistry climate models even partially account for the presence of cropland trees. We first show that the tree cover over intensely farmed regions in Asia, Australia and South America is significantly underestimated (e.g. only 1-3% tree cover over north-India) in the Model of Emissions of Gases and Aerosol from Nature (MEGAN) and absent in Noah land-surface module of the Weather Research and Forecasting (WRF-Chem) Model. By including the actual tree cover (~10%) over the north-west Indo Gangetic Plain in the Noah land-surface module of the WRF-Chem and the MEGAN module, during the rice growing monsoon season in August, we find that the latent heat flux alone increases by 100%-300% while sensible heat flux reduces by 50%-100%, leading to a reduction in daytime boundary layer height by 200-400 m. This greatly improves agreement between the modelled and measured temperature, boundary layer height and surface ozone, which were earlier overestimated and isoprene and its oxidation products which were earlier underestimated. Mitigating peak daytime temperatures and ozone improves rice production by 10 to 20%. Our findings from north west Indo-Gangetic Plain establish that such plantations mitigate heat stress, and have beneficial effects on crop yields while also sequestering carbon. Expanding agroforestry practices to 50% of the cropland area could result in up to 40% yield gain regionally. Implementing such strategies globally could increase crop production and sequester 0.3-30 GtC per year, and therefore future climate mitigation and food security efforts should consider stakeholder participation for increased cropland agroforestry in view of its beneficial effects.

Pathological and immunological protection induced by inactivated reverse genetics-based H3N8 equine influenza vaccine candidate in murine model

Equine influenza (EI) is an important viral respiratory disease of equines caused by influenza A virus (IAV). The antigenic drift in IAVs necessitates regular updating and harmonization of vaccine strain with the circulating virus. The reverse genetics-based recombinant viruses could be easy instrument in generating vaccine against circulating virus in a quick and effective manner. Present study has been envisaged to evaluate the immunogenicity and protective efficacy of inactivated recombinant equine influenza virus (rgEIV) vaccine candidate having six segments from H1N1 virus (A/WSN/33/H1N1) and HA (hemaglutinin) and NA (neuraminidase) segments from H3N8 equine influenza virus [(A/eq/Jammu-Katra/06/08) of clade 2 of Florida sublineage] generated through reverse genetic engineering. BALB/c mice were immunized with inactivated rgEIV adjuvanted with aluminium hydroxide gel and challenged with H3N8 virus (A/eq/Jammu-Katra/06/08). The protective efficacy was evaluated through serology, cytokine profiling, clinical signs, gross and histopathological changes, immunohistochemistry and residual virus quantification. Immunizations induced robust humoral immune response as estimated through hemagglutination inhibition assay (HAI). The antibodies were isotyped and the predominant subclass was IgG1. The vaccine candidate produced mixed Th1 and Th2 responses through stimulation of IFN-γ, IL-2, IL-4 and IL-6 expression. Immunization protected mice against challenge as reflected through reduction in clinical signs and body weight loss, early recovery, mild pathological changes (gross and histopathological lesions) as evident through scoring of lesions, low residual virus in nasopharynx and lungs quantified through egg titration and quantitative reverse transcriptase PCR (qRT-PCR). The study demonstrates that inactivated recombinant EIV generated through reverse genetic approach provides equivalent protection to that observed with inactivated whole H3N8 EIV vaccine. Keywords: equine influenza; reverse genetics; vaccine; pathology; murine model.

Fully Automated Integrated Segmentation of Carotid Artery Ultrasound Images Using DBSCAN and Affinity Propagation

Purpose

B-mode ultrasound images are used in identifying the presence of fat deposit if any in carotid artery. The intima media, lumen, bifurcation boundary is detected by the echogenic characteristics embedded in the carotid artery.

Methods

A fully automatic self-learning based segmentation is proposed by extracting the edges by a modified affinity propagation, which are given as inputs to the Density Based Spatial Clustering of Applications with Noise (DBSCAN) for super pixel segmentation. The segmented results are analyzed with Gradient Vector Flow (GVF) snake model and Particle Swarm Optimization (PSO) clustering based segmentation using various performance measures.

Results

The proposed parameter free, fully automatic segmentation method combining Affinity propagation and DBSCAN are evaluated for a database of 361 images and gives reinforced results in the longitudinal B-mode ultrasound images. The proposed approach gives an improved accuracy of 12% increase when compared with the manual segmentation and 15% compared with segmentation by affinity propagation and DBSCAN when performed individually. The average Root Mean Square Error (RMSE) is 110 ± 44 µm.

Conclusion

Extracted edge points are used for clustering in a fully automated carotid artery segmentation approach.

Ataxia and mobility in children following surgical resection of posterior fossa tumour: A longitudinal cohort study

PURPOSE

To report the course of ataxia in children up to 2 years post-operatively, following surgical resection of a posterior fossa tumour (PFT).

METHODS

Thirty-five children, (median age 9 years, range 4-15) having resection of PFT, were assessed using the Scale for the Assessment and Rating of Ataxia (SARA), Brief Ataxia Rating Scale (BARS) and the mobility domain of the Paediatric Evaluation of Disability Index (PEDI-m) at initial post-operative period (baseline), 3 months, 1 year and 2 years post-operatively.

RESULTS

Baseline median scores of the SARA and BARS were 8.5 (range 0-35.5), and 7 (0-25) respectively. Ataxia improved at 3 months (median SARA and BARS reduction 3.5 and 4, respectively). Additional gradual improvements in SARA were recorded at 1 (median reduction 2) and 2 years post-operatively (median reduction 0.5). Median baseline PEDI-m was 54.75 (range 15.2-100) with improvement at 3 months (median increase 36.95) and small improvement at 1 year (median increase 2.5) and 2 years (median increase 5.8). Children with medulloblastoma and midline tumours (median baseline SARA 10 and 11, respectively) demonstrated more severe ataxia than children with low-grade gliomas and unilateral tumours (median baseline SARA 7.5 and 6.5, respectively).

CONCLUSION

The largest improvement in ataxia scores and functional mobility scores is demonstrated within the first 3 months post-operatively, but ongoing gradual improvement is observed at 2 years. Children with medulloblastoma and midline tumour demonstrated higher ataxia scores long term.