Transnational health protection strategies and other health-seeking behavior among undocumented and indigenous dairy workers in a rural new immigrant destination.

Latin American immigrants in new immigrant destinations (NIDs) experience numerous barriers that negatively impact their access to healthcare. Yet the wide range of health-seeking behaviors deployed in response to these barriers-particularly among those who are undocumented and indigenous-are not well understood. Further, studies of immigrant health in NIDs tend to take place in those locations, rather than using a multi-sited design. Building on NID scholarship, the transnational social protection literature, and work on structural vulnerability, this study uses a multi-sited research design to examine the health-seeking behaviors that undocumented and indigenous immigrant workers exhibit in a rural NID. Data consist of interviews conducted intermittently from 2010 to 2017 in Mexico and the U.S. with 56 individuals from indigenous villages in Veracruz who worked on dairy farms in Wisconsin and Minnesota, as well as expert interviews. We found numerous barriers to healthcare that together constituted a limited resource environment for undocumented dairy workers. This accentuated their structural vulnerability and influenced responses to health problems. Strategies among undocumented and indigenous immigrant dairy workers in a rural NID included: self-care, delaying care, relying on local ties, cross-border health consultation, cross-border health packages, and returning home for health. Furthermore, we found that women in the family or community often facilitated cross-border health activity, and that traditional folk medicine was common. We argue that these workers' health protection strategies not only serve to secure their individual status as productive workers, but on a larger scale, they play an important part in preserving the migrant labor regime in this rural NID. Further, we argue that the indigenous knowledge that is transmitted largely by women via immigrants' informal social networks is an important yet often invisible part of the carework that maintains this relatively new labor force.

Chimeric Claudins: A New Tool to Study Tight Junction Structure and Function.

The tight junction (TJ) is a structure composed of multiple proteins, both cytosolic and membranal, responsible for cell-cell adhesion in polarized endothelium and epithelium. The TJ is intimately connected to the cytoskeleton and plays a role in development and homeostasis. Among the TJ's membrane proteins, claudins (CLDNs) are key to establishing blood-tissue barriers that protect organismal physiology. Recently, several crystal structures have been reported for detergent extracted recombinant CLDNs. These structural advances lack direct evidence to support quaternary structure of CLDNs. In this article, we have employed protein-engineering principles to create detergent-independent chimeric CLDNs, a combination of a 4-helix bundle soluble monomeric protein (PDB ID: 2jua) and the apical-50% of human CLDN1, the extracellular domain that is responsible for cell-cell adhesion. Maltose-binding protein-fused chimeric CLDNs (MBP-CCs) used in this study are soluble proteins that retain structural and functional aspects of native CLDNs. Here, we report the biophysical characterization of the structure and function of MBP-CCs. MBP-fused epithelial cadherin (MBP-eCAD) is used as a control and point of comparison of a well-characterized cell-adhesion molecule. Our synthetic strategy may benefit other families of 4-α-helix membrane proteins, including tetraspanins, connexins, pannexins, innexins, and more.

Geriatric trauma: demographics, injuries, and mortality.

OBJECTIVES: To identify injuries that elderly sustain during high-energy trauma and determine which are associated with mortality. DESIGN: Retrospective review of prospectively collected database. SETTING: Academic trauma center. PATIENTS: Patients selected from database of all trauma admissions from January 2004 through June 2009. Study population consisted of patients directly admitted from scene of injury who sustained high-energy trauma with at least one orthopaedic injury and were 65 years or older (n = 597). INTERVENTION: Review of demographics, trauma markers, injuries, and disposition statuses. MAIN OUTCOME MEASUREMENTS: Statistical analysis using χ test, Student t test, and logistic regression analysis. RESULTS: The most common fractures were of the rib, distal radius, pelvic ring, facial bones, proximal humerus, clavicle, ankle, and sacrum. The injuries associated with the highest mortality rates were fractures of the cervical spine with neurological deficit (47%), at the C2 level (44%), and of the proximal femur (25%), pelvic ring (25%), clavicle (24%), and distal humerus (24%). The fractures significantly associated with mortality were fractures of the clavicle (P = 0.001), foot joints (P = 0.001), proximal humerus or shaft and head of the humerus (P = 0.002), sacroiliac joint (P = 0.004), and distal ulna (P = 0.002). CONCLUSIONS: Elderly patients present with significantly worse injuries, remain in the hospital longer, require greater use of resources after discharge, and die at 3 times the rate of the younger population. Although the high mortality rates associated with cervical spine, hip, and pelvic ring fractures were not unexpected, the injuries that were statistically associated with mortality were unexpected. Injuries such as clavicle fracture were statistically associated with mortality. As our population ages and becomes more active, the demographic may gain in clinical importance. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Arthroplasty in the young patient.

Shoulder pain and loss of function caused by degenerative joint disease is extremely disabling to young people who have an active lifestyle. If non-operative and minimally invasive treatment fails, shoulder arthroplasty is a reasonable option. This article reviews the options and indications for their use in shoulder disability in the young patient.

Seasonal timing of diapause induction limits the effective range of Diorhabda elongata deserticola (Coleoptera: Chrysomelidae) as a biological control agent for tamarisk (Tamarix spp.).

The leaf beetle Diorhabda elongata Brullé subspecies deserticola Chen, collected in northwestern China, has been released in the western United States to control tamarisk (Tamarix spp.). While beetle establishment and saltcedar defoliation have been noted at northern study sites, this species has not established at latitudes south of the 38th parallel. Critical daylength for diapause induction was measured in the laboratory and ranged between 14 h 50 min to 15 h 08 min, depending on temperature, and adults were shown to cease reproduction and enter diapause at daylengths of 14 h 30 min or less. Critical daylength in the field was measured at approximately 14 h 39 min and occurred 13 d before 50% of the population reached diapause. South of 36 degrees 20' N, the longest days of the year are shorter than 14 h 39 min, making the beetles univoltine in the southern United States. North of 36 degrees 20' N, a window of reproductive activity opens 13 d after the critical daylength is reached in the spring and closes 13 d after it is passed in the summer, allowing at least a partial second summer generation. It is predicted that south of the 38th parallel, premature diapause will increase mortality and disrupt synchrony between the life cycle of the beetle and host plant availability. This could hinder establishment and help explain the failure of this population south of the 38th parallel, providing a rationale for testing other populations of D. elongata in the southern range of Tamarix in North America.

Glenoid replacement in total shoulder arthroplasty.

Advances in glenoid replacement have contributed to improved patient outcomes and satisfaction while decreasing complications following total shoulder arthroplasty.

New developments in ochronosis: review of the literature.

Ochronosis commonly affects all connective tissue. Recognition of changes secondary to the deposition of ochronotic pigments has increased with advances in diagnostic technology, allowing both improved imaging and early biochemical and genetics-based diagnosis of alkaptonuria, the cause of ochronosis. Successful symptomatic treatment of ochronotic arthropathy with joint replacement has been documented, and a new pharmacotherapeutic agent, nitisinone, is currently under investigation for both prevention and treatment of ochronosis. This review of the literature highlights recently recognized complications, new diagnostic techniques, and treatment options.