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Human trafficking is a crime and a human rights violation that involves various and simultaneous traumatic events (sexual and physical violence, coercion). Yet, it is unknown how the patterning of violence and coercion affects the mental health of female and male trafficking survivors.
We conducted a cross-sectional study using a sample of 1015 female and male survivors of trafficking who received post-trafficking assistance services in Cambodia, Thailand or Vietnam. We assessed symptoms of anxiety and depression with the Hopkins Symptoms Checklist and symptoms of post-traumatic stress disorder (PTSD) with the Harvard Trauma Questionnaire. Violence was measured with questions from the World Health Organization International Study on Women's Health. Latent class analysis (LCA) was used to identify distinct patterns of violence and coercion in females and males. Novel multi-step mixture modelling techniques were employed to assess the association of the emergent classes with anxiety, depression and PTSD in females and males.
LCA identified two distinct classes of violence and coercion experiences in females (class I: severe sexual and physical violence and coercion (20%); class II: sexual violence and coercion (80%)) and males (class I: severe physical violence and coercion (41%); class II: personal coercion (59%)). Females in class I had a two-fold increase in the odds of anxiety (OR = 2.10; 95% CI: 1.57–2.81) and PTSD (OR = 2.07; 95% CI: 1.03–4.17) compared with females in class II, but differences in the prevalence of anxiety, depression and PTSD were not significant when comparing males in class I to class II.
Specific patterns of violence and coercion provide a more in-depth understanding of the role of gender in the experience of violence and coercion and its association with mental health in survivors of trafficking. This information could be useful to target comprehensive mental health services for female and male trafficking survivors.
We discuss the cultural roles of dog and red fox recovered from Carlisle Island, Islands of Four Mountains, Alaska, within the context of Aleutian ethnographic and zooarchaeological records. Three dog bones were recovered from the Ulyagan archaeological site, Unit 5, in levels that date to AD 1450–1645. Three red fox bones come from the Ulyagan site, Unit 4, in levels that date 460 BC–AD 95. Our analyses show that both red fox and domestic dog date earlier than the contact with Russians and that these canids do not extend west of the Islands of Four Mountains archipelago. Given the rich history of human intervention on the Aleutians ecosystems over the last 250 years, we argue that indigenous red fox inhabited the Islands of the Four Mountains region prior to western contact; however, foxes did not have a pronounced cultural role for prehistoric Aleuts. Domestic dogs accompanied humans in the Aleutians after AD 950, suggesting that these canids might be linked with the Neo-Aleut culture. In the light of Arctic and oceanic cases of human use of dogs considered in the paper, we suggest that dogs might have served as reserve food sources during long trips for people migrating west.
Combined archaeological, ecological, and geologic research on Chuginadak and Carlisle Islands in the Islands of Four Mountains (IFM) probed questions about the sustainability of human settlements over the past 4000 years in the face of geologic, ecological, and social hazards. We use a human ecodynamics approach to frame the investigation and present original archaeological evidence from this poorly known region of the remote Aleutian Islands. Several village sites occupied during the last four millennia are clustered in locations that were not damaged by earthquake-induced tsunamis; however, new geologic evidence indicates that at least one volcanic eruption forced humans to abandon one or more prehistoric village sites. Combined archaeological, ecological, and geologic analyses demonstrate resilient Unangax̂ occupations of the IFM through long-term climate change as well as earthquakes, tsunamis, and volcanic eruptions with occasional community vulnerability to volcanic eruptions.
We present the results of multiproxy study of a peat deposit from Carlisle Island (the Islands of Four Mountains, Aleutians). Vegetation on the initial stage of the peat is characterized by heath vegetation dominated by Ericales indicating cold conditions at 7300–6100 cal yr BP. The appearance of Betula and Alnus is the result of long-distance transportation attributable to strong winds at this time. Sedge-grass (Cyperaceae and Poaceae) communities began replacing heath vegetation at 6100 cal yr BP because of the climatic amelioration. C/N ratios and pollen spectra remain relatively stable at 6100–2450 cal yr BP. For the CR-03 peatland, volcanic tephra contributed significantly to the Fourier transform infrared spectroscopy spectral data. Volcanic input created overlap of an aluminosilicate signal with carbohydrate vibrations. Significant changes occurred at approximately 2450 cal yr BP when there is the some evidence of cooler and wetter conditions of the Neoglacial. High values of δ15N observed at 7100–7000 cal yr BP reflect the fertilizing effect of seabird nesting colonies. A decrease in δ15N ca. 6900 cal yr BP may indicate initial settlement on Carlisle Island corresponding with harvesting seabirds. Human predation continued until a series of volcanic eruptions, which deposited Okmok II and CR-02 tephra layers at ca. 2000 and 1050 cal yr BP, respectively.
To compare bacterial contamination of military-approved uniforms and hospital-provided scrubs donned by nursing staff in an inpatient setting.
Randomized experimental crossover study.
Large academic military medical center.
Inpatient units were randomized to predetermine the order of uniform sampling. Participants included nursing staff who provided direct patient care across 7 eligible inpatient units. Sampling of 6 designated sites on the uniform was completed on arrival to work, at ~4 hours into their shift, and at the 8-hour time point, for a total of 18 samples. Sampling of each participant occurred on 2 separate occasions, once in a military-approved uniform, and once in hospital-provided scrubs. After 24 hours of incubation, a colony-counting machine was used to calculate the total colony-forming units (CFU) of the sample.
Across all time points, military-approved uniforms demonstrated a 2-fold bacterial increase at the abdominal site and 3-fold increases at the sleeve cuff and waist pocket regions compared to the same regions on hospital-provided scrubs.
Nurses should be aware that bacteria are present at much higher levels on their personal military uniforms compared to hospital-provided scrubs. Additional research is needed to determine whether these findings are a function of wear, laundering, or environmental factors. Nurses should adhere to daily uniform washing to reduce bacterial load and minimize risk of nosocomial infections to the patients they care for.
An estimated 293,300 healthcare-associated cases of Clostridium difficile infection (CDI) occur annually in the United States. To date, research has focused on developing risk prediction models for CDI that work well across institutions. However, this one-size-fits-all approach ignores important hospital-specific factors. We focus on a generalizable method for building facility-specific models. We demonstrate the applicability of the approach using electronic health records (EHR) from the University of Michigan Hospitals (UM) and the Massachusetts General Hospital (MGH).
We utilized EHR data from 191,014 adult admissions to UM and 65,718 adult admissions to MGH. We extracted patient demographics, admission details, patient history, and daily hospitalization details, resulting in 4,836 features from patients at UM and 1,837 from patients at MGH. We used L2 regularized logistic regression to learn the models, and we measured the discriminative performance of the models on held-out data from each hospital.
Using the UM and MGH test data, the models achieved area under the receiver operating characteristic curve (AUROC) values of 0.82 (95% confidence interval [CI], 0.80–0.84) and 0.75 ( 95% CI, 0.73–0.78), respectively. Some predictive factors were shared between the 2 models, but many of the top predictive factors differed between facilities.
A data-driven approach to building models for estimating daily patient risk for CDI was used to build institution-specific models at 2 large hospitals with different patient populations and EHR systems. In contrast to traditional approaches that focus on developing models that apply across hospitals, our generalizable approach yields risk-stratification models tailored to an institution. These hospital-specific models allow for earlier and more accurate identification of high-risk patients and better targeting of infection prevention strategies.
We obtained radiocarbon (14C) dates with accelerator mass spectrometry (AMS) of vascular plant samples and a charcoal sample collected from peat deposits near the prehistoric village site informally designated CR-03 on Carlisle Island in the Islands of Four Mountains group, Alaska, to determine the eruption age of the CR-02 tephra. A fine vitric ash erupted from Okmok caldera, Umnak Island (ca. 2 ka BP) was also discovered in the bog. The ages of the CR-02 tephra and Okmok II ash are estimated to be 1050 and 2000 cal BP, respectively. Because both tephras are distinctive and widespread, these are important chronostratigraphic markers for archaeological sites in this island group. The 14C dates obtained from this bog are 800 years younger than the dates of the charcoal fragments from cultural layers in the Unit 3 of prehistoric village site CR-02 (AMK-0003).
Kentucky bluegrass (Poa pratensis L.) invades northern Great Plains rangelands. On the Sheyenne National Grassland in southeastern North Dakota, three research sites, each with a different level of Kentucky bluegrass invasion, were chosen to evaluate effectiveness of burning and burning–herbicide combinations to control Kentucky bluegrass. Initial Kentucky bluegrass invasion levels were 37%, 77%, and 91% for LOW, MODERATE, and HIGH invaded sites, respectively. Within each invaded site, four replicated strips (20 by 60 m) were established, with half of each strip burned in late October 2005 and the other half burned in early May 2006. Herbicide treatments of (1) no herbicide, (2) 2.24 kg ha−1 of glyphosate, and (3) 0.43 kg ha−1 of imazapic were randomly assigned to 10 by 20 m subplots within each burn. Control plots were established at the same time. Relative basal cover of native grass, native forb, and Kentucky bluegrass was estimated annually using 50 10-point frames within each subplot. On the HIGH site in 2006, fall-burned plots with a spring glyphosate application had three times the native grass cover and only one fourth of the Kentucky bluegrass cover compared with controls. Similar results with the same treatment occurred at the MODERATE site. Native grasses became the most abundant plant community on these plots in the MODERATE and HIGH sites within 1 yr. Treatment differences were transitory, and the LOW site differed from the MODERATE and HIGH sites. In 2007, on fall-burned plots with spring glyphosate application, the amount of Kentucky bluegrass was 14% and 30%, and native grass species were 52% and 42% on the MODERATE and HIGH sites, respectively, which was similar to the initial values on the LOW site. These data emphasize the importance of initial invasion level in developing restoration strategies and provide evidence burning and herbicide combinations can be valuable management tools even on heavily invaded grasslands.
Whole apples have not been previously implicated in outbreaks of foodborne bacterial illness. We investigated a nationwide listeriosis outbreak associated with caramel apples. We defined an outbreak-associated case as an infection with one or both of two outbreak strains of Listeria monocytogenes highly related by whole-genome multilocus sequence typing (wgMLST) from 1 October 2014 to 1 February 2015. Single-interviewer open-ended interviews identified the source. Outbreak-associated cases were compared with non-outbreak-associated cases and traceback and environmental investigations were performed. We identified 35 outbreak-associated cases in 12 states; 34 (97%) were hospitalized and seven (20%) died. Outbreak-associated ill persons were more likely to have eaten commercially produced, prepackaged caramel apples (odds ratio 326·7, 95% confidence interval 32·2–3314). Environmental samples from the grower's packing facility and distribution-chain whole apples yielded isolates highly related to outbreak isolates by wgMLST. This outbreak highlights the importance of minimizing produce contamination with L. monocytogenes. Investigators should perform single-interviewer open-ended interviews when a food is not readily identified.
Field stars provide important constraints for the late stages of stars' angular momentum evolution. We measured rotation periods ranging from 0.1 to 150 days for approximately 450 mid-to-late M dwarfs using photometry from the MEarth transiting planet survey. We use parallaxes, proper motions, and radial velocities to calculate galactic kinematics for these solar neighborhood M dwarfs. The velocity dispersions increase towards longer rotation periods, indicating that there is a relationship between rotation and age for these stars.
Radiocarbon dates (n = 18) from three archaeological sites on Adak Island, Alaska, were analyzed to understand the marine reservoir offset. Samples of marine and terrestrial origins recovered from the same archaeological context were compiled in nine pairs. The mean ΔR value calculated for them totaled 545 ± 10 yr. This value can be regarded as a sound estimate of the marine reservoir offset in the central Aleutians.
The US Center for Medicare and Medicaid Services (CMS) requires nursing homes and long-term-care facilities to document residents' vaccination status on the Resident Assessment Instrument (RAI). Vaccinating residents can prevent costly hospital admissions and deaths. CMS and public health officials use RAI data to measure vaccination rates in long-term-care residents and assess the quality of care in nursing homes. We assessed the accuracy of RAI data against medical records in 39 nursing homes in Florida, Georgia, and Wisconsin. We randomly sampled residents in each home during the 2010–2011 and 2011–2012 influenza seasons. We collected data on receipt of influenza vaccination from charts and RAI data. Our final sample included 840 medical charts with matched RAI records. The agreement rate was 0·86. Using the chart as a gold standard, the sensitivity of the RAI with respect to influenza vaccination was 85% and the specificity was 77%. Agreement rates varied within facilities from 55% to 100%. Monitoring vaccination rates in the population is important for gauging the impact of programmes and policies to promote adherence to vaccination recommendations. Use of data from RAIs is a reasonable approach for gauging influenza vaccination rates in nursing-home residents.
Selective single-walled carbon nanotube (SWNT) growth is a challenging problem, limiting their use in a wide variety of applications. Significant degrees of freedom in these experiments may lead to synthesis of multi-walled carbon nanotubes (MWNTs), which are less preferred. Thus, a method for constraining the synthesis results to only SWNTs is desired. A machine learning based approach for selectively growing SWNTs using a laser-induced chemical vapor deposition growth system is introduced. This approach models the complex relationships between the associated synthesis parameters to predict SWNT growth. The parameters under consideration include argon, ethylene, hydrogen and carbon dioxide partial pressures, growth temperature, and water vapor concentration. The catalyst consists of 10 nm of alumina and 1 nm of nickel deposited onto 10 µm diameter silicon pillars with a height of 10 µm. Determination of SWNT growth is performed through in-situ Raman spectroscopy using a 532 nm excitation laser. A total of 121 experiments are used to train a SWNT vs. MWNT classifier with a resulting model accuracy of 94.21%. The classifier model is applied to a range of simulated inputs, and the subset of these inputs that meet a >90% probability of SWNT growth are investigated further. The simulated inputs consist of 531,201,645 unique growth parameter combinations spanning the entire parameter space. A reduced dataset of 449,117 growth parameter combinations define 90% probability of SWNT growth according to the model. Randomly selected input parameters from this reduced dataset were tested experimentally, resulting in SWNT growth for all performed experiments validating the classifier model. This approach maps input growth conditions to SWNT growth selectivity using a limited set of experimental data and allows for further investigation into SWNT growth rates and chiral dependencies.
Although the cadmium chloride treatment is an essential process for high efficiency thin film cadmium telluride photovoltaic devices, the precise mechanisms involved that improve the cadmium telluride layer are not well understood. In this investigation we apply advanced micro-structural characterization techniques to study the effect of varying the time of the cadmium chloride annealing treatment on the micro-structure of cadmium telluride solar cells deposited by close spaced sublimation (CSS) and relate this to cell performance. A range of techniques has been used to observe the morphological changes to the micro-structure as well as the chemical and crystallographic changes as a function of treatment parameters. Electrical tests that link the device performance with the micro-structural properties of the cells have also been undertaken. Techniques used include Transmission Electron Microscopy (TEM) for sub-grain analysis and XPS for composition-depth profiling. The study provides a new insight in to the mechanisms involved in the initiation and the subsequent complete re-crystallization of the cadmium telluride layer.
Lurasidone is an atypical antipsychotic medication approved for the treatment of schizophrenia over a dose range of 40–160 mg/day. This study examined D2 receptor occupancy and its association with clinical improvement and side effects in patients with schizophrenia or schizoaffective disorder following repeated doses of 80, 120, or 160 mg/day of lurasidone.
Twenty-five patients with The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnoses of schizophrenia or schizoaffective disorder were washed out of their antipsychotic medications (5 half-lives) and randomly assigned to 80, 120, or 160 mg/day of lurasidone. Subjects were imaged with 18F-fallypride at baseline and at steady-state lurasidone treatment to determine D2 receptor occupancy.
Blood lurasidone concentration (plus major metabolite), but not dose, significantly correlated with D2 receptor occupancy. D2 receptor occupancy in several subcortical structures is associated with positive but not negative symptom improvement or the presence of movement symptoms.
Blood concentrations greater than 70 ng/mL may be required to achieve a 65% occupancy level in subcortical areas. Intersubject blood concentrations at fixed dose were highly variable and may account for the lack of dose correlations.
Positron emission tomography (PET) occupancy data suggest that greater than 65% occupancy can be achieved across the dose range of 80–160 mg/day and that some patients require higher doses to achieve antipsychotic efficacy; this finding supports prior randomized clinical trial results.