BackgroundIndigenous persons living in Latin America suffer from a higher prevalence of type 2 diabetes compared to their non-indigenous counterparts. This difference has been attributed to a wide range of factors. Future interventions could be influenced by a deeper understanding of the challenges that impact care in rural regions and in other low-income settings.MethodsThis study was conducted using a modified grounded theory approach. Extended observations and fifteen interviews were performed with adult male and female residents of three rural Mayan towns in Sololá Department, Guatemala using purposive sampling. Questions focused on the perceptions of individuals living with type 2 diabetes and their caregivers regarding disease and treatment.ResultsAcross interviews the most common themes that emerged included mistreatment by healthcare providers, mental health comorbidity, and medication affordability. These perceptions were in part influenced by indigeneity, poverty, and/or gender.ConclusionsBoth structural and cultural barriers continue to impact diabetes care for indigenous communities in rural Guatemala. The interviews in this study suggest that indigenous people experience mistrust in the health care system, unreliable access to care, and mental health comorbidity in the context of type 2 diabetes care. These experiences are shaped by the complex relationship among poverty, gender, and indigeneity in this region. Targeted interventions that are conscious of these factors may increase their chances of success when attempting to address similar health disparities in comparable populations.
Existing thermal management methods for electronics do not meet technology needs and remain a major bottleneck in the evolution of computing, sensing, and information technology. The decreasing size of microelectronics components and the resulting increasing thermal output density require novel cooling solutions. Electrohydrodynamic ionic wind pumps, also known as electrostatic fluid accelerators (EFA), have the potential of becoming a critical element of electronic thermal management solutions. In order to take full advantage of EFA-based thermal management, it is essential to miniaturize EFA technology. This paper demonstrates the successful operation of a meso-scale microfabricated silicon EFA. A cantilever structure fabricated in bulk silicon with a radius of tip curvature of 25 μm is used as the corona electrode. The device was fabricated using a Deep Reactive Ion Etching (DRIE) microfabrication process. Forced convection cooling is demonstrated using infrared imaging, showing a 25°C surface temperature reduction over an actively heated substrate. The fabrication and test results of a meso-scale microfabricated EFA are presented in this paper.
Background:
Mild traumatic brain injury (mTBI) remains a prevalent public health concern. Implementation of an mTBI guideline encouraged screening all patients at risk for mTBI, followed by outpatient follow-up in a “concussion clinic.” This resulted in an increase in inpatient concussion evaluations, followed by high-volume referral to the concussion clinic. This prompted the routine use of an outpatient mTBI symptom screening tool. The purpose of this quality improvement study was to analyze the characteristics of an mTBI population at outpatient follow-up and describe the clinicians' care recommendations as determined through the use of an mTBI symptom screening tool.
Methods:
This is a retrospective review of mTBI patients at a Level 1 trauma center. The study includes patients who completed a concussion screening in the outpatient setting over a 6-month period. Patients were included if older than 16 years, sustained blunt trauma, and had a formal neurocognitive evaluation by a certified speech therapist within 48 hr of initial injury.
Results:
Of the 247 patients included, 197 (79.8%) were referred to the concussion clinic, 33 (13.4%) had no further outpatient needs, and 17 (6.9%) were referred for outpatient neurocognitive rehabilitation. On follow-up, 97 patients were deemed to have no further postconcussion needs by the trauma nurse practitioner; 57 patients were cleared by the speech therapist. In total, 43 outpatient mTBI follow-up encounters resulted in referral for ongoing therapy.
Conclusion:
Routine screening for concussion symptoms and detailed clinical evaluation allows for prompt recognition of further posttraumatic mTBI needs.
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