The tsunami that struck South-east Asia on 26 December 2004 left more than 500,000 people in Aceh, Indonesia, homeless and displaced to temporary barracks and other communities. This study examines the associations between prolonged habitation in barracks and the nature of fears reported by school-age children and adolescents. In mid-2007, 30 months after the tsunami, the authors interviewed 155 child and parent dyads. Logistic regression analysis was used to compare the fears reported by children and adolescents living in barracks with those reported by their peers who were living in villages. After adjusting for demographic factors and tsunami exposure, the data reveals that children and adolescents living in barracks were three times more likely than those living in villages to report tsunami-related fears. The study demonstrates that continued residence in barracks 30 months after the tsunami is associated with higher rates of reporting tsunami-related fears, suggesting that barracks habitation has had a significant impact on the psychological experience of children and adolescents since the tsunami.
Thirty months after the Indian Ocean tsunami of 26 December 2004, thousands of families in Aceh Province, Indonesia, remained in temporary barracks while sanitation conditions and non-governmental organisation support deteriorated. This study sought to determine the factors associated with functional impairment in a sample of 138 displaced and non-displaced Acehnese children. Using multivariate linear regression models, it was found that displacement distance was a consistent predictor of impairment using the Brief Impairment Scale. Exposure to tsunami-related trauma markers was not significantly linked with impairment in the model. Paternal employment was a consistent protective factor for child functioning. These findings suggest that post-disaster displacement and the subsequent familial economic disruption are significant predictors of impaired functioning in children's daily activities. Post-disaster interventions should consider the disruption of familiar environments for families and children when relocating vulnerable populations to avoid deleterious impacts on children's functioning.
Objectives Promotion of high-quality care at a lower cost requires educational initiatives across the continuum of medical education. A needs assessment was performed to inform the design of an educational tool with the goal of teaching laboratory stewardship to medical students. Methods The needs assessment consisted of semistructured interviews with core clerkship directors and residency program directors at our institution, a national survey to the Undergraduate Medical Educators Section (UMEDS) of the Association of Pathology Chairs, and a review of existing online resources that teach high-value care. Results Two major themes emerged regarding opportunities to enhance laboratory stewardship education: appropriate ordering (knowledge of test indications, pretest/posttest probability, appropriateness criteria, recognition of unnecessary testing) and correct interpretation (understanding test specifications, factors that affect the test result, recognizing inaccurate results). Conclusions The online educational tool will focus on the curricular needs identified, using a multidisciplinary approach for development and implementation.
Purpose This paper aims to conduct a qualitative needs assessment to explore the effectiveness of Houston’s refugee resettlement efforts in the areas of employment, health care and education. Design/methodology/approach Using referral sampling, the authors identified refugee community leaders and staff members at the five refugee resettlement agencies in Houston. The authors conducted 29 qualitative interviews with these contacts from February–August 2017. Findings Recently resettled refugees may struggle to find and maintain employment in Houston due to difficulty accessing public transportation. Refugees seeking medical care in Houston often have difficulty navigating the complexities of the health-care system and communicating with their physicians due to language barriers. Finally, refugee children may have trouble adapting to Houston public schools, sometimes because they have limited experience with formal education. This study provided insights into the challenges Houston refugees face during resettlement and these barriers can be mitigated with policies designed specifically to address them. Practical implications The authors recommend decreasing public transportation fees for refugees, supporting programs that donate used vehicles to refugees, expanding access to English as a Second Language classes for refugee children and adults and giving refugees designated time to learn English upon arrival. Originality/value Houston welcomes more resettled refugees than any other American city. However, few studies have explored the barriers refugees face during the resettlement process.
Abstracts iii15NEURO-ONCOLOGY • MAY 2017 same time however, the survey documents substantial differences in access to crucial biomarkers and molecular techniques across geographic regions and within individual countries. Concerns are raised concerning the validity of test assays with MGMT, 1p19q, and ATRX being perceived as most problematic. CONCLUSIONS: Together neuropathologists advocate the need for international harmonization of standards and consensus guidelines, and the majority is willing to actively engage in quality control. The "integrated diagnosis" for infiltrating gliomas in the 2016 revised World Health Organization (WHO) classification of tumors of the central nervous system requires assessment of the tumor for IDH mutations and 1p/19q codeletion. Since TERT promoter mutations and ATRX alterations have been shown to be associated with prognosis, we analyzed whether these tumor markers provide additional prognostic information within each of the five WHO 2016 categories. We used data for 1206 patients from UCSF Adult Glioma Study, the Mayo Clinic and The Cancer Genome Atlas (TCGA) with infiltrative glioma, grades II-IV for whom tumor status for IDH, 1p/19q codeletion, ATRX, and TERT had been determined. All cases were assigned to one of 5 groups following the WHO 2016 diagnostic criteria based on their morphologic features, and IDH and 1p/19q codeletion status. These groups are: 1-Oligodendroglioma, IDH-mutant and 1p/19q-codeleted; 2-Astrocytoma, IDH-mutant; 3-Glioblastoma, IDH-mutant; 4-Glioblastoma, IDH-wildtype; and 5-Diffuse glioma, IDH-wildtype. Within each group, we used univariate and multivariate Cox proportional hazards models to assess associations with overall survival with patient age at diagnosis, grade, and ATRX alteration status and/or TERT promoter mutation status. Among Group 1 IDH-mutant 1p/19q-codeleted oligodendrogliomas, the TERT-WT group had significantly worse overall survival than the TERT-MUT group (HR: 2.72, 95%CI: 1.05-7.04, p=0.04). In both Group 2, IDHmutant astrocytomas and Group 3, IDH-mutant glioblastomas, neither TERT mutations nor ATRX alterations were significantly associated with survival. Among Group 4, IDH-wildtype glioblastomas, ATRX alterations were associated with favorable outcomes (HR: 0.36, 95% CI: 0.17-0.81, p=0.01). Among Group 5, IDH-wildtype diffuse gliomas, the TERT-WT group had significantly better overall survival than the TERT-MUT group (HR: 0.48, 95% CI: 0.27-0.87), p=0.02). Thus, we present evidence that in certain WHO 2016 diagnostic groups, testing for TERT promoter mutations or ATRX alterations may provide additional useful prognostic information. BACKGROUND: Tumor Treating Fields (TTFields) is an established, frequency-tuned, anti-mitotic, physical treatment modality that acts in metaphase, anaphase and telophase. TTFields are delivered to the brain by a patient operated, portable medical device (Optune™, Novocure Ltd.). This multicenter, prospective, randomized phase 3 trial (EF-14) tested the efficacy and safety of combining TTFields wi...
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