Nursing practice and global refugee migration: initial impressions from an Intergovernmental-Academic Partnership.

AIM: This report from the field describes impressions of the initial impact of bilateral, multi-sectoral field-based activities undertaken to strengthen International Organization for Migration/United Nations Migration Agency and US-based nurses' capacity to address complex clinical, social and cultural challenges experienced by refugees in resettlement. Authors comment on the defined and thorough health assessment process that refugees go through prior to resettlement, and focus on the essential nursing role in the health assessment process and continuum of care. The development of the interdisciplinary and collaborative partnership is described as well as next steps to move the partnership forward. BACKGROUND: In 2017, International Organization for Migration/United Nations Migration Agency and the University of Minnesota, guided by experts from the United States Centers for Disease Control and Prevention, began a unique bilateral Intergovernmental-Academic partnership to enhance the health care of refugees. A key component was to strengthen nursing care of refugees through the standardization of clinical practice and nursing leadership. SOURCES OF EVIDENCE: Listening sessions, direct interaction between International Organization for Migration/United Nations Migration Agency and US-based refugee resettlement stakeholders, patterns in resettlement. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: The report highlights the potential public health impact of a bilateral and collaborative initiative that develops and bridges key points in the migration and health trajectory of people with refugee status. Separated by geography, context and scope of work, health professionals in different roles in varied worldwide settings with a spectrum of resources may not fully understand the work of each other. Project activities were a platform through which US-based and internationally based nurses established mutuality, reciprocity and equity as partners. By strengthening systems and resources, the partnership reinforces the abilities of nurses who engage in this important work, to optimize health and wellbeing of people with refugee status.

The biological and behavioral computations that influence dopamine responses.

Phasic dopamine responses demonstrate remarkable simplicity; they code for the differences between received and predicted reward values. Yet this simplicity belies the subtle complexity of the psychological, computational, and contextual factors that influence this signal. Advances in behavioral paradigms and models, in monkeys and rodents, have demonstrated that phasic dopamine responses reflect numerous behavioral computations and factors including choice, subjective value, confidence, and context. The application of optogenetics has provided evidence that dopamine reward prediction error responses cause value learning. Furthermore, studies using advanced circuit tracing techniques have begun to uncover the biological network implementation of the reward learning algorithm. The purpose of this review is to summarize the recent advances in dopamine neurophysiology and synthesize an updated account of the behavioral function of dopamine signals.

Syphilis Among U.S.-Bound Refugees, 2009-2013.

U.S. immigration regulations require clinical and serologic screening for syphilis for all U.S.-bound refugees 15 years of age and older. We reviewed syphilis screening results for all U.S.-bound refugees from January 1, 2009 through December 31, 2013. We calculated age-adjusted prevalence by region and nationality and assessed factors associated with syphilis seropositivity using multivariable log binomial regression models. Among 233,446 refugees, we identified 874 syphilis cases (373 cases per 100,000 refugees). The highest overall age-adjusted prevalence rates of syphilis seropositivity were observed among refugees from Africa (1340 cases per 100,000), followed by East Asia and the Pacific (397 cases per 100,000). In most regions, male sex, increasing age, and living in non-refugee camp settings were associated with syphilis seropositivity. Future analysis of test results, stage of infection, and treatment delivery overseas is warranted in order to determine the extent of transmission risk and benefits of the screening program.

Predictors of protective behaviors among American travelers to the 2009 Hajj.

BACKGROUND: Respiratory-borne infectious diseases can spread rapidly at mass gatherings. The 2009 Hajj took place during the influenza A (H1N1) pandemic. This study investigates factors associated with compliance with recommended influenza A (H1N1)-related health practices and behaviors among American pilgrims to the 2009 Hajj: receiving seasonal influenza vaccinations, receiving influenza A (H1N1) vaccinations, and behaviors intended to mitigate respiratory illness. METHODS: American residents from Minnesota and Michigan completed anonymous surveys prior to and following travel to the 2009 Hajj. Surveys assessed demographics; knowledge, attitudes and practices (KAP) related to influenza A (H1N1); seasonal and H1N1 vaccinations; health-seeking behaviors; sources of health information; and protective behaviors during the Hajj. RESULTS: Pre- and post-travel surveys were completed by 186 participants. Receiving seasonal influenza vaccination was reported by 138 (63%) respondents, and 80 (36%) reported receiving an influenza A (H1N1) vaccine. One hundred forty-four (79%) respondents reported engaging in protective behaviors during the Hajj to prevent illness. In multivariable models, greater perceived severity of influenza A (H1N1) before traveling was associated with: seasonal influenza vaccination (OR=1.74, 95% CI=1.14-2.62, p=.01), influenza A (H1N1) vaccination (OR=2.02, 95% CI=1.35-3.02, p=.001), and engaging in protective behaviors during the Hajj (OR=1.62, 95% CI=1.00-2.63, p=.003). CONCLUSIONS: This study found that accurate knowledge of influenza A (H1N1) symptoms, transmission, and prevention was associated with greater perceived severity of influenza A (H1N1); and perceived influenza A (H1N1) severity was associated with engaging in recommended protective health practices. Understanding the barriers to and facilitators of compliance with recommended behaviors can help guide the development of tailored outreach strategies to mitigate the impact and spread of respiratory disease.

Rapid modulation of local neural activity by controlled drug release from polymer-coated recording microelectrodes.

We demonstrate targeted perturbation of neuronal activity with controlled release of neurochemicals from conducting polymer-coated microelectrodes. Polymer coating and chemical incorporation are achieved through individually addressable electrodeposition, a process that does not compromise the recording capabilities of the electrodes. Release is realized by the application of brief voltage pulses that electrochemically reduce the polymer and dissociate incorporated neurochemicals; whereby they can diffuse away and achieve locally effective concentrations. Inhibition of evoked synaptic currents in neurons within 200 µm of a 6-cyano-7-nitroquinoxaline-2,3-dione releasing electrode lasts for several seconds. Spiking activity of neurons in local circuits recorded extracellularly near the releasing electrode is silenced for a similar duration following release. This methodology is compatible with many neuromodulatory chemicals and various recording electrodes, including in vitro and implantable neural electrode arrays, thus providing an inexpensive and accessible technique capable of achieving sophisticated patterned chemical modulation of neuronal circuits.

Management of a giant fluid-filled bulla by closed-chest thoracostomy tube drainage.

A 53-year-old man was admitted to the hospital for management of pneumonia and a giant fluid-filled bulla. He appeared acutely ill and had persistent fever despite prolonged therapy with parenteral antibiotics and aggressive bronchial drainage. Percutaneous placement of an 8.5F catheter into the bulla enabled drainage of both fluid and air within the bulla and led to resolution of his symptoms within 24 h. This report demonstrates that drainage of giant fluid-filled bullae may lead to rapid resolution of symptoms and describes a novel management technique for this condition.

Oxygen metabolites stimulate release of high-molecular-weight glycoconjugates by cell and organ cultures of rodent respiratory epithelium via an arachidonic acid-dependent mechanism.

Several common pulmonary disorders characterized by mucus hypersecretion and airway obstruction may relate to increased levels of inhaled or endogenously generated oxidants (O2 metabolites) in the respiratory tract. We found that O2 metabolites stimulated release of high-molecular-weight glycoconjugates (HMG) by respiratory epithelial cells in vitro through a mechanism involving cyclooxygenase metabolism of arachidonic acid. Noncytolytic concentrations of chemically generated O2 metabolites (purine + xanthine oxidase) stimulated HMG release by cell and explant cultures of rodent airway epithelium, an effect which is inhibitable by coaddition of specific O2 metabolite scavengers or inhibitors of arachidonic acid metabolism. Addition of O2 metabolites to epithelial cells provoked production of PGF2a, an effect also inhibitable by coaddition of O2 metabolite scavengers or inhibitors of arachidonic acid metabolism. Finally, addition of exogenous PGF2a to cell cultures stimulated HMG release. We conclude that O2 metabolites increase release of respiratory HMG through a mechanism involving cyclooxygenase metabolism of arachidonic acid with production mainly of PGF2a. This mechanism may be fundamental to the pathogenesis of a variety of lung diseases associated with hypersecretion of mucus and/or other epithelial fluids, as well as a basic cellular response to increased oxidants.

Detecting errors in blood-gas measurement by analysis with two instruments.

We performed a two-stage prospective evaluation of the error detection capabilities of duplicate analysis of blood-gas specimens. In the first stage we analyzed 1601 specimens with a Corning Model 175 blood-gas analyzer as the test instrument and a Corning Model 178 analyzer as the reference instrument, and in the second stage we analyzed 1544 specimens with two Model 178 analyzers. In each stage the designated reference instrument underwent troubleshooting whenever an analytical error was detected; the test instrument underwent troubleshooting only when error conditions were indicated by means other than duplicate analysis. An error was considered to have occurred if the difference between the duplicate analyses exceeded 0.02 (for pH), 0.53 kPa, i.e., 4 mmHg (pCO2), or 7% (pO2). The number of specimens for which errors were detected was 97 (6.1%) in the first stage, 23 (1.5%) in the second. For each analyte more errors were detected with the Model 175 analyzer (of older design) than with the newer Model 178 analyzer. Furthermore, in certain periods associated with the use of particular electrodes there were very high error rates for individual analytes: 8% for pCO2, 18% for pO2. We conclude that duplicate analysis should be considered as a possible required standard for error detection.

Spiral vein bypass for superior vena cava syndrome due to mediastinal fibrosis.

A 22-year-old man underwent palliative surgery for superior vena cava syndrome due to a benign obstructive process compatible with fibrosing mediastinitis. By using a spiral vein constructed from autologous saphenous vein, an innominate vein to the right atrial appendage shunt was created. This technique, which was first described experimentally in 1974 and performed clinically in 1976, may warrant more liberal application in patients with superior vena cava syndrome caused by malignant and benign diseases.