Search

Category 4 Hurricane Maria made landfall in Puerto Rico on 20 September 2017 and ploughed across the territory with sustained winds of 155 mph. Just two weeks earlier, category 5 Hurricane Irma had struck the island already damaging critical infrastructure making Hurricane Maria even more devasting. The hurricanes caused catastrophic damage, resulting in the largest and longest response to a domestic disaster in the history of the United States. This paper explores the recovery process in Puerto Rico using a community resilience lens. The study examines narratives, the media environment, trusted sources, and information preferences following the crisis. Community workshops, interviews, and focus groups reveal indicators of resilience in Puerto Rico alongside areas for improvement. Theoretical contributions discuss the role of identity, sense of place, and the impact of culture on community resilience. Practical contributions touch on messaging, acknowledging infrastructure vulnerabilities, and the importance of strengthening community relationships. [ABSTRACT FROM AUTHOR]

Background: Eye movement dysfunction is a common abnormality in Schizophrenia and other psychotic disorders. Various eye movement paradigms can be used to measure predefined parameters using eye trackers. The current study intends to understand the eye movement characteristics in individuals suffering from psychosis using newer eye-tracking instruments with better precision. Methodology: In this study, we included 29 individuals meeting the diagnostic criteria for schizophrenia spectrum and other psychotic disorders based on the clinical assessment as per Diagnostic and Statistical Manual of Mental Disorders, 5th Edition along with 29 age- and gender-matched healthy controls and measured various eye tracking parameters using a Tobii Pro Spectrum. We compared the eye-tracking parameters between both groups. Results: There were significant differences between the groups in the free-viewing task. The average duration of fixations was higher, whereas the number of fixations and total amplitude of saccades was found to be reduced in the patient group. The peak velocity of the first saccade was also seen to be reduced in the patient group. However, there were no abnormalities in the anti-saccade, predictive saccade, memory saccade, and smooth pursuit tasks. Eye movement parameters were also found to be significantly correlated with the cognitive task measurements. Conclusion: These findings confirm the presence of eye movement abnormalities in psychosis spectrum disorders and their role in cognitive deficits in psychosis. Altered free viewing may be linked to deficits in social cognition found in patients with schizophrenia. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Because physicians' decisions drive health care costs and quality, there is growing interest in applying behavioral economics approaches, including behavioral nudges, to influence physicians' decisions. This paper investigates adoption of behavioral nudges by health system--affiliated physician organizations (POs), types of nudges being used, PO leader perceptions of nudge effectiveness, and implementation challenges. STUDY DESIGN: Mixed-methods study design (PO leader survey followed by in-depth qualitative interviews). Purposive sample of 30 health system--affiliated POs in 4 states; POs varied in size and quality performance. METHODS: We collected data between October 2017 and June 2019. The survey asked PO leaders to report their organization's use of 5 categories of nudges to influence primary and specialty physicians' actions. We conducted semistructured phone interviews to confirm survey responses, elicit examples of the nudges that POs reported using, understand how nudges were structured, and identify implementation challenges. We present descriptive tabulations of nudge use and effectiveness ratings. We applied thematic analysis to the interview data. RESULTS: Almost all POs in this study reported nudge use. Clinical templates, patient action lists, and altered order entry were most commonly used. However, PO leaders reported that nudge use was limited to a narrow range of clinical applications, not widespread across the organization, and mostly structured as suggestions rather than default actions or hard stops. CONCLUSIONS: Nudge use remains limited in practice. Opportunities exist to expand use of nudges to influence physician behavior; however, expanding use of behavioral nudges will require PO investment of resources to support their construction and maintenance. [ABSTRACT FROM AUTHOR]

Background and Aims: Relapse is a major clinical concern in alcohol use disorders. The magnitude of the problem, poor access and availability of treatment, and changing social milieu placed India in a challenging position. This was a systematic review of Indian studies on rates and determinants of relapse to alcohol. Methods: Systematic search (January 1980-May 2020) was carried out on PubMed and Google Scholar to select studies that presented either rates or predictors (or both) to alcohol. Relapse was broadly defined based on the characterization in the included articles. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard for reporting systematic reviews. Results: Thirty-six studies were selected for the qualitative synthesis from the 68 studies. In the pooled sample of 2481 participants, the relapse rate ranged from 3.4% to 90%. The study duration varied from 1 to 36 months. Results suggested that the rates were overall higher in the observational than interventional studies and in studies from states with community prevalence of alcohol use >15% than in those <10%. There was significant heterogeneity among studies. Risk factors of relapse identified were demographic (e.g., younger age), psychological (e.g., craving), situational (e.g., peer influence), stressful life situations (e.g., financial problems), and family history of alcohol use. Conclusion: Relapse is likely in a substantial proportion of participants. Addressing the risk factors might help in delaying relapse. Future studies could concentrate on inclusive study design and robust methodology, to examine and understand the rates and risk factors of relapse. [ABSTRACT FROM AUTHOR]

Background and Aims: Sexual dysfunction is often associated with substance use disorders. This study aimed to synthesize Indian literature on sexual dysfunction among patients with substance use disorders. Materials and Methods: Electronic search engines were used to identify studies of the last 20 years that reported sexual dysfunction with different substance use disorders. Information was extracted using a predefined template. Quality appraisal of the included studies was carried out using Joanna Briggs Institute checklist. Results: Twenty-seven relevant papers were identified that pertained to 24 distinct studies. Most of them were in patients with alcohol dependence, and fewer were in patients with opioid dependence. The study designs were primarily single-group cross-sectional, though many case--control, cross-sectional studies were also identified. The proportion of participants with sexual dysfunction ranged from 22.2% to 76% for studies related to alcohol dependence and 40% to 90% for studies pertaining to opioid dependence. Varied types of sexual dysfunctions were identified, including poor satisfaction, lack of desire, premature ejaculation, and erectile dysfunction. Efforts to address bias and confounders were not reported in most studies. Conclusion: Sexual dysfunction affects a substantial proportion of patients with substance use disorders. Clinicians can make an effort to ascertain and address sexual dysfunction in their routine clinical practice while dealing with patients with substance use disorders. [ABSTRACT FROM AUTHOR]

Purpose.To identify clinical and dosimetric factors associated with acute hematologic and gastrointestinal (GI) toxicities during definitive therapy using intensity-modulated radiotherapy (IMRT) for anal squamous cell carcinoma (ASCC). Materials and methods.We retrospectively analyzed 108 ASCC patients treated with IMRT. Clinical information included age, gender, stage, concurrent chemotherapy, mitomycin (MMC) chemotherapy and weekly hematologic and GI toxicity during IMRT. From contours of the bony pelvis and bowel, dose-volume parameters were extracted. Logistic regression models were used to test associations between toxicities and clinical or dosimetric predictors. Results.The median age was 59 years, 81 patients were women and 84 patients received concurrent MMC and 5-fluorouracil (5FU). On multivariate analysis (MVA), the model most predictive of Grade 2 + anemia included the maximum bony pelvis dose (Dmax), female gender, and T stage [p = 0.035, cross validation area under the curve (cvAUC) = 0.66]. The strongest model of Grade 2 + leukopenia included V10 (percentage of pelvic bone volume receiving ≥ 10 Gy) and number of MMC cycles (p = 0.276, cvAUC = 0.57). The model including MMC cycle number and T stage correlated best with Grade 2 + neutropenia (p = 0.306, cvAUC = 0.57). The model predictive of combined Grade 2 + hematologic toxicity (HT) included V10 and T stage (p = 0.016, cvAUC = 0.66). A model including VA45 (absolute bowel volume receiving ≥ 45 Gy) and MOH5 (mean dose to hottest 5% of bowel volume) best predicted diarrhea (p = 0.517, cvAUC = 0.56). Conclusion.Dosimetric constraints to the pelvic bones should be integrated into IMRT planning to reduce toxicity, potentially reducing treatment interruptions and improving disease outcomes in ASCC. Specifically, our results indicate that Dmax should be confined to ≤ 57 Gy to minimize anemia and that V10 should be restricted to ≤ 87% to reduce incidence of all HT. [ABSTRACT FROM PUBLISHER]