Lessons Learned From TranslateCovid, a Multilingual Online Resource Hub for Asian American and Pacific Islander Communities and Beyond.

The COVID-19 pandemic exacerbated health disparities among immigrant communities. Delivering accurate information and addressing misinformation on protective measures and vaccination to linguistically disadvantaged groups was critical for mitigating the effects of the pandemic. One group that was especially vulnerable to miscommunication about COVID-19 was non-native English-speaking immigrants. To address these disparities, the Asian American Studies Center and the Fielding School of Public Health at the University of California, Los Angeles, partnered to create a multilingual resource hub, TranslateCovid.org, to disseminate credible and reliable information about COVID-19 safety measures, the science behind the vaccines, and vaccine safety. We identified >1300 verified resources in 60 languages from government, academic, and nonprofit organizations and reposted them on the TranslateCovid website. We also developed public service announcement videos on handwashing, use of face masks, and social distancing in 10 languages and a fact sheet for frequently asked questions in 20 languages. We used a participatory approach to develop strategies for disseminating these resources. We discuss lessons learned, including strategies for forming government, community, and academic partnerships to support the timely development and dissemination of information. We conclude with a discussion on the unique role of universities in promoting equitable access to public health resources among immigrant communities in times of crisis.

Ending Disparities and Achieving Justice for Individuals with Mental Disabilities.

The intersection of crime and mental disabilities is a topic of intense public scrutiny and concern. It is well known that the widespread closure of psychiatric hospitals led to an increase in the arrest and incarceration of individuals with mental illness. Nationally, as the number of state hospital beds that remain open "has fallen to its lowest level on record, … mentally ill individuals inside and outside the criminal justice system" compete for scarce resources in "a bed shell game with life-and-death implications." Against this backdrop, attorneys who practice in New York encounter statutory schemes governing the adjudication and retention of incapacitated defendants and those determined to not be responsible because of "mental disease or defect" that are confounding even to the most experienced counsel. Acquiring proficiency in this discrete area of law must be coupled with awareness that defendants with mental disabilities invariably confront widespread societal prejudices, myths, and stereotypes regarding their circumstances, such as that those who invoke mental status defenses are malingering or inherently dangerous. "The [American] public's outrage [in 1981] over a jurisprudential system that could allow a defendant who shot an American President on national television to plead 'not guilty' became a 'river of fury' after the jury's verdict was announced." The conditional release of John Hinckley from St. Elizabeth's Hospital on September 10, 2016, thirty-five years after he shot former President Ronald Regan and three others, is a watershed moment that has caused renewed public criticism of the insanity defense. Criminal defendants with mental disabilities have been "deprived of treatment, discriminated against, [and] mistreated." They have also been subjected to over-punishment because of the harms they endure while incarcerated. The common view that dangerous propensities are associated with mental illness and that future risk can be predicted is not evidence-based. This article will review the nature of mental disabilities and their prevalence in the criminal justice system, and will introduce fundamental concepts regarding the defense of individuals with mental disabilities. New York State statutes governing the retention, care, and treatment of incapacitated defendants and those found not guilty by reason of insanity will be explored in depth along with proposals for chapter amendments to this state's Criminal Procedure Law. Theory and practice are examined together toward the goal of ending disparities in outcomes for individuals with mental disabilities in the criminal justice system. This article's conclusion is that miscarriages of justice for those with mental disabilities can be avoided by reform of statutory schemes, education of the bench and bar regarding the nature and consequences of mental disabilities, and by embracing concepts of therapeutic justice not yet integrated into our criminal justice system.

Steeple sign: a case of croup.

Croup, or laryngotracheobronchitis, is a common viral respiratory tract illness seen in the pediatric population (). This article describes the case of a child who presents with croup and the characteristic "steeple sign" seen on the radiograph. The patient received a diagnosis of croup secondary to the parainfluenza virus infection. It is imperative for advanced practice nurses to recognize the signs and symptoms of croup when these patient present to emergency care settings. Advanced practice nurses must also consider possible differential diagnoses, accurately interpret the radiographs, and intervene according with supportive care and appropriate management.

Medical decision making in emergency care.

The role of the nurse practitioner (NP) or physician assistant (PA) in the emergent or urgent care setting requires proficient assessment skills in addition to the constant integration of information that leads to a sound medical decision-making (MDM) process. In every patient encounter, the NP/PA must efficiently gather adequate data to formulate a "hypothesis" and rapidly consider many "possible or probable" diagnoses to reach the most likely conclusion regarding the patient's condition. This MDM process requires deliberate thought and a higher level of cognitive functioning to process and analyze data and draw conclusions.

"RAPID" team triage: one hospital's approach to patient-centered team triage.

Patients who present to the emergency department want definitive care by a health care provider who can perform an initial assessment, initiate treatment, and implement a disposition plan. The traditional "nurse triage" model often creates barriers to the process of rapidly evaluating patients. Therefore, innovative strategies must be explored to improve the time of patient arrival to the time seen by a qualified provider in order to complete a thorough medical screening examination. One such approach is a rapid team triage system that provides a patient-centered process. This article describes the implementation of a rapid team triage model in an urban community hospital.

Exogenous insulin enhances glucose-stimulated insulin response in healthy humans independent of changes in free fatty acids.

CONTEXT: Islet ß-cells express both insulin receptors and insulin signaling proteins. Recent studies suggest insulin signaling is physiologically important for glucose sensing. OBJECTIVE: Preexposure to insulin enhances glucose-stimulated insulin secretion (GSIS) in healthy humans. We evaluated whether the effect of insulin to potentiate GSIS is modulated through regulation of free fatty acids (FFA). DESIGN AND SETTING: Subjects were studied on three occasions in this single-site study at an academic institution clinical research center. PATIENTS: Subjects included nine healthy volunteers. INTERVENTIONS: Glucose-induced insulin response was assessed on three occasions after 4 h saline (low insulin/sham) or isoglycemic-hyperinsulinemic (high insulin) clamps with or without intralipid and heparin infusion, using B28 Asp-insulin that could be distinguished from endogenous insulin immunologically. During the last 80 min of all three clamps, additional glucose was administered to stimulate insulin secretion (GSIS) with glucose concentrations maintained at similar concentrations during all studies. MAIN OUTCOME MEASURE: ß-Cell response to glucose stimulation was assessed. RESULTS: Preexposure to exogenous insulin increased the endogenous insulin-secretory response to glucose by 32% compared with sham clamp (P = 0.001). This was accompanied by a drop in FFA during hyperinsulinemic clamp compared with the sham clamp (0.06 ± 0.02 vs. 0.60 ± 0.09 mEq/liter, respectively), which was prevented during the hyperinsulinemic clamp with intralipid/heparin infusion (1.27 ± 0.17 mEq/liter). After preexposure to insulin with intralipid/heparin infusion to maintain FFA concentration, GSIS was 21% higher compared with sham clamp (P < 0.04) and similar to preexposure to insulin without intralipid/heparin (P = 0.2). CONCLUSIONS: Insulin potentiates glucose-stimulated insulin response independent of FFA concentrations in healthy humans.

A 15-year-old male with persistent knee pain.

Most children and adolescents who present with extremity pain in the emergency department (ED) have minor injuries or musculoskeletal problems that are easily diagnosed and managed. A history of a child or teenager with persistent extremity pain lasting more than a few weeks or pain that wakes the child at night is of clinical concern and requires investigation. There are serious clinical etiologies that must be included in the differential diagnosis of this group of patients. It is essential to take the time during the initial screening examination to determine the real reason for each patient ED visit and review previous medical care.

Wound care and laceration repair for nurse practitioners in emergency care: part II.

This is Part II of a 2-part series on wound care and laceration repair for advanced practice nurses. In Part I, the phases and categories of wound healing were outlined. The factors that affected wound healing were also discussed along with an approach for systematic wound management. Patient assessment, special circumstances involving underlying structures, and foreign bodies were also reviewed. Patient preparation, including wound cleansing, irrigation, scrubbing, and debridement were also covered along with anesthetic and analgesic tips and techniques for advanced practice nurses (APNs) in emergency care. In Part II, wound closure (e.g., sutures, staples, and adhesives) and wound closure techniques are discussed along with the pertinent aftercare instructions for patients with these wounds. Implications for APNs caring for patients with wounds in emergency care are also presented in this article.

Biomarkers in fasting serum to estimate glucose tolerance, insulin sensitivity, and insulin secretion.

BACKGROUND: Biomarkers for estimating reduced glucose tolerance, insulin sensitivity, or impaired insulin secretion would be clinically useful, since these physiologic measures are important in the pathogenesis of type 2 diabetes mellitus. METHODS: We conducted a cross-sectional study in which 94 individuals, of whom 84 had 1 or more risk factors and 10 had no known risk factors for diabetes, underwent oral glucose tolerance testing. We measured 34 protein biomarkers associated with diabetes risk in 250-µL fasting serum samples. We applied multiple regression selection techniques to identify the most informative biomarkers and develop multivariate models to estimate glucose tolerance, insulin sensitivity, and insulin secretion. The ability of the glucose tolerance model to discriminate between diabetic individuals and those with impaired or normal glucose tolerance was evaluated by area under the ROC curve (AUC) analysis. RESULTS: Of the at-risk participants, 25 (30%) were found to have impaired glucose tolerance, and 11 (13%) diabetes. Using molecular counting technology, we assessed multiple biomarkers with high accuracy in small volume samples. Multivariate biomarker models derived from fasting samples correlated strongly with 2-h postload glucose tolerance (R(2) = 0.45, P < 0.0001), composite insulin sensitivity index (R(2) = 0.91, P < 0.0001), and insulin secretion (R(2) = 0.45, P < 0.0001). Additionally, the glucose tolerance model provided strong discrimination between diabetes vs impaired or normal glucose tolerance (AUC 0.89) and between diabetes and impaired glucose tolerance vs normal tolerance (AUC 0.78). CONCLUSIONS: Biomarkers in fasting blood samples may be useful in estimating glucose tolerance, insulin sensitivity, and insulin secretion.

Insulin enhances glucose-stimulated insulin secretion in healthy humans.

Islet beta-cells express both insulin receptors and insulin-signaling proteins. Recent evidence from rodents in vivo and from islets isolated from rodents or humans suggests that the insulin signaling pathway is physiologically important for glucose sensing. We evaluated whether insulin regulates beta-cell function in healthy humans in vivo. Glucose-induced insulin secretion was assessed in healthy humans following 4-h saline (low insulin/sham clamp) or isoglycemic-hyperinsulinemic (high insulin) clamps using B28-Asp insulin that could be immunologically distinguished from endogenous insulin. Insulin and C-peptide clearance were evaluated to understand the impact of hyperinsulinemia on estimates of beta-cell function. Preexposure to exogenous insulin increased the endogenous insulin secretory response to glucose by approximately 40%. C-peptide response also increased, although not to the level predicted by insulin. Insulin clearance was not saturated at hyperinsulinemia, but metabolic clearance of C-peptide, assessed by infusion of stable isotope-labeled C-peptide, increased modestly during hyperinsulinemic clamp. These studies demonstrate that insulin potentiates glucose-stimulated insulin secretion in vivo in healthy humans. In addition, hyperinsulinemia increases C-peptide clearance, which may lead to modest underestimation of beta-cell secretory response when using these methods during prolonged dynamic testing.