Exploring the Digital Divide among the Bhutanese Refugee Community during COVID-19: Engaged Research in Action.

The digital divide proved a critical barrier to accessing information and healthcare during the COVID-19 pandemic and negatively impacted the Bhutanese refugee community. Moving beyond a technological model of the digital divide that highlights a lack of access to computers and the internet, we engaged the community to co-produce a dynamic approach that identifies the impact of socio-cultural and socio-environmental factors as well. Our paper reports on our community-academic research partnership and explores how the digital divide exacerbates health disparities in a midwestern Bhutanese refugee community. Combining the efforts of the community, anthropologists and social workers, this paper reports on the health disparities that confront the community as well as interventions designed to mitigate social inequities.

Challenges, inequalities and COVID-19: Examples from indigenous Oaxaca, Mexico.

COVID-19 is a challenge for indigenous communities in Mexico. Social inequalities and limited access to services combine with historical patterns of discrimination to amplify its negative impacts. Nevertheless, there are important ways in which indigenous communities organise and respond. Our paper, organised in three parts, summarises these challenges as well as the response. In the first section, we introduce indigenous Oaxaca and the challenges facing indigenous communities. In the second section, we note the ways in which indigenous communities rely on their traditions in response to the pandemic and limitations they face. In the third and concluding section, we argue that the social inequalities that define indigenous life in Oaxaca must be acknowledged in order to create an effective public health response to COVID-19.

Hispanic/Latino Acculturation Profiles and Telomere Length: Latent Class Analysis on a Nationally Representative Sample.

Background: Acculturation profiles and their impact on telomere length among foreign-born Hispanics/Latinos living in the United States (US) are relatively unknown. The limited research available has linked acculturation with shortened telomere length. Objectives: To identify acculturation profiles among a US representative sample of Hispanics/Latinos and to then examine telomere length differences between profiles. Methods: We conducted a latent class analysis among a non-institutionalized US-representative sample of Hispanics/Latinos using the 1999-2002 National Health and Nutrition Examination Survey (N = 2,292). The latent variable of acculturation was assessed by length of time in the US and language used as a child, read and spoken, usually spoken at home, used to think, and used with friends (i.e., Spanish and/or English). Telomere length assessed from leukocytes was used as the distal continuous outcome. Results: We identified five profiles: (1) low acculturated [33.2% of sample]; (2) partially integrated [18.6% of sample]; (3) integrated [19.4% of sample]; (4) partially assimilated [15.1% of sample]; and (5) assimilated [13.7% of sample]. Acculturation profiles revealed nuanced differences in conditional probabilities with language use despite the length of time spent in the US. While telomere length did vary, there were no significant differences between profiles. Conclusion: Profiles identified revealed that possible life-course and generational effects may be at play in the partially assimilated and assimilated profiles. Our findings expand public health research using complex survey data to identify and assess the dynamic relationship of acculturation profiles and health biomarkers, while being among the first to examine this context using a person-centered approach.

Stress, migration, and allostatic load: a model based on Mexican migrants in Columbus, Ohio.

BACKGROUND: Immigration is a disruptive event with multiple implications for health. Stressors, including family separation, acculturation, job insecurity, restricted mobility, sojourns, dangerous border crossings, stigmatization, and marginalization, shape immigrant health in ways we are only beginning to untangle. Around the world, there are over 200 million international migrants. In 2015, there were 43.2 million immigrants living in the US, 26.8% of whom were born in Mexico. Investigating how stress affects health among migrants facilitates better understanding of their experiences. METHODS: Here, we review existing research on stress and how allostatic load varies among migrants with specific attention to Mexican migrants in the US. Next, we explore research incorporating biomarkers of allostasis and narratives of migration and settlement to examine disease risks of Mexican migrants residing in Columbus, Ohio. This mixed-methods approach allowed us to examine how social stressors may influence self-reports of health differentially from associations with assessed discrimination and physiological biomarkers of health. RESULTS: These data sources are not significantly associated. Neither narratives nor self-reports of health provide significant proxies for participants' physiological health. CONCLUSIONS: We propose, the pairing of objectively assessed health profiles with narratives of migration better illustrate risks migrants face, while allowing us to discern pathways through which future health challenges may arise. Immigration and acculturation to a new nation are biologically and culturally embedded processes, as are stress and allostatic responses. To understand how the former covary with the latter requires a mixed-methods bioethnographic approach. Differences across multiple social and physiological systems, affect individual health over time. We propose incorporating physiological biomarkers and allostatic load with migrants' narratives of their migration to unravel complex relationships between acculturation and health.

Quantifying the passive stretching response of human tibialis anterior muscle using shear wave elastography.

BACKGROUND: Quantifying passive stretching responses of individual muscles helps the diagnosis of muscle disorders and aids the evaluation of surgical/rehabilitation treatments. Utilizing an animal model, we demonstrated that shear elastic modulus measured by supersonic shear wave elastography increases linearly with passive muscle force. This study aimed to use this state-of-the-art technology to study the relationship between shear elastic modulus and ankle dorsi-plantarflexion angle of resting tibialis anterior muscles and extract physiologically meaningful parameters from the elasticity-angle curve to better quantify passive stretching responses. METHODS: Elasticity measurements were made at resting tibialis anterior of 20 healthy subjects with the ankle positioned from 50° plantarflexion to up to 15° dorsiflexion at every 5° for two cycles. Elasticity-angle data was curve-fitted by optimizing slack angle, slack elasticity, and rate of increase in elasticity within a piecewise exponential model. FINDINGS: Elasticity-angle data of all subjects were well fitted by the piecewise exponential model with coefficients of determination ranging between 0.973 and 0.995. Mean (SD) of slack angle, slack elasticity, and rate of increase in elasticity were 10.9° (6.3°), 5.8 (1.9) kPa, and 0.0347 (0.0082) respectively. Intraclass correlation coefficients of each parameter were 0.852, 0.942, and 0.936 respectively, indicating excellent test-retest reliability. INTERPRETATION: This study demonstrated the feasibility of using supersonic shear wave elastography to quantify passive stretching characteristics of individual muscle and provided preliminary normative values of slack angle, slack elasticity, and rate of increase in elasticity for human tibialis anterior muscles. Future studies will investigate diagnostic values of these parameters in clinical applications.

Relationship between shear elastic modulus and passive muscle force: an ex-vivo study.

As muscle is stretched, it reacts with increasing passive resistance. This passive force component is important for normal muscle function. Unfortunately, direct measurement of passive muscle force is still beyond the current state-of-the-art. This study aimed to investigate the feasibility of using Supersonic shear wave elastography (SSWE) to indirectly measure passive muscle force. Sixteen gastronomies pars externus and 16 tibialis anterior muscles were dissected from 10 fresh roaster chickens. For each muscle specimen, the proximal bone-tendon junction was kept intact with its tibia or femur clamped in a fixture. Calibration weights (0-400 g in 25 g per increment) were applied to the distal tendon via a pulley system and muscle elasticity was measured simultaneously using SSWE. The measurements were repeated for 3 cycles. The elasticity-load relationship of each tested muscle for each loading cycle was analyzed by fitting a least-squares regression line to the data. Test-retest reliability was evaluated using intraclass correlation coefficient (ICC). Results demonstrated that the relationships between SSWE elasticity and passive muscle force were highly linear for all the tested muscles with coefficients of determination ranging between 0.971 and 0.999. ICCs were 0.996 and 0.985, respectively, for the slope and y-intercept parameters of the regression lines, indicating excellent reliability. These findings indicate that SSWE, when carefully applied, can be a highly reliable technique for muscle elasticity measurements. The linear relationship between SSWE elasticity and passive muscle force identified in the present study demonstrated that SSWE may be used as an indirect measure of passive muscle force.

Association of OCT angle recess width with IOP response after intravitreal triamcinolone injection.

PURPOSE: A circumferential pretrabecular anatomical structure, the angle recess (AR), can be imaged with anterior segment ocular coherence tomography. AR's utility to predict ocular hypertension after intravitreal triamcinolone injection was assessed. METHODS: All intravitreal triamcinolone injection recipients from 2002 to 2005 with high-resolution anterior segment ocular coherence tomography images had AR width (between the anteriormost prominence of the iris root and posterior cornea) measured by masked physicians using the caliper function of Stratus ocular coherence tomography. Intraocular pressures (IOPs) from 1 month before to 6 months after the injection were compiled for IOP rise (Δ) and maximal IOP (max), categorized as "minimal" (IOPmax < 21 mmHg and/or IOPΔ ≤ 5 mmHg), "moderate" (IOPmax 21-29 mmHg and/or IOPΔ 6-14 mmHg), or "severe" (IOPmax ≥ 30 mmHg and/or IOPΔ ≥ 15 mmHg). Linear regression and analyses of variance were applied. RESULTS: Twenty-six eyes satisfied the entry criteria, with 11 (42%) eyes demonstrating minimal, 11 (42%) moderate, and 4 (15%) severe IOP responses. The corresponding (mean ± SEM) AR widths were: 326 ± 31.5 µm, 281 ± 22.0 µm, and 138 ± 20.3 µm, respectively. Highly significant AR width differences existed between moderate and severe responders and between minimal and severe responders (both P < 0.004); 5 of 6 patients with IOP ≥ 29 mmHg had AR < 200 µm. CONCLUSION: These findings indicate that a potentially clinically useful relationship exists between AR width and IOP elevation accompanying intravitreal triamcinolone injection. Anterior segment screening could become a beneficial extension of ocular coherence tomography for retinal practices.

Immediate effect of nimmo receptor tonus technique on muscle elasticity, pain perception, and disability in subjects with chronic low back pain.

OBJECTIVE: Objectives of this study were to (1) quantify the immediate effect of Nimmo technique on muscle elasticity, pain perception, and disability and (2) evaluate comparative effectiveness of treating all primary and secondary trigger points (TrPs) vs primary TrP only. METHODS: Fourteen chronic low back pain subjects recruited from a chiropractic college were tested in this within-day repeated-measures design study. Gluteus medius containing a prominent TrP was indented for 4 sessions using a mechanoacoustic indentor system. A finite element optimization method extracted hyperelastic material constants of the gluteus medius. Load-deformation response on a standardized block was simulated. Area under the load-deformation curve from 0% to 25% deformation (A(FE)) and force at 25% deformation (F(FE)) were determined. No treatment was applied between the first and second sessions. Only the primary TrP in gluteus medius was treated between the second and third sessions. Full Nimmo treatment was used between the third and fourth sessions requiring treatment of all primary and secondary TrPs. The A(FE), F(FE), tissue thickness, subjective pain, and Oswestry Disability Index were compared between sessions. RESULTS: After full Nimmo treatment, A(FE) and F(FE) were significantly smaller than baseline (P = .021 and .027, respectively) and focal TrP treatment only (P = .003 and .001, respectively). The changes accompanied concomitant improvement in subjective pain and disability. It appears that focal TrP treatment resolves TrP, but full Nimmo treatment further reduces electrogenic spasm. CONCLUSIONS: Immediate effect of a single full Nimmo treatment appears to reduce muscle tone, subjective pain, and disability and be more beneficial than focal TrP treatment.

A mechano-acoustic indentor system for in vivo measurement of nonlinear elastic properties of soft tissue.

OBJECTIVES: Soft tissue exhibits nonlinear stress-strain behavior under compression. Characterizing its nonlinear elasticity may aid detection, diagnosis, and treatment of soft tissue abnormality. The purposes of this study were to develop a rate-controlled Mechano-Acoustic Indentor System and a corresponding finite element optimization method to extract nonlinear elastic parameters of soft tissue and evaluate its test-retest reliability. METHODS: An indentor system using a linear actuator to drive a force-sensitive probe with a tip-mounted ultrasound transducer was developed. Twenty independent sites at the upper lateral quadrant of the buttock from 11 asymptomatic subjects (7 men and 4 women from a chiropractic college) were indented at 6% per second for 3 sessions, each consisting of 5 trials. Tissue thickness, force at 25% deformation, and area under the load-deformation curve from 0% to 25% deformation were calculated. Optimized hyperelastic parameters of the soft tissue were calculated with a finite element model using a first-order Ogden material model. Load-deformation response on a standardized block was then simulated, and the corresponding area and force parameters were calculated. Between-trials repeatability and test-retest reliability of each parameter were evaluated using coefficients of variation and intraclass correlation coefficients, respectively. RESULTS: Load-deformation responses were highly reproducible under repeated measurements. Coefficients of variation of tissue thickness, area under the load-deformation curve from 0% to 25% deformation, and force at 25% deformation averaged 0.51%, 2.31%, and 2.23%, respectively. Intraclass correlation coefficients ranged between 0.959 and 0.999, indicating excellent test-retest reliability. CONCLUSIONS: The automated Mechano-Acoustic Indentor System and its corresponding optimization technique offers a viable technology to make in vivo measurement of the nonlinear elastic properties of soft tissue. This technology showed excellent between-trials repeatability and test-retest reliability with potential to quantify the effects of a wide variety of manual therapy techniques on the soft tissue elastic properties.