The relationship of pre- and post-resettlement violence exposure to mental health among refugees: a multi-site panel survey of somalis in the US and Canada.

BACKGROUND: A large body of research highlights the lasting impact of pre-resettlement violence on the mental health of refugees after resettlement. However, there is limited research on violence exposure after resettlement and its association with mental health. We examine the association of pre- and post-resettlement violence with post-resettlement mental health symptoms in a survey of Somali refugees in the US and Canada. METHODS AND FINDINGS: We collected survey data from 383 Somalis across five cities in the US and Canada (Boston, MA; Minneapolis, MN; Lewiston, NC; Portland, ME; Toronto, Canada). Wave 1 data were collected between May 2013 and January 2014, while Wave 2 was collected between June 2014 and August 2015. Data from both waves were used to examine whether the association of past violence exposures persists across time and with more recent violence exposures. The War Trauma Screening Scale assessed exposure to any pre- and post-resettlement violence at Wave 1, while the My Exposure to Violence scale assessed any past-year violence exposure at Wave 2. Mental health outcomes included symptoms of depression and anxiety (Hopkins Symptom Checklist) and post-traumatic stress symptoms (Harvard Trauma Questionnaire). Separate linear regression models at Waves 1 and 2 examined the relationship of past violence exposure to standardized scores of mental health symptoms. Participants were 22 years of age, on average. Fifty-six percent of our sample had been exposed to violence after resettlement by Wave 2. At Wave 1, the associations of pre- and post-resettlement violence with mental health were comparable in magnitude across depression [ß = 0.39, 95% CI (0.21 0.57) vs. ß = 0.36, 95% CI (0.10 0.62)], anxiety [ß = 0.33, 95% CI (0.12 0.55) vs. ß = 0.38, 95% CI (0.01 0.75)], and PTSD [ß = 0.55, 95% CI (0.37 0.72) vs. ß = 0.47, 95% CI (0.21 0.74)]. At Wave 2, pre-resettlement violence was associated with depressive symptoms only [ß = 0.23, 95% CI (0.06 0.40)], while past-year exposure to violence had the largest association with all mental health outcomes [depression: ß = 0.39, 95% CI (0.17 0.62); anxiety: ß = 0.46, 95% CI (0.01 0.75); PTSD: ß = 0.67, 95% CI 0.46 0.88)]. CONCLUSIONS: Our study is the first to examine refugees' exposure to post-resettlement violence across time, finding that Somali refugees' exposure is both persistent and prevalent after resettlement. Post-resettlement violence had a larger association with mental health than pre-resettlement exposure by Wave 2. Our study highlights the urgent need to understand the role of post-resettlement violence exposure for refugees in the US and Canada.

You Have to Pay to Live: Somali Young Adult Experiences With the U.S. Health Care System.

There is increasing documentation that refugees face experiences of interpersonal or structural discrimination in health care and employment. This study examines how Somali refugees understand various forms of discrimination in employment and health care related to their health, utilization of, and engagement with the health care system in the United States. We draw on semistructured qualitative interviews (N = 35) with Somali young adults in three U.S. states-Minnesota, Massachusetts, and Maine. Using modified grounded theory analysis, we explore how experiences of discrimination in employment and health care settings impact health care access, utilization, and perceptions of health among Somali young adults. Discrimination was identified as a major barrier to using health services and securing employment with employer-sponsored insurance coverage. These findings highlight how interpersonal and structural discrimination in employment and health care are mutually reinforcing in their production of barriers to health care utilization among Somali refugees.

CONNJUR Workflow Builder: a software integration environment for spectral reconstruction.

CONNJUR Workflow Builder (WB) is an open-source software integration environment that leverages existing spectral reconstruction tools to create a synergistic, coherent platform for converting biomolecular NMR data from the time domain to the frequency domain. WB provides data integration of primary data and metadata using a relational database, and includes a library of pre-built workflows for processing time domain data. WB simplifies maximum entropy reconstruction, facilitating the processing of non-uniformly sampled time domain data. As will be shown in the paper, the unique features of WB provide it with novel abilities to enhance the quality, accuracy, and fidelity of the spectral reconstruction process. WB also provides features which promote collaboration, education, parameterization, and non-uniform data sets along with processing integrated with the Rowland NMR Toolkit (RNMRTK) and NMRPipe software packages. WB is available free of charge in perpetuity, dual-licensed under the MIT and GPL open source licenses.

We left one war and came to another: resource loss, acculturative stress, and caregiver-child relationships in Somali refugee families.

Refugee families often encounter a number of acculturative and resettlement stressors as they make lives for themselves in host countries. These difficulties may be compounded by past trauma and violence exposure, posing increased risk for mental health problems. Greater knowledge is needed about protective processes contributing to positive development and adjustment in refugee families despite risk (e.g., resilience). The aims of this research were to identify and examine strengths and resources utilized by Somali refugee children and families in the Boston area to overcome resettlement and acculturative stressors. We used maximum variation sampling to conduct a total of 9 focus groups: 5 focus groups (total participants N = 30) among Somali refugee adolescents and youth, capturing gender and a range of ages (15 to 25 years), as well as 4 focus groups of Somali refugee mothers and fathers in groups (total participants N = 32) stratified by gender. Drawing from conservation of resources theory (COR), we identified 5 forms of resources comprising individual, family, and collective/community strengths: religious faith, healthy family communication, support networks, and peer support. "Community talk" was identified as a community dynamic having both negative and positive implications for family functioning. Protective resources among Somali refugee children and families can help to offset acculturative and resettlement stressors. Many of these locally occurring protective resources have the potential to be leveraged by family and community-based interventions. These findings are being used to design preventative interventions that build on local strengths among Somali refugees in the Boston area.

Rethinking mental healthcare for refugees.

After several years of downturn in new resettlement, the United States is projected to admit 125,000 refugees in the current fiscal year. Refugee communities have known risks of developing mental health problems due to high rates of exposure to war and conflict-related trauma and chronic stressors associated with displacement and resettlement. In this commentary, we examine limitations in the current system of mental health care available to newly arriving refugee communities and make recommendations for expanding and redesigning services to better meet the needs of culturally diverse refugee communities. This includes drawing on public health and prevention frameworks to implement a continuum of services including basic services and security, trauma-informed prevention services to meet the needs of individuals, families and communities and specialized clinical care for those that need it. Across all services, we recommend robust engagement and partnership with refugee community leaders to design and deliver programs.

Trauma history and psychopathology in war-affected refugee children referred for trauma-related mental health services in the United States.

There is an increasing need to deliver effective mental health services to refugee children and adolescents across the United States; however, the evidence base needed to guide the design and delivery of services is nascent. We investigated the trauma history profiles, psychopathology, and associated behavioral and functional indicators among war-affected refugee children presenting for psychological treatment. From the National Child Traumatic Stress Network's Core Data Set, 60 war-affected refugee children were identified (51.7% males, mean age = 13.1 years, SD = 4.13). Clinical assessments indicated high rates of probable posttraumatic stress disorder (30.4%), generalized anxiety (26.8%), somatization (26.8%), traumatic grief (21.4%), and general behavioral problems (21.4%). Exposure to war or political violence frequently co-occurred with forced displacement; traumatic loss; bereavement or separation; exposure to community violence; and exposure to domestic violence. Academic problems and behavioral difficulties were prevalent (53.6% and 44.6%, respectively); however, criminal activity, alcohol/drug use, and self-harm were rare (all < 5.45%). These findings highlight the complex trauma profiles, comorbid conditions, and functional problems that are important to consider in providing mental health interventions for refugee children and adolescents. Given the difficulties associated with access to mental health services for refugees, both preventive and community-based interventions within family, school, and peer systems hold particular promise.

A Pipeline Software Architecture for NMR Spectrum Data Translation.

The problem of formatting data so that it conforms to the required input for scientific data processing tools pervades scientific computing. The CONNecticut Joint University Research Group (CONNJUR) has developed a data translation tool based on a pipeline architecture that partially solves this problem. The CONNJUR Spectrum Translator supports data format translation for experiments that use Nuclear Magnetic Resonance to determine the structure of large protein molecules.

CONNJUR spectrum translator: an open source application for reformatting NMR spectral data.

NMR spectroscopists are hindered by the lack of standardization for spectral data among the file formats for various NMR data processing tools. This lack of standardization is cumbersome as researchers must perform their own file conversion in order to switch between processing tools and also restricts the combination of tools employed if no conversion option is available. The CONNJUR Spectrum Translator introduces a new, extensible architecture for spectrum translation and introduces two key algorithmic improvements. This first is translation of NMR spectral data (time and frequency domain) to a single in-memory data model to allow addition of new file formats with two converter modules, a reader and a writer, instead of writing a separate converter to each existing format. Secondly, the use of layout descriptors allows a single fid data translation engine to be used for all formats. For the end user, sophisticated metadata readers allow conversion of the majority of files with minimum user configuration. The open source code is freely available at http://connjur.sourceforge.net for inspection and extension.

Rapid Review to Inform the Rehabilitation and Reintegration of Child Returnees from the Islamic State.

Background: An estimated 49,000 women and children who lived in the Islamic State are being held in the Al-Hol refugee camp in Syria. Several countries have repatriated some of these women and children, though most have thus far refused to do so. Many countries are asking whether it is possible to successfully rehabilitate and reintegrate this group and how the evidence base could inform their approach. Objective: The overall objective of this paper is to inform the rehabilitation and reintegration of child returnees from the Islamic State by rapidly reviewing the evidence on children exposed to trauma and adversity. Methods: A rapid review was conducted to identify pertinent evidence regarding outcomes, risk and protective factors, and interventions and to build a framework that could guide policies and practices. Prior work in the areas of refugee children, war-impacted children, child criminal gang members, child victims of maltreatment, and child victims of sex trafficking was reviewed. Evidence was collected and analyzed from 31 prior reviews and studies. Findings: The Rehabilitation and Reintegration Intervention Framework (RRIF) incorporates five levels (individual, family, educational, community, and societal) and identifies five primary goals: 1) promoting individual mental health and well-being; 2) promoting family support; 3) promoting educational success; 4) promoting community support; and 5) improving structural conditions and protecting public safety. Implementing this framework requires public-private partnership with extensive civil society involvement. Conclusions: Rehabilitation and reintegration programs should be based on the evidence of prior work with children exposed to trauma and adversity. RRIF defines a multi-level approach that encompasses promoting individual mental health and well-being, family support, educational success, community support, structural conditions, and public safety. Further multi-disciplinary research is needed to develop evidence in several identified areas concerning child health and developmental problems, family custody, faith and religiosity, and violent extremism assessment and prevention.

Conceptual-level workflow modeling of scientific experiments using NMR as a case study.

BACKGROUND: Scientific workflows improve the process of scientific experiments by making computations explicit, underscoring data flow, and emphasizing the participation of humans in the process when intuition and human reasoning are required. Workflows for experiments also highlight transitions among experimental phases, allowing intermediate results to be verified and supporting the proper handling of semantic mismatches and different file formats among the various tools used in the scientific process. Thus, scientific workflows are important for the modeling and subsequent capture of bioinformatics-related data. While much research has been conducted on the implementation of scientific workflows, the initial process of actually designing and generating the workflow at the conceptual level has received little consideration. RESULTS: We propose a structured process to capture scientific workflows at the conceptual level that allows workflows to be documented efficiently, results in concise models of the workflow and more-correct workflow implementations, and provides insight into the scientific process itself. The approach uses three modeling techniques to model the structural, data flow, and control flow aspects of the workflow. The domain of biomolecular structure determination using Nuclear Magnetic Resonance spectroscopy is used to demonstrate the process. Specifically, we show the application of the approach to capture the workflow for the process of conducting biomolecular analysis using Nuclear Magnetic Resonance (NMR) spectroscopy. CONCLUSION: Using the approach, we were able to accurately document, in a short amount of time, numerous steps in the process of conducting an experiment using NMR spectroscopy. The resulting models are correct and precise, as outside validation of the models identified only minor omissions in the models. In addition, the models provide an accurate visual description of the control flow for conducting biomolecular analysis using NMR spectroscopy experiment.

An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011.

An increase of Bhutanese refugee suicides were reported in the US between 2009 and 2012. This investigation examined these reported suicides in depth to gain a better understanding of factors associated with suicide within this population. The study employed 14 psychological autopsies to elicit underlying motivations and circumstances for self-inflicted death and to identify potential future avenues for prevention and intervention among refugee communities. Disappointment with current (un)employment, lack of resettlement services and social support, and frustrations with separation from family were believed to contribute to suicidal acts. Suicide within refugee populations may be connected with experiences of family withdrawal, integration difficulties, and perceived lack of care. It is important to assess the effectiveness of improving refugee services on the mental health of migrants. More research is needed in order to better understand, and respond to, suicide in resettled populations.

Suicidal Ideation and Mental Health of Bhutanese Refugees in the United States.

Refugee agencies noticed a high number of suicides among Bhutanese refugees resettled in the United States between 2009 and 2012. We aimed to estimate prevalence of mental health conditions and identify factors associated with suicidal ideation among Bhutanese refugees. We conducted a stratified random cross-sectional survey and collected information on demographics, mental health conditions, suicidal ideation, and post-migration difficulties. Bivariate logistic regressions were performed to identify factors associated with suicidal ideation. Prevalence of mental health conditions were: depression (21 %), symptoms of anxiety (19 %), post-traumatic stress disorder (4.5 %), and suicidal ideation (3 %), significant risk factors for suicidal ideation included: not being a provider of the family; perceiving low social support; and having symptoms of anxiety and depression. These findings suggest that Bhutanese refugees in the United States may have a higher burden of mental illness relative to the US population and may benefit from mental health screening and treatment. Refugee communities and service providers may benefit from additional suicide awareness training to identify those at highest risk.

Erratum to: Suicidal Ideation and Mental Health of Bhutanese Refugees in the United States.

In the original version of this article, one of the ten author names was listed incorrectly as "Trong Aoe." The name should be listed as "Trong Ao." The affiliation of two of the co-authors (Sharmila Shetty and Eboni Taylor) was incorrect. The correct affiliation is: Immigrant, Refugee and Migrant Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention. The correct full list of author names and their affiliations is presented above.

Delineation and analysis of the conceptual data model implied by the "IUPAC Recommendations for Biochemical Nomenclature".

Computational analysis of the bonding, geometric, and topological relationships within proteins typically takes on the order of hours, mainly devoted to the writing of scripts and code to correctly parse the data. The Structured Query Language (SQL) built into modern database management systems eliminates the need for data parsing, effectively reducing the analysis time to seconds. To this end, we have formulated a conceptual data model (CDM) for proteins based on the IUPAC recommendations for biochemical nomenclature. This conceptual data model makes explicit the inherent bonding relationships between the atoms of a protein, as well as the geometric (bond angle and torsion angle) and topological (chirality) relationships between the bonds. The validity of the CDM has been tested with a reduced implementation using commercial database software. The ease in both populating the database with data from the Protein Data Bank and formulating/executing queries supports the correctness of the model. The ability to conduct truly interactive analyses of protein structure is essential to fully capitalize on the explosion in postgenomic protein structure data.

Review of child and adolescent refugee mental health.

OBJECTIVE: To review stressful experiences and stress reactions among child and adolescent refugees, as well as interventions and ethical considerations in research and clinical work, within the framework of the chronological experiences of child refugees; namely, the phases of preflight, flight, and resettlement. Highlighted are special refugee populations such as unaccompanied minors, asylum seekers, and former child soldiers. Pertinent medical findings are summarized. METHOD: The authors reviewed articles from 1990 to 2003 addressing the topics above. Literature was gathered from databases including PsycINFO, Medline, and SocioFile. Pertinent earlier papers and those from other disciplines cited in database-identified articles were also included. RESULTS: Child and adolescent refugees suffer from significant conflict-related exposures. Reactions to stress may be mediated by coping strategies, belief systems, and social relations. CONCLUSIONS: More research is needed on interventions, specifically on efficacy and cultural relevance. Interventions that have an impact on multiple ecological levels need further development and evaluation.

Parser Combinators: a Practical Application for Generating Parsers for NMR Data.

Nuclear Magnetic Resonance (NMR) spectroscopy is a technique for acquiring protein data at atomic resolution and determining the three-dimensional structure of large protein molecules. A typical structure determination process results in the deposition of a large data sets to the BMRB (Bio-Magnetic Resonance Data Bank). This data is stored and shared in a file format called NMR-Star. This format is syntactically and semantically complex making it challenging to parse. Nevertheless, parsing these files is crucial to applying the vast amounts of biological information stored in NMR-Star files, allowing researchers to harness the results of previous studies to direct and validate future work. One powerful approach for parsing files is to apply a Backus-Naur Form (BNF) grammar, which is a high-level model of a file format. Translation of the grammatical model to an executable parser may be automatically accomplished. This paper will show how we applied a model BNF grammar of the NMR-Star format to create a free, open-source parser, using a method that originated in the functional programming world known as "parser combinators". This paper demonstrates the effectiveness of a principled approach to file specification and parsing. This paper also builds upon our previous work [1], in that 1) it applies concepts from Functional Programming (which is relevant even though the implementation language, Java, is more mainstream than Functional Programming), and 2) all work and accomplishments from this project will be made available under standard open source licenses to provide the community with the opportunity to learn from our techniques and methods.

An Open-Source Sandbox for Increasing the Accessibility of Functional Programming to the Bioinformatics and Scientific Communities.

Scientists are continually faced with the need to express complex mathematical notions in code. The renaissance of functional languages such as LISP and Haskell is often credited to their ability to implement complex data operations and mathematical constructs in an expressive and natural idiom. The slow adoption of functional computing in the scientific community does not, however, reflect the congeniality of these fields. Unfortunately, the learning curve for adoption of functional programming techniques is steeper than that for more traditional languages in the scientific community, such as Python and Java, and this is partially due to the relative sparseness of available learning resources. To fill this gap, we demonstrate and provide applied, scientifically substantial examples of functional programming, We present a multi-language source-code repository for software integration and algorithm development, which generally focuses on the fields of machine learning, data processing, bioinformatics. We encourage scientists who are interested in learning the basics of functional programming to adopt, reuse, and learn from these examples. The source code is available at: https://github.com/CONNJUR/CONNJUR-Sandbox (see also http://www.connjur.org).

Iterative Development of an Application to Support Nuclear Magnetic Resonance Data Analysis of Proteins.

The CONNecticut Joint University Research (CONNJUR) team is a group of biochemical and software engineering researchers at multiple institutions. The vision of the team is to develop a comprehensive application that integrates a variety of existing analysis tools with workflow and data management to support the process of protein structure determination using Nuclear Magnetic Resonance (NMR). The use of multiple disparate tools and lack of data management, currently the norm in NMR data processing, provides strong motivation for such an integrated environment. This manuscript briefly describes the domain of NMR as used for protein structure determination and explains the formation of the CONNJUR team and its operation in developing the CONNJUR application. The manuscript also describes the evolution of the CONNJUR application through four prototypes and describes the challenges faced while developing the CONNJUR application and how those challenges were met.

The "lost boys" of Sudan: use of health services and functional health outcomes of unaccompanied refugee minors resettled in the U.S.

To assess whether mental health counseling and other health services were associated with functional health outcomes of unaccompanied Sudanese refugee minors in the U.S., this study was a descriptive survey of 304 Sudanese refugee minors in foster care through the U.S. Unaccompanied Refugee Minors Program (URMP). Functional health outcomes included scores of Child Health Questionnaire (CHQ) scales and questions regarding care for symptoms or problems associated with behavioral disorders, i.e. somatization. Posttraumatic stress disorder (PTSD) was assessed using the Harvard Trauma Questionnaire (HTQ). Health services questions derived from the National Health Interview Survey. Minors reported high rates of counseling (45%); however no differences were noted in counseling use by those with PTSD compared with others. Counseling was not associated with health outcomes. The majority (76%) reported seeking medical care for symptoms or problems often associated with behavioral and emotional problems; however such care-seeking was more common among those with PTSD (OR = 2.5, 95% CI = 1.004-6.26). Through the efforts of the URMP, the Sudanese unaccompanied minors received high levels of psychosocial support despite the absence of their biological parents. Those with worse functional health were no more likely than others to have received mental health counseling while being more likely to seek care from any health professional. This was also the case for those with PTSD compared to those without it. In linear regression analyses, reported receipt of mental health counseling did not impact either positively or negatively on the score of any CHQ scale.