American Native Research Articles

Groundbreaking Research from NIDA Addressing the Challenges of the Opioid Epidemic.

The 2024 ACMT Ward and Ryan Donovan Memorial Fund lecture was presented by Dr. Nora Volkow, the director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH). This article in an edited version of her keynote address during ACMT's 2024 Annual Scientific Meeting. During the course of her talk, Dr. Volkow discussed the historical factors contributing to the ongoing global opioid epidemic, examined the evidence behind different front-line and policy strategies used to battle the opioid epidemic, and highlighted the importance of recent cultural changes that support more deliberate screening for substance use disorders and pathways for initiating treatment of opioid use disorders in vulnerable populations. An urgent need exists to improve inclusion of social and structural determinants of health in implementation science addressing opioid use disorders, with better attention to special populations, including Native American Indians and Alaskan Natives, African Americans, those over 65years of age, and teenagers.

Digital Natives and Community Resilience: An Exploration of AAPI Families’ Digital Technology Use

The current study adopted community resilience and explored Asian American and Pacific Islander (AAPI) digital natives’ supporting family members’ digital technology use and outcomes related to engagement. A sample of 29 AAPI late adolescents answered open-ended questions about the challenges, benefits, and familial dynamics when the group helped or instructed older family members in using digital technologies. Findings showcased complex intergroup dynamics between digital natives and their family members, including increased mutual respect, greater communication access, and worry of family members’ physical ailments interrupting digital technology use. Outcomes demonstrated how AAPI digital natives, amid family systems, embraced collectivist tendencies as a means of resilience amid the ongoing challenges related to digital technology use.

Subaltern Voices and Strategic Essentialism in Silko’s The Man to Send Rain Clouds

This article studies the Subaltern voices and Strategic Essentialism in Leslie Marmon Silko’s The Man to Send Rain Clouds. These concepts unveil individual voices raised against the power structures and the Pueblo characters strategically respond towards the Western’s hegemony and syncretism. There is depiction of rebellion and adaptation through Subalternity and Strategic Essentialism respectively, by the Native Americans in the short story. Leon’s effort towards securing his traditional values and cultural practices, highlights struggle towards autonomy and preservation in the text. The story depicts the uncertainty of preservation and adaptation, as characters suggest to quench the thirst of the old man through Catholic’s Holy water. This paper discloses the harms committed by the Euro-Americans to the Native American culture and the Natives' efforts to preserve their culture and to survive under the oppressive regime.

Native Sinus Hemodynamics and Thrombosis in Transcatheter Heart Valve: Effect of Implant Depth and Coronary Flow.

This study aimed to investigate the hemodynamic and anatomic factors associated with sinus thrombosis following transcatheter aortic valve replacement (TAVR), integrating invivo patient data analysis and invitro experiments. Postprocedural, 4-dimensional, multiphase computed tomography data from 211 patients enrolled in the ADAPT-TAVR (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement) study were analyzed. The prevalence of native sinus thrombosis was examined in relation to valve type, implant depth, and anatomic features. Invitro experiments used particle image velocimetry to observe changes in sinus flow based on the transcatheter heart valves (23-mm SAPIEN3, Edwards Lifesciences; and 29-mm CoreValve, Medtronic) height and coronary artery flow. Native sinus thrombosis was more common in self-expanding valves (39.1% versus 14.9%, P=0.004). In per-cusp analysis of invivo patient data, adjusted transcatheter heart valve implant depth (odds ratio, 1.2 [95% CI, 1.1-1.3]; P<0.001), noncoronary sinus of Valsalva (odds ratio, 4.0 [95% CI, 2.0-7.8]; P<0.001), sinus inflow diameter (odds ratio, 0.8 [95% CI, 0.6-0.9]; P=0.008), and implanted valve size (odds ratio, 0.8 [95% CI, 0.7-1.0]; P=0.025) were significant factors associated with native sinus thrombosis. In the invitro experiments, CoreValve showed noticeable flow stasis compared with SAPIEN3. High-positioned SAPIEN3 was linked to reduced velocity within the native sinus of Valsalva. Coronary artery flow led to higher sinus velocity and improved particle washout, reducing sinus thrombosis risk. This study provides insights into the relationship between transcatheter heart valve deployment and native sinus thrombosis, emphasizing the role of anatomic factors in relation to the risk of sinus thrombosis.

Disparities in cancer mortality outcomes among adult immigrants in the United States.

134 Background: The “immigrant health paradox” posits that immigrants are generally healthier than US natives of similar demographic and socioeconomic background. However, immigrant noncitizens with cancer face unique barriers to care, including limited access to routine screening and continuous healthcare coverage, which may portend worse outcomes. Methods: The 2011-2018 National Health Interview Survey Linked Mortality Files were used to identify all adult (age ≥18 years) US natives, foreign-born citizens, and noncitizens with a cancer history. Differences by group were assessed using the chi-squared test with Rao &amp; Scott’s second-order correction. Cox-proportional hazards models tested associations between nativity/citizenship status and cancer-specific (CSM) and all-cause mortality (ACM), adjusted by age, gender, and survey year. Sequential models separately tested the added effects of individual patient-level covariates selected a priori —including race/ethnicity, smoking status, region, educational attainment, employment, insurance status, and having a usual source of care. Results: A total of 23,603,743 US natives, 1,647,188 foreign-born citizens and 477,861 noncitizens met criteria for inclusion. Compared to US natives, immigrants had significantly greater distribution of gastroesophageal (2.3%, noncitizens vs 2.3%, foreign-born citizens vs 1.0%, US natives, p &lt;0.001), head &amp; neck (8.4% vs 6.2% vs 4.4%, p =0.003), and lung cancers (3.1% vs 4.2% vs 2.8%, p =0.03). Of the1,302,0771 US natives, 105,258 foreign-born citizens, and 21,937 noncitizens who died during the study period, cancer was the primary cause of death for 52% of noncitizens and 62% of foreign-born citizens (vs 44%, p &lt;0.001). Lung cancer was the most common diagnosis in this group, accounting for 40% of cancer deaths among non-citizens (vs 19% vs 13%; p =0.03). Relative to US natives, foreign-born citizens had a significantly lower risk of all-cause (adjusted HR [95%CI], 0.67 [0.54-0.83]) but not cancer-specific mortality (0.94 [0.71-1.23]); no differences in mortality risk among noncitizens were observed. On subset analysis limited to adults with lung cancer, noncitizens had over twice the hazard of cancer death (2.72 [1.22-6.09]) as well as death from any cause (2.14 [1.01-4.55]). While the association with ACM was no longer significant in sequential models, the association remained significant for CSM. Importantly, insurance status attenuated but did not eliminate the risk of lung cancer death for noncitizens (2.63 [1.16-5.96]). Conclusions: Although immigrant noncitizens did not have a significantly greater risk of cancer death overall, those with lung cancer were more than twice as likely to die from their disease, even after adjustment for patient-level variables, including insurance status and having a usual source of care. Future research is warranted to identify root causes and potential points for intervention.

The Colonial Construction of Indian Country: Native American Literatures and Federal Indian Law. By Eric Cheyfitz

The Colonial Construction of Indian Country: Native American Literatures and Federal Indian Law. By Eric Cheyfitz

Addressing the Impacts of Racism on American Indian and Alaska Native Child Health

The legacy of racism toward Native Americans is far-reaching. We will review the topic using the conceptual model of racism as a form of violence as it is inherent in racism, as are prejudice and power. Using the basic frameworks of racism as internalized, interpersonal, institutional, and structural, we will discuss the many types of racism affecting Native Americans today. Racism is the bedrock of generations of trauma experienced in Native communities. The generational/historical trauma of racism has led to epigenetic-level changes affecting Native American people today. We will cover the health impacts of racism and the many institutions built in racist frameworks that continue to perpetuate racism, such as family separation and child removal by child protective services, adverse policing, and disparate incarceration. These allow reflection on policies and the intentionality of racist structures. We will conclude with what can and should be done, particularly as clinicians who work within and adjacent to existing systems of oppression.

Resistance webs: survival and resistance of native american peoples in 'There there' by Tommy Orange

Resistance webs: survival and resistance of native american peoples in 'There there' by Tommy Orange

Rancid rumors or Native wisdom: Evaluating the efficacy of animal fats as insect repellents attributed to historic-period Native Americans.

Little is known about Native American adaptations to blood-sucking arthropods prior to and following European contact. Multiple accounts starting in the 16th century suggest that rancid animal grease was employed by Gulf Coast indigenes as a mosquito repellent. Although many Native American ethnobotanical remedies for biting insects have been recorded, the use of animal products for this purpose is not well documented. Moreover, few traditional Native American mosquito repellents have been examined using controlled laboratory methods for repellency testing. In this study, we tested the repellent efficacy of fats derived from alligator, bear, cod, and shark that were aged to various stages of rancidity. Using yellow fever mosquitoes, (Aedes aegypti), we performed an arm-in-cage assay to measure the complete protection times resulted from these fats, when applied to human skin. We used a Y-tube olfactometer assay to evaluate long-distance repellency and tested tick-repellency in a crawling assay. Our results suggest that rancid animal fats from cod, bear, and alligator are potent albeit short-lived mosquito repellents. We found that both rancid and fresh fats do not repel ticks. Our findings show the validity of traditional ethnozoological knowledge of Native American people and support aspects of the ethnohistorical record.

Indigenous Knowledge for Environmental Conservation: An Ecocritical Approach to Silko’s Ceremony and Gardens in the Dunes

This paper examines the belief systems and ceremonies of the Native American people also known as American Indians or Indigenous tribal groups, exploring how their primitive ritual practices contribute to preserving the environment and maintaining the abundance of nature. The study argues that these people’s traditional wisdom which is based on close observations, one-to-one contact with the environment, and the first-hand experience sharpened over millennia, empowers them to understand the self-regulatory and self-renewal patterns of the natural world and take necessary precautions for environmental sustainability. To prove this argument, the study has undertaken Leslie Mormon Silko’s two major texts Ceremony and Gardens in the Dunes for textual analysis. Using ecocriticism as its theoretical framework, the study has borrowed insights from John Hannigan’s typologies of environmentalism, and Winona LaDuke or Gerald Vizenor’s concept of tribal wisdom. The finding of the study contends that indigenous knowledge plays a vital role in promoting natural balance and social equity. The study concludes that the conservation of natural environment ensures harmony, sustainable agriculture, development, and food security.

The relation between aortic morphology and transcatheter aortic heart valve thrombosis: Particle tracing and platelet activation in larger aortic roots with and without neo-sinus

Transcatheter aortic heart valve thrombosis (THVT) affects long-term valve durability, transvalvular pressure gradient and leaflet mobility. In this study, we conduct high-fidelity fluid–structure interaction simulations to perform Lagrangian particle tracing in a generic model with larger aortic diameters (THVT model) with and without neo-sinus which is compared to a model of unaffected TAVI patients (control model). Platelet activation indices are computed for each particle to assess the risk of thrombus formation induced by high shear stresses followed by flow stagnation. Particle tracing indicates that fewer particles contribute to sinus washout of the THVT model with and without neo-sinus compared to the control model (−34.9%/−34.1%). Stagnating particles in the native sinus of the THVT model show higher platelet activation indices than for the control model (+39.6% without neo-sinus, +45.3% with neo-sinus). Highest activation indices are present for particles stagnating in the neo-sinus of the larger aorta representing THVT patients (+80.2% compared to control).This fluid–structure interaction (FSI) study suggests that larger aortas lead to less efficient sinus washout in combination with higher risk of platelet activation among stagnating particles, especially within the neo-sinus. This could explain (a) a higher occurrence of thrombus formation in transcatheter valves compared to surgical valves without neo-sinus and (b) the neo-sinus as the prevalent region for thrombi in TAV. Pre-procedural identification of larger aortic roots could contribute to better risk assessment of patients and improved selection of a patient-specific anti-coagulation therapy.

Parallels Between Cupping in Traditional Chinese Medicine and Ventosas in Native American Cultures

Parallels Between Cupping in Traditional Chinese Medicine and <i>Ventosas</i> in Native American Cultures

Pharmacognostical Studies on the Leaves of Caesalpinia sappan Linn (Fabaceae)

Botanical medicine, herbalism, and herbal medicine are all terms that describe the same practice. There are many different chemical compounds found in and produced by herb plants that have physiological effects. Traditional herbal medicine is an integral part of the medical systems of all indigenous peoples, including Ayurvedic, naturopathic, homeopathic, traditionally oriental, and native American Indian medicines. The amount and quality of medicinal components determine the medicinal plant’s therapeutic effectiveness. Misidentification is the first step in the unlawful use of plant-based materials or herbal remedies. Pharmacognostical studies of medicinal plants by proper standardization parameters ensures plant identification and authentication. Brazil, or Sappan wood, is a popular name for Caesalpinia sappan Linn., which belongs to the Fabaceae family. In Hindi, it is referred to as Bakam/Patang. The Malay Peninsula, Sri Lanka, India, Myanmar, and Vietnam all have a long history of using the medicinal herb C. sappan Linn. heartwood is beneficial for Pitta, burning feelings, injuries, ulcers, leprosy, dermatological ailments, dysentery, diabetes, loose stool, and more, according to Ayurveda. The tree’s huge, decorative panicles of yellow blossoms are the reason it’s grown in gardens. The plant grows rapidly after being produced from seed. Cultivated throughout every region of tropical Asia, this spreading shrub or tree may reach a height of 10 m. It is native to and exists in the wild in places like the southern part of India, the West Bengal region, Orissa, Madhya Pradesh, Malaya, as well as Sri Lanka. The wood has an especially smooth, uniform appearance, is somewhat massive, and has a strong, orange-red color. Its grain is straight. Branchlets, pubescent and rufous, equipped with tiny prickles. Pinnae are 9 to 14 pairs in number. Leaves are big, hairy to glabrous, and have little prickles at the base and leaflets are subsessile, oblong, membranous, and obliquely truncate, with 10 to 20 pairs per pinna. Primarily, it promotes blood flow and acts as an analgesic, emmenagogue, hemostatic, and anti-inflammatory in traditional Chinese medicine for traumatic diseases. One of the ingredients of the world-famous Indian toothpaste and powder Vicco-Vajradanti is the wood of the C. sappan Linn Tree. Some research suggests that C. sappan Linn. may have antidiabetic effects. The flavonoid of C. sappan Linn. wood extract is protosappanin, Brazilin, and gallic acid compounds. Brazilin has a mechanism of action to increase the production of fructose 2,6 bisphosphate and hexose six phosphate. Fructose 2,6 bisphosphate in the metabolic process has a role in regulating glycolysis and gluconeogenesis in the liver. Increased fructose 2,6 bisphosphate in a state of hyperglycemia will stimulate the process of glucose breakdown (glycolysis) by activating phosphofructokinase 1 intended for the purpose of can be a reduction in blood glucose levels in body. This paper deals with the morphological studies and microscopical studies carried out on the leaves of C. sappan Linn according to the World Health Organization (WHO) accepted parameter for the identification of medicinal plants. For a better understanding of structure, zooming in using a Zeiss Axio Cam Erc5s digital camera and a Nikon ECLIPSE-E200 trinocular microscope under strong field lighting also employed.

Identifying modifiable risk factors to improve immigrant breast cancer screening in the United States.

1530 Background: Despite marked reductions in breast cancer mortality since 1990, recent data suggest that progress has slowed—owing in part to plateaus in breast cancer screening in underserved populations. Historically low rates of screening coupled with rising breast cancer incidence make immigrants an important population for targeted intervention. Herein, we (1) compare contemporary rates of breast cancer screening among immigrants versus US natives; and (2) identify modifiable risk factors to inform the development of interventions to improve screening among immigrants in the United States. Methods: Using data from the 2019 and 2021 National Health Interview Surveys, screening eligible female participants (ages 40-79 years old) were identified, then classified by immigrant status as defined by nativity (US native vs. foreign-born). Primary outcome was receipt of screening mammogram in the last two years. Logistic regression models examined associations between immigrant status and mammography, with and without adjustments for age, metropolitan residence, overall health status, and survey year. Sequential analysis was then used to assess the degree to which modifiable social risk factors influence the magnitude of the association between immigrant status and mammography. Results: Of 20,090 female participants included in the study, 20% were immigrants. Compared to US natives, immigrants were less likely to have received a mammogram in the last two years (67% vs. 72%, aOR [95%CI], 0.87 [0.78-0.96], p=0.006)—an effect that was most pronounced among immigrant noncitizens (57%; 0.55 [0.47-0.64], p&lt;0.001) but reversed among immigrants with US citizenship (74%; 1.14 [1.01-1.29], p=0.03). Of the factors assessed, having a usual source of care (5.73 [4.77-6.87]) or insurance (4.60 [3.74-5.67]) was associated with the greatest odds of biennial mammography, followed by educational attainment (1.38 [1.19-1.60]) and employment (1.19 [1.09-1.30]; all p&lt;0.001). While having a usual source of care or employment attenuated—but did not eliminate—the association between immigrant status and mammography (0.87 [0.78-0.96], p=0.01 and 0.89 [0.80-0.99], p=0.03, respectively), this finding was not observed upon inclusion of insurance status or education in sequential models (0.97 [0.87-1.09], p=0.6 and 1.09 [0.96-1.21], p=0.13, respectively). With respect to insurance type, Medicare Advantage (4.60 [3.74-5.67]) conferred the largest benefit, followed by private insurance (4.54 [4.00-5.26]), Medicaid (2.63 [2.20-3.14]), and Medicare (4.39 [3.53-5.46]; all p&lt;0.001). Conclusions: Breast cancer screening remains low in noncitizen immigrant populations. Targeted interventions to improve access to health insurance coverage and primary care for noncitizens may be most effective for improving rates of screening mammography among immigrants and thus warrant further investigation.

Sociodemographic differences in suicide/intentional self-harm among cancer survivors versus the general United States population.

11097 Background: Suicide is a national public health crisis, and one of the leading causes of death in the United States. Worse yet, the suicide mortality rate is at least double among cancer survivors compared to the general population. Suicide rates vary across the population, but it is unclear how sociodemographic factors explain differences in suicide rates among cancer survivors versus the general United States population. Methods: We analyzed two sets of population-based data. First, we retrieved suicide/self-harm mortality rates for the general population from the National Vital Statistics System. Next, we accessed cancer case data from the Surveillance, Epidemiology, End Results (SEER) program to estimate number of deaths due to suicide/self-harm among cancer patients, per 100,000 persons, with a 95% confidence interval. All analyses were restricted to contiguous states with full state representation in SEER (CA, CT, GA, ID, IA, KY, LA, NJ, NM, NY, TX, UT). We then compared subgroup differences by sex, race/ethnicity, age, and state. Results: In 2020, there were 15,813 deaths in the general population (12.1 suicide/100,000 persons; 95% CI: 11.9, 12.3), and 1,127 among cancer survivors (22.1 suicide/100,000 persons; 95% CI: 22.0, 22.1) due to suicide/intentional self-harm. Among racial/ethnic groups, the largest difference was found in the non-Hispanic White cancer survivors, with 10.4 more suicide/100,000 persons vs. White individuals in the general population. In contrast, two racial minority groups had higher suicide mortality rate in the general population vs. cancer survivors: Non-Hispanic Black individuals (general population = 7.4 suicide/100,000 persons vs cancer survivors = 6.9 suicide/100,000 persons), and Native American Indian (general population = 16.6 suicide/100,000 persons vs. cancer survivors = 11.3 suicide/100,000 persons). Among females, suicide mortality rate was slightly higher by 1.3 suicide/100,000 persons in cancer survivors vs. general population, and much higher among male cancer survivors vs. general population (19.9 suicide/100,000 persons more). For age groups, the lowest difference in suicide mortality between cancer survivors vs. general population was in the 65-84 age group (5.1 more suicide/100,000 persons). Across all other age groups, suicide rates were 11.9 to 14.4 higher in cancer survivors vs. the general population. Across the 12 states in our analysis, the smallest difference was in Iowa (1.9 more suicide/100,000 persons), and the largest difference was in Idaho (27.0 more suicide/100,000 persons). Conclusions: In most subgroups, people diagnosed with cancer appear to be at greater risk of death from suicide/intentional self-harm than the general population. As the number of people living with cancer continues to grow, policies increasing the quality of life for cancer patients are warranted.

Anatomical and demographic prognosticators of pancreatic cancer.

e16310 Background: Pancreatic cancer is known to have one of the poorest median of survival (mOS) of all cancers. It is now the third leading cause of cancer-related mortality after lung &amp; colorectal cancer. With the current trends, understanding &amp; knowing prognosticators can aid in determining outcomes of pancreatic cancer. Methods: The data was collected from Surveillance, Epidemiology and End Result database Research Plus Data, 17 Registries, Nov 2022 Sub (2000-2020). We extracted pancreatic cancer cases based on primary site encoding for head, body &amp; tail of pancreas, Islets of Langerhans (IoL), other specified parts &amp; overlapping lesion of pancreas, pancreas, NOS (no other specific). The analysis was further completed by comparing survival using the Log-rank test (GraphPad Prism). Results: A total of 221,304 cases were extracted between 2000-2020. The median age of diagnosis was 71 years. 50.54% were males, &amp; 49.45% were females. The incidence rates are shown below. Whites (69.99%) were commonly affected, followed by Blacks (11.05%), Hispanics (10.79%), Asians &amp; Pacific islanders (7.41%), Alaskan natives &amp; American-Indians (0.57%). A distribution in anatomy was notable for head of the pancreas (46.00%), followed by tail (13.20%), body (11.34%), pancreatic duct (0.49%), IoL (0.10%). A survival curves were compared on different variables. Gender showed no statistical difference. mOS for patients diagnosed &gt;70 years was 3 months &amp; &lt;70 years was 8 months (p value &lt;0.0001, CI 0.3716 to 0.3784, HR 1.731). mOS for calculated for Whites (5), Blacks (4), Asian &amp; Pacific islanders (6), Alaskan natives &amp; American-Indians (4), &amp; hispanics (5) (p value &lt;0.0001). mOS based on involved parts of pancreas were compared for: head (6), body (6), tail (5), pancreatic duct (8), IoL (59) (p &lt;0.0001). Conclusions: Median age of diagnosis was in 71, with a slight male predilection. Overall incidence rate is trending up. It is significantly higher for males, &amp; is significantly lower for females than that of the general population. Whites are most commonly affected, &amp; Alaskan natives &amp; American natives are rarely affected. Survival is significantly greater if diagnosed &lt;70 years. Most common site involved is the head of pancreas, &amp; the least is IoL. mOS is ~10 times greater for IoL, but it's an endocrine pancreatic cancer which is treated differently. From the exocrine pancreas, survival is the best for pancreatic duct cancer, &amp; the worst for pancreatic duct. If anatomic &amp; demographic prognosticators are combined with molecular, radiologic factors, it can be beneficial in predicting the outcomes of this cancer with poor prognosis. [Table: see text]

An Analysis of Disparities and Political Implications in Native American Healthcare

For centuries, an agenda of colonialist-driven politics has left the Native American community alienated from society. Generally stemming from the negligent political values pushed by the United States government, multiple external factors have left Native Americans with a fraction of the prosperity and unity that they once held. Through a series of statistical and holistic analyses of Native American culture and population levels over the years, it has become evident that the lack of attention and support from publicly funded institutions has increased Native vulnerability to a world of rising health threats. In addition to an already meager amount of financial support, organizations directed at helping Natives are met with stubborn governmental legislation that has refused to create the substantial change necessary to modernize a failing system. As such, even though recent advancements have been made and new establishments are on the rise, the most prominent issue regards the government’s unwillingness to expand and create meaningful change. With these issues in mind, this analysis of health disparities impacting the Native American community provides support for the argument that the United States Federal Government must take more action towards making reparations for its past mistakes, in addition to providing the basis for a healthcare system that American Indians can rely on.

Electrocardiographic characteristics and catheter ablation of premature ventricular complex- mediated ventricular fibrillation

Abstract Background Premature ventricular contractions (PVCs) can trigger ventricular fibrillation (VF) in patients with/or without structural heart disease. There are limited data on coexisting electrocardiographic (ECG) features and catheter ablation outcomes in these patients which could suggest the concomitant presence of an abnormal electrical and structural substrate. Purpose We investigated ECG and electroanatomic characteristics and clinical outcomes in patents who underwent catheter ablation of PVCs triggering VF. Methods We analyzed data from a consecutive series of patients who underwent catheter ablation between 08/2019 and 04/2023 for PVCs triggering VF. On the 12-lead ECG, we assessed the following abnormalities: (a) Early repolarization (ER) pattern in either inferior or lateral leads (Figure 1), or (b) QRS Notching of either the native sinus beat or PVC (Figure 2). Post-ablation follow up outcomes were collected using a combination of ICD interrogation, remote transmission and clinical follow up. Results The cohort included 15 patients: age 52.1±16.8 years, 46.7% females, and 26.7% presenting with VF storm. On average, there were 3.8 HV shocks/per patient from an ICD prior to the index ablation procedure (range: 0-19 shocks). On the 12-lead ECG, the mean coupling interval of the PVC leading to VF was 204±82 ms, and an overall narrow PVC morphology with a mean QRS duration of 107±17 ms. We observed early repolarization (ER) in 6 (40%) of the cohort. In most patients (n=11; 73.3%), at least one of the 2 ECG abnormalities were present. An endocardial-only approach was adequate in all patients, and during catheter ablation, Purkinje potentials were targeted in 10 (66%) of the patients. Based on activation and pace-mapping, the PVCs were localized to the following sites: (a) left ventricular (LV) septum in 11 (73.3%), (b) papillary muscles in 2 (13.3%), and (c) other sites such as the Moderator band and right ventricular outflow tract in the remaining 2 (13.3%) patients. The ablation locations on the LV septum extended from basal to mid-septum. After an average of 1.7 ablation procedures targeting PVC-triggering VF, 12 (80%) patients remained free of sustained ventricular arrhythmias and ICD shocks, over a mean follow up of 479±395 days. Conclusion In most patients with PVCs-triggering VF, there was an evidence of an ECG abnormality either in the form of an ER pattern or notching of either the Sinus QRS or the PVC complex on pre-ablation ECG. During ablation, Purkinje potentials and PVCs were mapped to and ablated in the region of the LV interventricular septum and papillary muscles. Over long-term follow up, catheter ablation seemed durable and effective in reducing VF episodes and ICD shocks.Presence of Early Repolarization patternPresence of a notching pattern in the Si

Cultural Parallels and Unique Features Kyrgyz and Native Americans: Comparative Analysis

This paper examines the cultural parallels and unique features of Kyrgyz people and Native Americans, shedding light on the remarkable similarities and differences that define these two distinct indigenous groups. Using an interdisciplinary approach, this study examines the historical, social, and cultural aspects of both Native Americans and Kyrgyz, seeking to unravel the complexity of their traditions, beliefs, and practices. The study reveals striking parallels between spiritual beliefs and reverence for nature that are deeply rooted in both cultures. The symbolic significance of animals, the spiritual connection to the earth, and the practice of traditional healing techniques reflect a shared appreciation of the natural world and a harmonious relationship with the environment. Moreover, oral traditions and stories from both groups serve as vital channels for preserving cultural heritage and passing ancestral wisdom from one generation to the next. On the other hand, the unique traits of each culture are revealed through the study of their artistic expressions, linguistic diversity and social structures. The nomadic heritage of the Kyrgyz has shaped their customs and folklore, while the diverse linguistic traditions and artistic skills of Native American tribes demonstrate the richness of their cultural traditions. In addition, the impact of historical and contemporary influences on both groups is examined to elucidate the resilience and adaptation of their cultural identities. The enduring legacy of colonialism and the persistence of indigenous knowledge in the face of contemporary challenges provide a critical backdrop for understanding the dynamic nature of Native American and Kyrgyz cultures. By contrasting these cultural characteristics, this comparative analysis aims to foster a deeper understanding of the interconnectedness of global indigenous communities while respecting the distinctiveness of their heritage. Ultimately, this study aims to stimulate intercultural dialogue and promote mutual understanding by highlighting the richness of human diversity and the enduring spirit of resilience of indigenous peoples.

Native americans in the stories of Sherman Alexie

In the XX century of American Literature the themes, new characters, new directions and genres could be observed in the novels, stories and poems. In their scholarly articles literary critics analyzed the multicultural dimension in the literature of this period as the country had raised a new generation of immigrants, who were writing about their national identities in American society. Thus XX century American literature could be considered as multicultural literature that depicted the life of new generation of people who belong to various cultures but who grew up and were educated in modern American society. In its turn this multiculturalism caused the development of different nations studies that examined this aspect of literature. Examples are Chinese, Japanese, Taiwanese and Mexican literary studies. Similarly, there is also Native American literature that studies creative works written by a new generation of Native American Indians. Representatives of Native American Literature raised several issues that young generation of native Americans are facing in American society. This paper deals with the stories of the Native American writer Sherman Alexie, whose works depict life, interests and problems of modern native Americans.