Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 394
Filtrar
Mais filtros

Intervalo de ano de publicação
1.
RNA ; 29(11): 1725-1737, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37567786

RESUMO

S-adenosylmethionine (SAM) is the methyl donor for nearly all cellular methylation events, so cells need to carefully control SAM levels. MAT2A encodes the only SAM synthetase expressed in the majority of human cells, and its 3'-UTR has six conserved regulatory hairpins (hp1-6) that can be methylated by the N6-methyladenosine methyltransferase METTL16. Hp1 begins 8 nt from the stop codon, whereas hp2-6 are clustered further downstream (∼800 nt). These hairpins have been proposed to regulate MAT2A mRNA levels in response to intracellular SAM levels by regulating intron detention of the last intron of MAT2A and by modulating the stability of the fully spliced mRNA. However, a dissection of these two posttranscriptional mechanisms has not been previously reported. Using a modular reporter system, we show that hp1 functions primarily when the detained intron is included in the reporter and when that intron has a suboptimal polypyrimidine tract. In contrast, the hp2-6 cluster modulates mRNA stability independent of the detained intron, although hp1 may make a minor contribution to the regulation of decay as well. Taken with previously published reports, these data support a two-tiered model for MAT2A posttranscriptional regulation by METTL16 through its interactions with hp1 and hp2-6. In the upstream tier, hp1 and METTL16 control MAT2A intron detention, whereas the second tier involves METTL16-dependent methylation of hp2-6 to control MAT2A mRNA stability. Thus, cells use a similar set of molecular factors to achieve considerable complexity in the posttranscriptional regulation of SAM homeostasis.


Assuntos
Adenosina , Regulação da Expressão Gênica , Humanos , Metilação , Adenosina/metabolismo , S-Adenosilmetionina/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Regiões 3' não Traduzidas/genética , Proteínas Cromossômicas não Histona/genética , Metionina Adenosiltransferase/genética , Metiltransferases/genética
2.
Emerg Infect Dis ; 30(13): S88-S93, 2024 04.
Artigo em Inglês | MEDLINE | ID: mdl-38561855

RESUMO

Correctional facilities house millions of residents in communities throughout the United States. Such congregate settings are critical for national infection prevention and control (IPC) efforts. Carceral settings can be sites where infectious diseases are detected in patient populations who may not otherwise have access to health care services, and as highlighted by the COVID-19 pandemic, where outbreaks of infectious diseases may result in spread to residents, correctional staff, and the community at large. Correctional IPC, while sharing commonalities with IPC in other settings, is unique programmatically and operationally. In this article, we identify common challenges with correctional IPC program implementation and recommend action steps for advancing correctional IPC as a national public health priority.


Assuntos
COVID-19 , Doenças Transmissíveis , Humanos , Estados Unidos/epidemiologia , Prisões , Pandemias/prevenção & controle , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Infecções
3.
BMC Psychiatry ; 24(1): 160, 2024 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-38395842

RESUMO

BACKGROUND: When an individual is detained in hospital it is important that they maintain contact with their family, friends and communities as these can be helpful for their well-being and recovery. Maintaining these relationships is also important to unpaid carers (family or friends), but they can be strained by carers' instigation of, or compliance with, the involuntary detention. Section 17 of the Mental Health Act (1983) in England and Wales allows for temporary leave from hospital, from an hour in the hospital grounds to going home for a few days. However, carers are not always involved in decisions around statutory s.17 leave, even where they are expected to support someone at home. This study aimed to explore how practice can be improved to better involve and support carers around s.17 leave. METHODS: Semi-structured interviews and focus groups were held with 14 unpaid carers and 19 mental health practitioners, including four Responsible Clinicians, in three sites in England in 2021. The research explored views on what works well for carers around s.17 leave, what could be improved and the barriers to such improvements. Transcripts were analysed using reflexive thematic analysis. RESULTS: Three themes were identified in the analysis: the need for carer support and the challenges surrounding provision; challenges with communication, planning and feedback around s.17 leave; and inconsistency in involving carers around s.17 leave. Permeating all themes was a lack of resources presenting as under-staffing, high demands on existing staff, and lack of time and capacity to work and communicate with carers. CONCLUSION: Implications include the need for more funding for mental health services for both prevention and treatment; staff training to increase confidence with carers; and standardised guidance for practitioners on working with carers around s.17 leave to help ensure consistency in practice. The study concluded with the production of a 'S.17 Standard', a guidance document based on the research findings consisting of 10 steps for practitioners to follow to support the greater involvement and support of carers.


Assuntos
Cuidadores , Serviços de Saúde Mental , Humanos , Cuidadores/psicologia , Saúde Mental , Inglaterra , Hospitais
4.
BMC Pediatr ; 24(1): 12, 2024 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-38178014

RESUMO

BACKGROUND: For individuals with severe mental illness, involuntary assessment and/or treatment (hereafter detention) can be a necessary intervention to support recovery and may even be lifesaving. Despite this, little is known about how often these interventions are used for children and adolescents. METHODS: This global scoping review set out to: (1) map the current evidence around mental health detentions of children and adolescents (< 18 years); (2) identify the clinical, sociodemographic, and behavioural factors associated with detention; and (3) document the views of professionals and young people on the implementation of mental health legislation. RESULTS: After searching databases of peer-reviewed literature and citation chaining, 42 articles from 15 jurisdictions were included. About one fifth of psychiatric admissions in national register data were detentions, however trends were only available for a few high-income Western countries. The circumstances justifying detention and the criteria authorising detention varied between studies, with a mix of clinical factors and observed behaviours reported as the reason(s) warranting/precipitating a detention. Particular groups were more likely to experience detention, such as children and adolescents from minority ethnic communities and those with a documented history of abuse. There was a notable absence of qualitative research exploring the views of professionals or children and adolescents on detention. CONCLUSION: Further research is needed to explore the impact of detention on those aged < 18 years, including national register-based studies and qualitative studies. This is particularly relevant in nations currently undergoing legislative reform.


Assuntos
Internação Involuntária , Transtornos Mentais , Saúde Mental , Adolescente , Criança , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Saúde Mental/legislação & jurisprudência , Grupos Minoritários , Prevalência , Fatores de Risco
5.
Bioethics ; 38(8): 713-721, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38875484

RESUMO

Almost a year after the enactment of the law regulating euthanasia in Spain, public opinion was shocked to learn that a defendant in criminal proceedings obtained medical assistance in dying following injuries sustained in an exchange of gunfire with the police after having committed a series of severe crimes. Although there are very few cases in the world where prisoners have received euthanasia, the one we will discuss in this article is the only known case where both the public prosecutor's office and the private prosecutors judicially opposed the defendant's euthanasia. This article aims to offer a new perspective on the ethical legitimacy of detainees' access to euthanasia: the ethics of caring solidarity. To do this, we will first place the case in its legal context. Subsequently, we will address the two main arguments proposed in the literature to justify euthanasia in detention: respect for the autonomy of the detainee and the principle of equivalence of care. Finally, after having identified serious shortcomings in both arguments, we will argue that the perspective of caring solidarity offers a better ethical basis for people in detention's access to euthanasia.


Assuntos
Eutanásia , Prisioneiros , Humanos , Espanha , Eutanásia/ética , Eutanásia/legislação & jurisprudência , Autonomia Pessoal , Respeito
6.
Proc Natl Acad Sci U S A ; 118(21)2021 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-34001622

RESUMO

US immigration enforcement policy seeks to change the behaviors and views of not only individuals in the United States but also those of prospective migrants outside the United States. Yet we still know relatively little about the behavioral and attitudinal effects of US enforcement policy on the population abroad. This study uses a randomized experiment embedded in a nationally representative survey that was administered in El Salvador, Guatemala, Honduras, and Mexico to analyze the effects of US deterrence policies on individuals' migration intentions and their attitudes toward the US immigration system. The two policies that the current study examines are immigration detention and nonjudicial removals. The survey results provide no evidence that a heightened awareness of these US immigration enforcement policies affects individuals' intentions to migrate to the United States. But heightened awareness about the widespread use of immigration detention in the United States does negatively impact individuals' assessments about the procedural and outcome fairness of the US immigration system. These findings suggest that immigration detention may foster delegitimating beliefs about the US legal system without producing the intended deterrent effect.

7.
J Environ Manage ; 365: 121465, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38901320

RESUMO

By infiltrating and retaining stormwater, Blue-Green Infrastructure (BGI) can help to reduce Combined Sewer Overflows (CSOs), one of the main causes of urban water pollution. Several studies have evaluated the ability of individual BGI types to reduce CSOs; however, the effect of combining these elements, likely to occur in reality, has not yet been thoroughly evaluated. Moreover, the CSO volume reduction potential of relevant components of the urban drainage system, such as detention ponds, has not been quantified using hydrological models. This study presents a systematic way to assess the potential of BGI combinations to mitigate CSO discharge in a catchment near Zurich (Switzerland). Sixty BGI combinations, including four BGI elements (bioretention cells, permeable pavement, green roofs, and detention ponds) and four different implementation rates (25%, 50%, 75%, and 100% of the available sewer catchment area) are evaluated for four runoff routing schemes. Results reveal that BGI combinations can provide substantial CSO volume reductions; however, combinations including detention ponds can potentially increase CSO frequency, due to runoff prolongation. When runoff from upstream areas is routed to the BGI, the CSO discharge reductions from combinations of BGI elements differ from the cumulative CSO discharge reductions achieved by individual BGI types, indicating that the sum of effects from individual BGI types cannot accurately predict CSO discharge in combined BGI scenarios. Moreover, larger BGI implementation areas are not consistently more cost-effective than small implementation areas, since the additional CSO volume reduction does not outweigh the additional costs. The best-performing BGI combination depends on the desired objective, being CSO volume reduction, CSO frequency reduction or cost-effectiveness. This study emphasizes the importance of BGI combinations and detention ponds in CSO mitigation plans, highlighting their critical factors-BGI types, implementation area, and runoff routing- and offering a novel and systematic approach to develop tailored BGI strategies for urban catchments facing CSO challenges.


Assuntos
Esgotos , Poluição da Água/prevenção & controle , Movimentos da Água , Eliminação de Resíduos Líquidos/métodos , Hidrologia
8.
Crim Behav Ment Health ; 34(4): 385-390, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38873856

RESUMO

BACKGROUND: Fazel and Favril presented a reanalysis of our previously published systematic review and meta-analysis on the prevalence of attention deficit hyperactivity disorder (ADHD) in prison. AIMS: The current paper addresses some of the criticisms of Fazel and Favril on our meta-analysis and presents a reanalysis of the data, focusing on adult detained persons. METHODS: We conducted a meta-regression on 28 studies (n = 7710) to estimae the pooled prevalence of ADHD. RESULTS: This reanalysis yielded a pooled estimate of 22.2% for the prevalence of ADHD (95% confidence interval [CI]: 15.7; 28.6), which disagrees with the estimate given by Fazel and Favril (8.3%, 95% CI: 3.8; 12.8). CONCLUSION: We argue that the ADHD prevalence provided by Fazel and Favril was an underestimate due to their use of too restrictive exclusion criteria and suboptimal analysis methods. Our reanalysis on detained adults suggests a higher ADHD prevalence, which highlights the need to diagnose and treat ADHD in prison.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Prisioneiros , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Humanos , Prisioneiros/estatística & dados numéricos , Prevalência , Prisões/estatística & dados numéricos , Adulto
9.
Crim Behav Ment Health ; 34(2): 163-181, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38268129

RESUMO

BACKGROUND/AIMS: Youth with prenatal alcohol exposure (PAE) are under-recognised in the justice system, warranting improved identification. This study aimed to compare neuropsychological profiles of adolescents, with and without PAE and identify neuropsychological tasks predictive of PAE-group membership. It was hypothesised that participants with PAE would score significantly lower on neuropsychological tests. METHODS: Participants included 85 young people sentenced to detention (mean 15.7 years, 78 males), 46 with PAE. A one-way-multivariate analysis of variance tested differences in neuropsychological functioning between PAE/No-PAE groups, while logistic regression determined tests predictive of PAE. RESULTS: No statistically significant difference in test scores emerged between groups, and regression was not indicative of any models predictive of PAE-group membership. Neuropsychological profiles were characterised by both strengths and weaknesses, with lower verbal and mathematical skills. CONCLUSION(S): While no statistically significant differences were found between the groups, the results provided a unique insight into the neurocognitive profile of Australian youth in detention. Routine screening assessments were recommended for young people sentenced to detention.


Assuntos
Delinquência Juvenil , Testes Neuropsicológicos , Efeitos Tardios da Exposição Pré-Natal , Humanos , Feminino , Adolescente , Masculino , Gravidez , Austrália Ocidental , Delinquência Juvenil/psicologia , Prisioneiros/psicologia , Prisioneiros/estatística & dados numéricos
10.
J Child Sex Abus ; 33(4): 415-423, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38769896

RESUMO

Research suggests that individuals involved in the criminal justice system have higher rates of childhood trauma, including experiences of child sexual abuse (CSA). Studies also suggest that childhood victimization has an impact on the success of mental health treatment for offenders which may contribute to recidivism rates. Accordingly, policymakers and correctional staff can be better informed in choosing appropriate assessments and intervention approaches when they understand the ways in which prior experiences of CSA impact individuals in correctional settings. This special section highlights four novel studies that advance the research examining CSA in incarcerated populations.


Assuntos
Vítimas de Crime , Prisioneiros , Criança , Humanos , Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Abuso Sexual na Infância/psicologia , Vítimas de Crime/psicologia , Prisioneiros/psicologia , Adulto
11.
J Child Sex Abus ; 33(4): 465-484, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38715349

RESUMO

To guide prevention and intervention efforts, the prevalence and impact of child sexual abuse (CSA) victimization among detained and incarcerated populations requires further examination, particularly with consideration of multi-type maltreatment experiences and sex-based variations. This longitudinal population-based study explores these relationships in an Australian birth cohort comprising all individuals born in Queensland in 1983 and 1984 (n = 82,409; 48.68% female). Data include all notified and substantiated harm(s) from child protection services (0 to 17 years), and sentences to youth detention and/or adult incarceration between ages 10 and 30. Findings indicate greater prevalence of CSA amongst detained/incarcerated individuals compared to the general population but emphasize the impact of cooccurring maltreatment (particularly neglect) on the likelihood of custodial outcomes. Important sex-based differences were noted in the intersection of CSA victimization and detention/incarceration. Findings reinforce the need for trauma-informed practices when working with custodial populations, particularly females, and highlight opportunities for prevention of detention/incarceration in at-risk populations, in line with a broader public health approach to child protection.


Assuntos
Abuso Sexual na Infância , Vítimas de Crime , Prisioneiros , Humanos , Feminino , Adolescente , Abuso Sexual na Infância/estatística & dados numéricos , Masculino , Adulto Jovem , Criança , Adulto , Prisioneiros/estatística & dados numéricos , Austrália/epidemiologia , Queensland/epidemiologia , Estudos Longitudinais , Estudos de Coortes , Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Prevalência
12.
Identities (Yverdon) ; 31(1): 123-139, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38322301

RESUMO

How are ethics articulated in the organization of migrants' detention in France? While state agents enjoy discretionary power, it is the third sector that claims legal knowledge and good practice, exposing an unresisting and reverent attitude towards the 'rule of law'. This legalistic gaze on the state attests to the impasse in questioning (the moral grounds of) laws and flaunting intense emotions on a daily basis, an expression of their moral dilemma. In doing so, police officers, legal practitioners and other service providers display contrasting ideological disapproval but practical compliance, creating an environment infused with melancholy. Melancholy enables them to be humble operators of state rules and regulations and, at the same time, to suffer endless (moral and emotional) pain. This article analyses inter-organizational and inter-personal affective experiences in order to demonstrate how melancholy reflects the morale that is manifest in the organization of migrants' detention.

13.
J Gen Intern Med ; 38(9): 2030-2037, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36451013

RESUMO

BACKGROUND: The USA has the largest immigration detention system in the world with over 20,000 individuals imprisoned by Immigration and Customs Enforcement (ICE) daily. Numerous reports have documented human rights abuses in immigration detention, yet little is known about its health impacts. OBJECTIVE: To characterize how the US immigration detention system impacts health from the perspective of people who were recently detained by ICE. DESIGN: Qualitative study using anonymous, semi-structured phone interviews in English or Spanish conducted between July 2020 and February 2021. PARTICIPANTS: Adults who had been detained by ICE for at least 30 days in the New York City metropolitan area within the previous 2 years, and that were fluent in English and/or Spanish. APPROACH: We explored participants' health histories and experiences trying to meet physical and mental health needs while in detention and after release. We conducted a reflective thematic analysis using an inductive approach. KEY RESULTS: Of 16 participants, 13 identified as male; five as lesbian, gay, bisexual, or queer; and four as Black; they were from nine countries. Participants had spent a median of 20 years living in the USA and spent a median of 11 months in immigration detention. Four themes emerged from our analysis: (1) poor conditions and inhumane treatment, (2) a pervasive sense of injustice, (3) structural barriers limiting access to care, and (4) negative health impacts of immigration detention. CONCLUSIONS: The narratives illustrate how structural features of immigration detention erode health while creating barriers to accessing needed medical care. Clinicians caring for immigrant communities must be cognizant of these health impacts. Community-based alternatives to immigration detention should be prioritized to mitigate health harms.


Assuntos
Emigrantes e Imigrantes , Emigração e Imigração , Adulto , Feminino , Humanos , Masculino , Saúde Mental , Pesquisa Qualitativa , Cidade de Nova Iorque
14.
Br J Psychiatry ; 222(1): 27-36, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36281471

RESUMO

BACKGROUND: Studies show ethnic inequalities in rates of involuntary admission and types of clinical care (such as psychological therapies). However, few studies have investigated if there is a relationship between clinical care practices and ethnic inequalities in involuntary admission. AIMS: This study investigated the impact of ethnicity and clinical care on involuntary admission and the potential mediation effects of prior clinical care. METHOD: In this retrospective cohort study, we used data from the electronic records of the South London and Maudsley NHS Foundation Trust and identified patients with a first hospital admission between January 2008 and May 2021. Logistic regression and mediation analyses were used to investigate the association between ethnicity and involuntary admission, and whether clinical care, in the 12 months preceding admission, mediates the association. RESULTS: Compared with White British people, higher odds of involuntary admission were observed among 10 of 14 minority ethnic groups; with more than twice the odds observed among people of Asian Chinese, of Asian Bangladeshi and of any Black background. There were some ethnic differences in clinical care prior to admission, but these had a minimal impact on the inequalities in involuntary admission. More out-patient appointments and home treatment were associated with higher odds of involuntary admission, whereas psychological therapies and having a care plan were associated with reduced odds of involuntary admission. CONCLUSIONS: Ethnic inequalities in involuntary admission persist after accounting for potential mediating effects of several types and frequencies of clinical care. Promoting access to psychological therapies and ensuring that care plans are in place may reduce involuntary admissions.


Assuntos
Etnicidade , Saúde Mental , Humanos , Estudos Retrospectivos , Etnicidade/psicologia , População Branca , Grupos Minoritários
15.
J Surg Res ; 290: 257-265, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37315440

RESUMO

INTRODUCTION: Equitable access to quality surgical care and low-cost healthcare services for all segments of the population remains a big problem in many African health systems. In Cameroon, it is very common to find medically discharged patients who have received surgical treatment and are unable to pay the resulting bills. These patients can be held in detention in hospitals until payments are complete. Even the corpses of patients who die with unpaid medical bills can be withheld until their family members pay off the debt. While this practice has been ongoing for many y, there remains very little scholarship on the issue reported in the literature. The main objective of this study was to uncover the lived experiences of discharged patients residing in hospital detention for being unable to pay their medical bills. METHODS: In-depth interviews, focus group discussions, and observations were conducted with purposefully selected patients living in detention in 2 rural private hospitals in the Fundong Health District in Cameroon. A thematic framework technique was used to analyze the transcribed data. The study was ethically approved by the Cameroon Bioethics Initiative, and informed consent was obtained from all participants. RESULTS: Living in hospital detention after receiving treatment constitutes an economic, social, and psychological burden for patients. Economically, it exacerbated poverty for the patients unable to purchase food, medications, and clothing due to lack of jobs and financial support. Socially, many of these individuals suffered from isolation, loneliness, shame, stigma, risk of contracting other diseases, and precarious sleeping conditions. The psychological burden was comprised of stress, depression, trauma, nightmares, and suicidal thoughts. CONCLUSIONS: The experiences of discharged patients in hospital detention suggest that they live in very deplorable conditions. There is a need for a functional healthcare protection mechanism, such as universal health coverage, to reduce the cost of healthcare services and surgical operations. Alternative payment mechanisms should also be considered.


Assuntos
Atenção à Saúde , Hospitais , Humanos , Camarões , Alta do Paciente , Avaliação de Resultados da Assistência ao Paciente
16.
Soc Psychiatry Psychiatr Epidemiol ; 58(9): 1343-1352, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36997745

RESUMO

PURPOSE: The Mental Health Act in Scotland is under review. Previous iterations increased patients' rights but the maximum time for short-term detentions remains unchanged, despite evolving psychiatric treatment models. We explored length, mode of ending and factors of influence on the application of short-term detention certificates (STDCs), which can last up to 28 days, across Scotland between 2006 and 2018. METHODS: Data on age, gender, ethnicity, date of commencement and ending of the STDC and detention site from all 42,493 STDCs issued to 30,464 patients over 12 years were extracted from the national repository for detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 and analysed using mixed models. RESULTS: One in five STDCs lapsed on day 28. Two in five were revoked and the remainder extended to a treatment order. STDCs that were not extended averaged 19 days, and revoked STDCs 14 days. The probability of a detention lapsing varied across hospitals and increased with patient age. The odds of a detention lapsing on day 28 were 62% lower and revoked detentions 10% shorter in 2018 relative to 2006. The odds of a detention extending decreased significantly from 2012 to 2018. Extended STDCs were associated with increased patient age, male gender, and ethnicity other than White Scottish. There was little initiation of or active revocation of STDCs on weekend days. CONCLUSION: The length of STDCs reduced over time, fewer detentions lapsed, and weekday patterning was evident in each year. These data can inform legislative and service reviews.


Assuntos
Internação Compulsória de Doente Mental , Transtornos Mentais , Saúde Mental , Humanos , Etnicidade , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Escócia/epidemiologia
17.
BMC Health Serv Res ; 23(1): 881, 2023 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-37608328

RESUMO

BACKGROUND: There are ongoing efforts to eliminate juvenile detention in King County, WA. An essential element of this work is effectively addressing the health needs of youth who are currently detained to improve their wellbeing and reduce further contact with the criminal legal system. This formative study sought to inform adaptation and piloting of an evidence-based systems engineering strategy - the Systems Analysis and Improvement Approach (SAIA) - in a King County juvenile detention center clinic to improve quality and continuity of healthcare services. Our aims were to describe the priority health needs of young people who are involved in Washington's criminal legal system and the current system of healthcare for young people who are detained. METHODS: We conducted nine individual interviews with providers serving youth. We also obtained de-identified quantitative summary reports of quality improvement discussions held between clinic staff and 13 young people who were detained at the time of data collection. Interview transcripts were analyzed using deductive and inductive coding and quantitative data were used to triangulate emergent themes. RESULTS: Providers identified three priority healthcare cascades for detention-based health services-mental health, substance use, and primary healthcare-and reported that care for these concerns is often introduced for the first time in detention. Interviewees classified incarceration itself as a health hazard, highlighting the paradox of resourcing healthcare quality improvement interventions in an inherently harmful setting. Fractured communication and collaboration across detention- and community-based entities drives systems-level inefficiencies, obstructs access to health and social services for marginalized youth, and fragments the continuum of care for young people establishing care plans while detained in King County. 31% of youth self-reported receiving episodic healthcare prior to detention, 15% reported never having medical care prior to entering detention, and 46% had concerns about finding healthcare services upon release to the community. CONCLUSIONS: Systems engineering interventions such as the SAIA may be appropriate and feasible approaches to build systems thinking across and between services, remedy systemic challenges, and ensure necessary information sharing for care continuity. However, more information is needed directly from youth to draw conclusions about effective pathways for healthcare quality improvement.


Assuntos
Instituições de Assistência Ambulatorial , Prisões Locais , Adolescente , Humanos , Washington , Recursos em Saúde , Melhoria de Qualidade
18.
Sensors (Basel) ; 23(7)2023 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-37050741

RESUMO

Wetlands play a vital role in ecosystems. They help in flood accumulation, water purification, groundwater recharge, shoreline stabilization, provision of habitats for flora and fauna, and facilitation of recreation activities. Although wetlands are hot spots of biodiversity, they are one of the most endangered ecosystems on the Earth. This is not only due to anthropogenic activities but also due to changing climate. Many studies can be found in the literature to understand the water levels of wetlands with respect to the climate; however, there is a lack of identification of the major meteorological parameters affecting the water levels, which are much localized. Therefore, this study, for the first time in Sri Lanka, was carried out to understand the most important parameters affecting the water depth of the Colombo flood detention basin. The temporal behavior of water level fluctuations was tested among various combinations of hydro-meteorological parameters with the help of Artificial Neural Networks (ANN). As expected, rainfall was found to be the most impacting parameter; however, apart from that, some interesting combinations of meteorological parameters were found as the second layer of impacting parameters. The rainfall-nighttime relative humidity, rainfall-evaporation, daytime relative humidity-evaporation, and rainfall-nighttime relative humidity-evaporation combinations were highly impactful toward the water level fluctuations. The findings of this study help to sustainably manage the available wetlands in Colombo, Sri Lanka. In addition, the study emphasizes the importance of high-resolution on-site data availability for higher prediction accuracy.

19.
Fam Process ; 62(4): 1640-1654, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-36710481

RESUMO

Hundreds of thousands of undocumented Mexican immigrants were deported from the United States or returned to Mexico voluntarily in the past two decades, taking with them their US-born citizen children (USCC). A family's relocation-forced deportation or voluntary return-and the subsequent settlement and adjustment to Mexico affect everyone's well-being. We interviewed 18 USCC whose parents were forcibly deported and 18 whose parents returned voluntarily about their circumstances, experiences, and perceptions. Four categories of relocation and adjustment issues emerged. USCC with deported parents felt the sudden and harsh arrest, detention, deportation, and separation from parents, and family reunification after deportation. Those in the voluntary-return group told of concerns about the planned separation and relocation to Mexico. Both groups experienced issues of family reintegration and adjustment to a new environment. While relocation prompted similarities and differences in families' settlement, issues unique to families played a part in children's adjustment. Clinicians in both the United States and Mexico must take into consideration the nature of the relocation, families' distinctive reactions, and the individual child's experience as some USCC will remain in Mexico and others will return to the US Mexican clinicians will encounter USCC still settling and adjusting to Mexico, and USCC who decide to remain permanently in Mexico. US clinicians may encounter USCC facing the challenges of re-entering American society, joining educational institutions, and becoming part of the labor force. USCC forming families may feel the impact of their pasts in parenting dynamics.


Assuntos
Deportação , Pais , Criança , Humanos , Estados Unidos , México , Poder Familiar , Emoções
20.
J Environ Manage ; 330: 117179, 2023 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-36608609

RESUMO

Various stormwater best management practices and green infrastructures (GIs) are recommended to address flooding, stormwater runoff, water quality, and sustainability. While detention basins are considered one of the main GI strategies, their benefits cannot be fully realized without properly maintaining them and making sure that they stay operational. Therefore, this paper used agent-based modeling (ABM) to devise an optimal maintenance program for detention basins to ensure that they function properly and continue to perform their water quality and flood control functions. More specifically, the following 2 agent types were incorporated in the model: 1) the detention basins were considered as static agents, and 2) the service teams responsible for the operation (maintenance, repair, and replacement) of the detention basins were considered as active agents. The developed ABM was applied for the entire network of stormwater detention basins in Newark, NJ. Sensitivity analysis was conducted to identify the most critical variables affecting the total cost of operating the network of detention basins as well as the functioning percentage of detention basins. In addition, optimization was implemented to determine the best maintenance program or policy that minimizes the total cost of operations, while also making sure that a desired functionality level or threshold is achieved for the entire network of detention basins. Finally, the ABM was statistically validated using a total of 10,000 Monte Carlo runs and 99% confidence intervals. The optimization results showed that, in order to minimize the total cost of maintaining the entire network of detention basins and ensure that at least 80% of the basins are in a functioning state at the end of the planning horizon, the decision-maker should implement the following maintenance program or strategy: have 2 service teams for the operations of the detention basins, follow a replacement policy, and replace detention basins after 3 maintenance periods. Also, the identified optimal maintenance program or strategy would result with an average total annual cost of around $4,085,000, where the average annual repair cost is around $2,572,200, the average annual maintenance cost is around $19,700, the average annual replacement cost is around $763,100, and the average annual service team cost is around $730,000. The proposed ABM for detention basins can be extended to other GIs as well as to different geographical areas. The usage of ABM has the advantage to reduce the subjectivity in developing plans for managing GIs.


Assuntos
Chuva , Qualidade da Água , Inundações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA