Northeastern United States Research Articles

Trend of immunization & gap in vaccine doses as observed in National Family Health Survey rounds in India

Background & objectives Immunization is an efficient and cost-effective way of lowering the infectious disease related morbidity and mortality in the community. The current study reviewed the trend of immunization, gaps in doses of vaccine given at the same time and gaps between the doses of same vaccine from National Family Health Survey (NFHS 1-5) rounds. Methods The current study extracted data from all five NFHS rounds conducted from 1992-93 to 2019-21. The study analyzed the State-wise and demography-wise distribution of trends of immunization from NFHS-1 to NFHS-5. State wise distribution of change in vaccination coverage between NFHS-4 and 5 was analyzed. The study also assessed the State-wise trends of fully vaccinated and unvaccinated children from NFHS 1-5. Results The northeastern States had maximum gap between the vaccination given at birth i.e., 47.3 per cent between BCG and Hepatitis B, and 32.8 per cent between BCG and birth dose of OPV in Manipur in NFHS -5. A gradual rise in the percentage of male (40.2%) and female (41.9%) childrens’ vaccination was found across the NFHS rounds with reduction in gap between the male and female vaccination from NFHS-1 (2.6%) to NFHS-5 (0.9%). The percentage of vaccination decreased proportionately with birth order. The vaccination coverage has increased in both urban and rural population, but the rise was higher in rural (45.9%) areas than urban (24.8%). An increase in percentage of fully vaccinated children by 41.2 per cent and decrease in percentage of non-vaccinated children by 26.4 per cent was observed from NFHS-1 to NFHS-5. Interpretation & conclusions Our analysis clearly suggests that immunization coverage has improved over a period of time but the variability in vaccine coverage across States and gap in vaccine doses needs attention of the policy makers to cover this for achieving our national immunization goals.

Situational diagnosis of basic sanitation planning in the upper west region of Rio Grande do Norte

This article examines the development and implementation of Municipal Basic Sanitation Plans (PMSB) in the Upper West Region of the Brazilian Northeastern state of Rio Grande do Norte. The investigation reveals that, despite the legal requirement for PMSB, many municipalities encounter significant challenges, including a dearth of trained personnel and financial resources, insufficient public engagement, and the absence of a unified information system for basic sanitation policy. Moreover, the lack of budget provisions for executing the actions outlined in the plans was identified as a critical issue. The article concludes that it is essential to fortify planning processes, ensure public participation, furnish the requisite technical and financial capacity, integrate basic sanitation actions into municipal budgetary frameworks, and address the political disarticulation of small municipalities.

The Lived Experiences of Telemedicine Intensive Care Unit Nurses.

Although nurses are the primary clinicians in telemedicine intensive care units (tele-ICUs), their experiences remain underresearched. To describe and interpret the lived experiences of tele-ICU nurses. A qualitative, hermeneutical, phenomenological approach based on van Manen's methodology was used to collect and interpret interview data. In-depth interviews were conducted with 11 tele-ICU nurses affiliated with a health system in the northeastern United States. The interviews were intended to elicit direct reports of specific incidents to capture the phenomenological experience. Field observations of the practice setting were conducted to enhance data richness. The participants were primarily female, aged 34 to 67 years, with 11 to 45 years of nursing experience. The following 4 major themes and 12 subthemes were identified: (1) watching intensively and panoptically, with subthemes (a) affirming unremitting diligence, (b) uncovering virtual knowing, and (c) easing perceptions of intrusion; (2) transcending complex boundaries, with subthemes (a) building trustful collaboration, (b) discerning vigilant interventions, and (c) exercising skillful investigation; (3) transforming nursing practice, with subthemes (a) mastering tact, (b) delineating the critical wholeness, and (c) augmenting safety and quality of care; and (4) developing an e-identity, with subthemes (a) tempering feelings of working in shadows, (b) evolving to the enhanced specialist role, and (c) achieving professional gratification. Tele-ICU nurses play a transformative role in nursing practice. These findings have implications for nursing practice, education, health policy, enhancement of the current American Association of Critical-Care Nurses (AACN) Tele-ICU Nursing Practice Model, and future research on ICU telemedicine.

How to build a powerline: Fast policies for decarbonization, the slow work of public participation, and the profitability of energy capital

Community opposition to new low-carbon energy infrastructure – and resulting project delays and cancellations – is increasingly taken by some climate activists, policymakers, and scholars as evidence of the incompatibility between urgent decarbonization and expanded public participation. This paper argues that too narrow a focus on this duality risks overlooking an additional mandate: the profitability of energy capital. This paper intervenes in the ‘rapid vs. just transitions’ debate by arguing that building low-carbon energy infrastructure requires a balancing of trade-offs between speed, local support, and profit for private developers. Using a case study of a controversial transmission project in the northeastern United States, I argue that project delays are attributable not (just) to uncooperative publics, but to energy capital's drive for profit, which discourages compromises with host communities that would increase project costs but cultivate local support. By treating the social legitimacy of low-carbon energy infrastructure as contingent on its ability to meet criteria for public acceptability, this paper argues that the slow work of public participation can in fact be the route to ‘fast policies’ for decarbonization when it fosters developer norms in line with community expectations for projects.

“You always worry about what other people think”: Experiences of antitrans stigma among trans youth and their siblings in the Northeastern United States.

“You always worry about what other people think”: Experiences of antitrans stigma among trans youth and their siblings in the Northeastern United States.

Moths versus Bees: Contrasts in Habitat Preferences Across Barrens of the Northeastern USA.

Bees and moths are globally important pollinators. Xeric barrens in the largely mesic northeastern USA support high levels of pollinator diversity, including rare bees and moths. We investigated the response of bee vs. moth communities to abiotic and vegetation drivers in barrens across the region. We sampled local environmental conditions, vegetation, bees, and moths for 2-4 years in 19 preserves. Employing random forest analysis, we tested the role of 29 abiotic and vegetation predictors of bee vs. moth abundance, species richness, Shannon-Wiener Index, evenness, and species composition. Variables related to climate, canopy cover, and soils were the most important predictors of abundance, diversity, and species composition for both bees and moths. Vegetation variables, such as species richness of shrubs and hostplants, were also important for bees. The direction of these relationships contrasted sharply between bees and moths: bees were more abundant and species rich in more open, sandy sites and moths the opposite. Habitat preferences for a subset of moth xeric specialists were much more similar to bees than to other moths, with a preference for open, sandy conditions. Contrasts between bees and moths in habitat preferences likely stemmed from differences in their life histories: bees rely on flowers for feeding and porous substrates for nesting, whereas most moth adults feed on flowers, but many moth caterpillars use woody plants as hosts. In sharp contrast to the results for abundance and richness, bees and moths responded similarly for the Shannon-Wiener Index, which raises important general questions about the conservation value of these two metrics. Our results suggest that, because of differences in habitat preferences among pollinators, barrens management for both open and more closed habitats is likely to promote the highest abundance and diversity of local bee and moth pollinator communities jointly.

Medical Decision-Making and Bereavement Experiences After Cardiac Arrest: Qualitative Insights From Surrogates.

Surrogates of incapacitated patients in the intensive care unit (ICU) face decisions related to life-sustaining treatments. Decisional conflict is understudied. To compare experiences of ICU surrogates by reported level of decisional conflict related to treatment decisions after a patient's cardiac arrest preceding death. Convergent mixed methods were used. Bereaved surrogates recruited from a single northeastern US academic medical center completed surveys including the low-literacy Decisional Conflict Scale (moderate-to-high cut point >25) and individual interviews about 1 month after the patient's death. Interview data were analyzed by directed and conventional content analysis. Surrogates were stratified by median total survey score, and interview findings were compared by decisional conflict level. Of 16 surrogates, 7 reported some decisional conflict (median survey score, 0; range, 0-25). About two-thirds decided to withdraw treatments. Three themes emerged from interviews: 2 reflecting decision-making experiences ("the ultimate act"; "the legacy of clinician communication") and 1 reflecting bereavement experiences ("I wish there was a handbook"). Surrogates reporting decisional conflict included those who first pursued but later withdrew treatments after a patient's in-hospital cardiac arrest. Surrogates with decisional conflict described suboptimal support, poor medical understanding, and lack of clarity about patients' treatment preferences. These findings provide insight into bereaved ICU surrogates' experiences. The low overall survey scores may reflect retrospective measurement. Surrogates who pursued treatment were underrepresented. Novel approaches to support bereaved surrogates are warranted.

Production economics and carbon footprint of an integrated timber harvesting operation in the Northeastern US

Woody biomass has tremendous potential to reduce the reliance on non-renewable energy, however, the high cost, uncertain harvesting carbon footprint, and policies may hinder it from becoming a predominant component of the US renewable energy sector, particularly in the Northeast. The objectives of this study were to a) assess productivity (m3 PMH−1) and cost ($ m−3) of a stump-to-truck integrated timber harvesting operation; b) identify and evaluate major factors affecting operational productivity and cost; and c) quantify carbon footprint of the harvesting operation. Detailed time and motion studies were conducted in a softwood dominated forest stand in upstate New York, during the summer of 2021. Stump-to-truck life cycle assessment (LCA) of roundwood harvesting and wood chips production was quantified using USLCI and US-EI 2.2 databases and TRACI method in Simapro 9.3.0.3 software. The functional units were 1 m3 of green roundwood (50 % moisture content) and 1 tonne of green wood chips (moisture content 50 %). The results showed that the harvesting cost was $12.98 m−3 and $7.40 tonne−1 for roundwood and wood chips, respectively. Grapple skidder had the lowest productivity (m3 PMH−1) and the highest carbon footprint. The carbon footprint of stump-to-truck timber harvesting operation accounted for 0.726 kg CO2 eq m−3 and 0.818 kg CO2 eq tonne−1 for roundwood and wood chips, respectively. The chipping cost was $7.40 tonne−1. The harvesting cost decreased by 4.5 % when self-loading truck was used instead of a loader. Estimating operating cost and carbon footprint of integrated timber harvesting operations is essential to promote the forest residues as a major contributor of bioenergy in the changing scenarios of climate.

Understanding the impact of COVID-19 on yoga instruction: Examining teaching methodology, class components, and injury patterns in the Northeastern US

ObjectivesThis study aimed to examine the impact of COVID-19 on the perspectives of yoga instructors (YIs) regarding teaching methodology, class components, and yoga-related injuries among their clients DesignA cross-sectional design in this study. SettingA total of 407 YIs from Northeastern United States completed a customized, web-based survey. Main outcome measuresChi-square tests were carried out to determine changes in yoga teaching format before and during the pandemic, as well as the counts of yoga related injuries between face-to-face (FtoF) and online teaching format. Independent t tests were used to compare the characteristics of yoga teaching elements. ResultsDuring the pandemic, 47 % of YIs adopted online teaching, followed by a mixed (45.9 %) format and FtoF (7.1 %) instruction. Both online and FtoF classes showed similar trends, with most reporting class sizes of 4–6, followed by 7–9 and then 1–3 students. Regardless of the teaching format, most YIs performed sun salutations and practiced mixed yoga styles. Among the YIs teaching yoga online, 84.6 % expressed their willingness to continue offering online classes post-pandemic and perceived the quality of online yoga teaching as high. Importantly, the number of injuries was low, and there were no significant differences in injury counts between FtoF (3.6 %) and online (4.2 %) teaching formats (p > 0.05). The most common injury in all forms of teaching yoga was a sprain/strain (42.9 %). ConclusionsThese findings could inform the development of research studies to examine the long-term feasibility and effectiveness of delivering online yoga since short-term benefits, safety, and YI acceptance appear favorable.

A Feasibility Randomized Controlled Trial of the Toolkit for Optimal Recovery after Concussion: A Live Video Program to Prevent Persistent Concussion Symptoms in Young Adults with Anxiety

ObjectivesTo assess the feasibility of the Toolkit for Optimal Recovery after Concussion (TOR-C), the first mind-body program aiming to prevent persistent concussion symptoms among young adults with anxiety, and an active control (Health Enhancement after Concussion; HE-C). We also tested preliminary improvements in outcome measures and putative mechanistic targets. DesignSingle-blind, 2-arm, randomized controlled trial.Setting: Academic medical center in the US Northeast. ParticipantsFifty young adults (ages 18-35) with a recent concussion (3-10 weeks prior) and anxiety (≥5 on the GAD7 questionnaire). InterventionsBoth interventions consisted of four 45-minute 1:1 sessions with a clinician over Zoom. TOR-C (n=25) taught mind-body, cognitive-behavioral, and return-to-activity skills. HE-C (n=25) taught health education (e.g., sleep, nutrition) without skills. Main Outcome MeasuresPrimary: feasibility outcomes (e.g., recruitment, credibility, expectancy, acceptability, safety, feasibility of assessments, fidelity, satisfaction, TOR-C homework adherence) with a-priori-set benchmarks. Secondary: intervention outcomes were concussion symptoms (PCSS), physical function (WHODAS), anxiety (GAD7/HAD-A), depression (HADS-D) and pain (NRS). TOR-C mechanistic targets were pain catastrophizing (PCS), mindfulness (CAMS-R), fear avoidance (FAB-TBI), limiting behavior and all-or-nothing behavior (BRIQ). ResultsBoth interventions met all feasibility benchmarks and were associated with significant improvements in outcomes (concussion symptoms, physical function, anxiety, depression and pain; d=0.44-1.21) and TOR-C mechanistic targets (pain catastrophizing, mindfulness, fear-avoidance, and limiting behavior; Cohen's d=0.41-1.24). Improvements in all-or-nothing behavior were only significant in TOR-C (d=0.52). Improvements in all mechanistic targets except all-or-nothing behavior following TOR-C were significantly associated with improvements in at least one outcome. ConclusionFindings provide strong support for the feasibility of TOR-C and HE-C, and preliminary evidence for improvements in mechanistic targets and outcomes. Findings inform a future fully-powered RCT testing efficacy of TOR-C vs. HE-C.

The Anticolonial Turn in Journalism and the Media in Pre-Independence India: How Newspaper Coverage by Foreign and Indian Newspapers of the Champaran, Dandi, and Dharasana Movements Made Gandhi a Household Name

ABSTRACT This article argues that the role played by the print media in India’s anticolonial struggle was a pivotal point of departure in the episteme of postcolonial histories—one that provided an impetus and guiding light to similar struggles worldwide, a position often ignored by Eurocentric academia studying media historiographies. It is based on extensive reviews of newspaper archives from the northeastern and northwestern states of Bihar and Gujarat in India, as well as archival review of the British press, and it outlines the coverage of Gandhi’s interventions in the two states that ultimately resulted in nationwide mobilization. The authors argue that the journalistic tradition of anti-colonial protest that developed in India provided an impetus to the advancement of anticolonial sentiments and the movement as a whole. This was supplemented in some measure by the more radical members of the British press, while the mainstream British press remained committed to the colonial project.

Molecular characterization of Hepatitis C Virus (HCV) from hospitalised cases of hepatitis in six northeastern states of India

Molecular characterization of Hepatitis C Virus (HCV) from hospitalised cases of hepatitis in six northeastern states of India

Short-Term Outcomes of a Healthy Relationship Intervention for the Prevention of Sexual Harassment and Sexual Assault in the US Military: Pilot Pretest-Postest Study.

Sexual harassment (SH) and sexual assault (SA) are serious public health problems among US service members. Few SH and SA prevention interventions have been developed exclusively for the military. Code of Respect (X-CoRe) is an innovative web-based, multilevel, SA and SH intervention designed exclusively for the active-duty Air Force. The program's goal is to increase Airmen's knowledge and skills to build and maintain respectful relationships, ultimately reducing SH and SA and enhancing Airmen's overall well-being and mission readiness. This pilot study aimed to assess the short-term psychosocial impact (eg, knowledge, attitudes, and self-efficacy) of the web-based component of X-CoRe on a sample of junior enlisted and midlevel Airmen. Airmen from a military installation located in the Northeastern United States were recruited to complete the 10 web-based modules in X-CoRe (9/15, 60% male; 7/15, 54% aged 30-35 years). Participants were given pretests and posttests to measure short-term psychosocial outcomes associated with SH and SA. Descriptive statistics and paired 2-tailed t tests were conducted to assess differences from preintervention to postintervention time points. After completing X-CoRe, participants had a significantly greater understanding of active consent (P=.04), confidence in their healthy relationship skills (P=.045), and confidence to intervene as bystanders (P=.01). Although not statistically significant (P>.05), mean scores in attitudes about SH, couple violence, and cyberbullying; perceptions of sexual misconduct as part of military life; and relationship skills self-efficacy with a romantic partner and friend also improved. The findings from this study demonstrate X-CoRe's effectiveness in improving critical determinants of SH and SA, making it a promising intervention for SH and SA prevention. More rigorous research is needed to determine X-CoRe's impact on SH and SA victimization and the long-term impact on associated psychosocial determinants.

Assessment of relationship between emotional intelligence and conflict resolution among nurse managers at tertiary Health Institutions of North Eastern States of Nigeria

Conflict in health care settings may be effectively managed if nurse managers possess conflict management skills such as reconciliation, listening, and effective communication to bring individuals closer and work together to find fair solutions and meet balanced needs. The study aimed at identifying the relationship between emotional intelligence and conflict resolution among nurse managers at tertiary Health Facilities, in the Northern States of Nigeria. The objectives of the study are to assess the level of emotional intelligence among nurse managers, also to identify the most common types of conflict, determine the causes of conflict, determine the conflict resolution strategies applied by the nurse managers and to identify relationship between emotional intelligence and conflict resolution among nurse managers in tertiary health institutions of North Eastern States. A mixed methods research design (quantitative and qualitative methods) was used. A total of 188 nurse managers and three Head Nursing Services departments formed the sample size. The nurse managers were given structured questionnaires and the Head of the Nursing Services department was interviewed (key informant interview). Three instruments were employed for data collection; Interview Guide, Structured Questionnaire and Participants Demographics Sheet. A simple random sampling technique was used for the study. The obtained data were coded and computed in an SPSS Version 26 and analyzed using percentages, mean and standard deviation for descriptive statistics while the Pearson Correlation Coefficient was used for the inferential statistics. The result of the study revealed that most of the nurse managers have a fair level of emotional intelligence when dealing with conflict among nurse managers. It also revealed that the most common type of conflict among nurses was related to environmental factors. The working environment was the highest cause of conflict among nurses. Social skill strategy was mostly used in conflict resolution. The study revealed that there was no significant relationship between years of experience and conflict resolution r=0.173. Based on the findings the researcher concluded that most of the respondents highly make use of social awareness in the application of emotional intelligence in conflict resolution, most of the causes of conflict among nurses were related to a working environment, and social skills were mostly used in conflict resolution among nurses. Based on the findings of the study, the researcher recommended that other sources of conflict management should be identified for nurse managers to manage conflict, nurse managers should use the skills they have to solve problems and conflict management to be part of a school of nursing curriculum.

Self-reported health effects from wildfire smoke: A cross-sectional study in New York State

Abstract Background Wildfires and exposure to wildfire smoke (WFS) are forecasted to increase, in part driven by climate change. As witnessed in 2023, regions in Europe and North America are facing more sustained periods of poor air quality due to WFS. Growing evidence suggests average daily WFS correlates with morbidity and mortality, but the impact of prolonged WFS exposure remains understudied, especially in areas where WFS is a newer occurrence. We examine associations between consecutive days of WFS experienced and self-reported health symptoms in the northeastern United States. Methods This retrospective cross-sectional study explored New York State (NYS) residents’ experience with WFS in summer 2023 via an online survey. Participants reported the longest period of consecutive WFS days and symptoms experienced. Log-binomial regression models estimated prevalence ratios (PR) and 95% confidence intervals (CI). Results 553 NYS residents were included, representing a healthy, primarily female and White population, ranging from 18 to 86 years. 549 (99.3%) reported experiencing WFS, with the longest period of consecutive WFS days varying (≤3 days: n = 152; 4 to 6 days: n = 255; ≥7 days: n = 146). 490 (88.6%) reported ≥1 health symptom, with itchy/watery eyes, sore throat, and headache as the most frequent. Compared to ≤ 3 consecutive WFS days, symptom prevalence was 9.1% higher for those reporting 4 to 6 days (PR [95% CI]:1.09 [1.00, 1.19]) and 16.7% higher for ≥7 days (1.17 [1.07, 1.27]). The trend of increased symptom prevalence with longer WFS periods persisted and was pronounced for specific symptoms. Control for potential confounders did not appreciably change estimates. Conclusions Our findings suggest longer sustained WFS exposure associates with higher symptom prevalence, which may be precursors to more serious health conditions. As global populations face more WFS with climate change, public health professionals should prioritize strategies to mitigate prolonged exposure. Key messages • In a convenience sample of 553 primarily healthy New York State residents, 99.3% reported experiencing wildfire smoke and 88.6% reported at least 1 symptom of poor health during summer 2023. • Associations between consecutive days of wildfire smoke experienced and prevalence of any and specific symptoms tended to vary in a dose-response manner.

An analysis of observed and predicted extreme heat and precipitation trends across four pulse producing regions in North America: North Dakota, Montana, Saskatchewan, and Northeastern United States

Abstract The consumption of plant-based proteins in leu of animal proteins is the most important dietary shift that would be needed to keep the world under 2 C of warming, and this shift would require a dramatic increase in the percentage of cropland devoted to nuts and pulses (Peters et al. 2016). As the demand for plant-based proteins, like pulse crops, continues to grow, it is critical to understand the impact of climate change on crop production. In this paper, we study two climate-related stressors for pulse production in North America: extreme heat and excess moisture during harvest. Pulses must be dried on the plant before harvest, requiring a 7-day dry spell before harvest or the use of Roundup (glyphosate) to kill the plants quickly. However, little is known about the changes in frequency of hot extremes or dry spells during harvest in pulse-growing regions. We analyze climate trends using the Unprecedented Simulated Extreme Ensemble (UNSEEN) method and an analysis of the Coupled Model Intercomparison Project (CMIP6) in four pulse growing regions across North America: Montana, North Dakota, Saskatchewan, and the Northeast USA. We find that temperature extremes have increased in all regions, with extreme events 3-4 times more likely today than in 1981, increasing the risk of crop loss. August and September rainfall during the harvest months has been decreasing in the Midwestern regions and it is projected to continue to decrease in the future; however, the likelihood of a wet August in the Northeast has nearly doubled. Even with this drying trend, farmers cannot assume that they will have a 7-day consecutive dry spell that would enable natural drying of pulses without synthetic drying agents like glyphosate. Future expansion of pulse production should incorporate adaptation measures to manage extreme heat and the potential for rain events during harvest.

Co-designing a Children’s Cabinet: a school district–university partnership for youth well-being post-pandemic

PurposeThis paper presents a case study of a school district–university partnership to co-design a Children’s Cabinet, a cross-sector initiative bringing together institutional and community leaders to address youth well-being in the aftermath of the COVID-19 pandemic. In a vibrant, immigrant-serving community in the Northeast United States, the partnership was initiated by district leaders in Spring 2021 after pandemic disruptions led to a youth mental health crisis.Design/methodology/approachOur descriptive, qualitative case study focuses on the structure and emerging design principles of the research–practice partnership, which established a Children’s Cabinet comprised of educational, government and community leaders along with researchers. From Spring 2021 through Spring 2024, we collected and analyzed member and youth interviews, ethnographic observations and artifacts from all meetings and process interviews with key partners.FindingsWe describe the structure of the partnership, including how researchers and district leaders collaborated on meeting facilitation and how researchers conducted and shared applied research. We then discuss three design principles that guided the work, including centering relationships, sustaining focus on key goals and embedding applied research.Originality/valueAs embedded research partners, our team is uniquely situated to narrate the nature and structure of the partnership and reflect on the design of our cross-sector initiative. Increasingly, universities are partnering directly with districts on school improvement initiatives. Our work shows how engaging in RPPs to bring together school, community and research partners can facilitate local leadership and collaboration to address complex, cross-sector goals such as increasing youth well-being.

Correlation of sub-centennial-scale pulses of initial Central Atlantic Magmatic Province lavas and the end-Triassic extinctions

The end-Triassic extinction (ETE) on land was synchronous with the initial lavas of the Central Atlantic Magmatic Province (CAMP) and occurred just after the brief 26 thousand year (kyr) reverse geomagnetic polarity Chron E23r that can be used for global correlation. Lava-by-lava paleomagnetic secular variation data, previously reported from Morocco and northeastern United States combined with our data for the North Mountain Basalt from the Fundy Basin of Canada show that the initial phase of CAMP volcanism occurred in only five directional groups or pulses each occupying less than a century. The first four directional groups occur during a ~40 kyr period based on available astrochronology and U-Pb geochronology. The coincidence of the initial major pulse of CAMP volcanism with the ETE points to short-lived volcanic winters albedo-induced by sulfate aerosols as a plausible key agent of the extinctions in the tropical continental realm, whereas looser correlations allow prolonged CO2 emissions to contribute to more long-ranging effects in the marine realm via ocean acidification and longer-term warming.

Knowledge of Palliative Care in Men and Women Diagnosed With Metastatic Breast Cancer.

The purpose of this study was to evaluate knowledge of Palliative Care (PC) and the impact of systemic and patient-related factors on the use of PC in a diverse population of men and women diagnosed with metastatic breast cancer. A telephone administered survey was used with patients receiving treatment at a Cancer Center in an urban area of the Northeast US. Descriptive statistics and chi square analysis were used. Of the 101 participants, 44% had no knowledge of PC and only 21.78% indicated that they were receiving palliative care. Participants who reported being followed by palliative care were less likely to have been treated in the emergency department in the past year (P = 0.003) or to have been hospitalized (P = 0.042). However, when asked about symptom burden, using the Edmonton Symptom Assessment Scale, patients who reported being followed by PC were more likely to report severe pain as compared to patients not receiving PC (P < 0.001). There were no associations found between race/ethnicity or social determinants of health and knowledge of PC or receipt of services. This sample of men and women diagnosed with metastatic breast cancer and being treated in a Cancer Center had limited knowledge and exposure to Palliative Care services across race and ethnicity. While no specific disparity was noted, the utilization of PC was low. Whether a function of a lack of referrals or patient preference, an effort should be made to increase PC referrals for all patients diagnosed with cancer.

Self-determination and Integration: A Site of Negotiation and a Village Named Panbari

The demand for self-determination of various nationalities has been central to the sociopolitical and cultural life of Assam, a northeastern state of India. The Statutory Autonomous Councils formed under the State Act are a non-territorial arrangement to address the question of self-determination without marking boundaries between co-habiting communities and therefore are a unique model of integration. However, this has led to conflicting situations reflecting how ‘integration’ emerges as a site of negotiation, redefines inter-community relationships, and challenges the state’s intervention in the matter. Drawing from a village study, this article endeavours to probe self-determination as a tool of (dis)integration, as a site of negotiation and argues that the various ways of addressing the question of self-determination adopted by the new nation-state ultimately affect the historically produced inter-community relationships. Methodologically, the article seeks to revisit the promises of ‘village study’ through the multicultural habitat named Panbari, a village in the northeast of Assam, and reflects how the every day in a small village establishes a guiding conversation with the everyday in a multicultural nation-state of India.