International education and the post-9/11 syndrome: A study of international educators in selected Miami-area colleges

This dissertation investigated the relationship between the September 11, 2001 terrorist attacks and the internationalization agenda of U.S. colleges and universities. The construct, post-9/11 syndrome, is used metaphorically to delineate the apparent state of panic and disequilibrium that followed the incident. Three research questions were investigated, with two universities in the Miami-area of South Florida, one private and the other public, as qualitative case studies. The questions are: (a) How are international student advisors and administrators across two types of institutions dealing with the post-9/11 syndrome? (b) What, if any, are the differences in international education after 9/11? (c) What have been the institutional priorities in relation to international education before and after 9/11? Data-gathering methods included interviews with international student/study abroad advisors and administrators with at least 8 years of experience in the function(s) at their institutions, document and institutional data analysis. The interviews were based on the three-part scheme developed by Schuman (1982): context of experience, details of experience and reflection on the meaning of experiences. Taped interviews, researcher insights, and member checks of transcripts constituted an audit trail for this study. Key findings included a progressive decline in Fall to Fall enrollment of international students at UM by 13.05% in the 5 years after 9/11, and by 6.15% at FIU in the seven post-9/11 years. In both institutions, there was an upsurge in interest in study abroad during the same period but less than 5% of enrolled students ventured abroad annually. I summarized the themes associated with the post-9/11 environment of international education as perceived by my participants at both institutions as 3Ms, 3Ts, and 1D: Menace of Anxiety and Fear, Menace of Insularity and Insecurity, Menace of Over-Regulation and Bigotry, Trajectory of Opportunity, Trajectory of Contradictions, Trajectory of Illusion, Fatalism and Futility, and Dominance of Technology. Based on these findings, I recommended an integrated Internationalization At Home Plus Collaborative Outreach (IAHPCO) approach to internationalization that is based on a post-9/11 recalibration of national security and international education as complementary rather than diametrically opposed concepts.

Use of Homeostatic Model Assessment Indexes for the Identification of Metabolic Syndrome and Insulin Resistance among Cuban-Americans: A Cross Sectional Study

Aim: to determine cut off points for The Homeostatic Model Assessment Index 1 and 2 (HOMA-1 and HOMA-2) for identifying insulin resistance and metabolic syndrome among a Cuban-American population. Study Design: Cross sectional. Place and Duration of Study: Florida International University, Robert Stempel School of Public Health and Social Work, Department of Dietetics and Nutrition, Miami, FL from July 2010 to December 2011. Methodology: Subjects without diabetes residing in South Florida were enrolled (N=146, aged 37 to 83 years). The HOMA1-IR and HOMA2-IR 90th percentile in the healthy group (n=75) was used as the cut-off point for insulin resistance. A ROC curve was constructed to determine the cut-off point for metabolic syndrome. Results: HOMA1-IR was associated with BMI, central obesity, and triglycerides (P3.95 and >2.20 and for metabolic syndrome were >2.98 (63.4% sensitivity and 73.3% specificity) and >1.55 (60.6% sensitivity and 66.7% specificity), respectively. Conclusion: HOMA cut-off points may be used as a screening tool to identify insulin resistance and metabolic syndrome among Cuban-Americans living in South Florida.

Beyond BMI: The “Metabolically healthy obese” phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality -- a systematic review

Background A subgroup has emerged within the obese that do not display the typical metabolic disorders associated with obesity and are hypothesized to have lower risk of complications. The purpose of this review was to analyze the literature which has examined the burden of cardiovascular disease (CVD) and all-cause mortality in the metabolically healthy obese (MHO) population. Methods Pubmed, Cochrane Library, and Web of Science were searched from their inception until December 2012. Studies were included which clearly defined the MHO group (using either insulin sensitivity and/or components of metabolic syndrome AND obesity) and its association with either all cause mortality, CVD mortality, incident CVD, and/or subclinical CVD. Results A total of 20 studies were identified; 15 cohort and 5 cross-sectional. Eight studies used the NCEP Adult Treatment Panel III definition of metabolic syndrome to define “metabolically healthy”, while another nine used insulin resistance. Seven studies assessed all-cause mortality, seven assessed CVD mortality, and nine assessed incident CVD. MHO was found to be significantly associated with all-cause mortality in two studies (30%), CVD mortality in one study (14%), and incident CVD in three studies (33%). Of the six studies which examined subclinical disease, four (67%) showed significantly higher mean common carotid artery intima media thickness (CCA-IMT), coronary artery calcium (CAC), or other subclinical CVD markers in the MHO as compared to their MHNW counterparts. Conclusions MHO is an important, emerging phenotype with a CVD risk between healthy, normal weight and unhealthy, obese individuals. Successful work towards a universally accepted definition of MHO would improve (and simplify) future studies and aid inter-study comparisons. Usefulness of a definition inclusive of insulin sensitivity and stricter criteria for metabolic syndrome components as well as the potential addition of markers of fatty liver and inflammation should be explored. Clinicians should be hesitant to reassure patients that the metabolically benign phenotype is safe, as increased risk cardiovascular disease and death have been shown.

Factors of Inflammation in Haitian Americans and African Americans with and without Type 2 Diabetes

Chronic low-grade inflammation has been implicated in the processes leading to the development of type 2 diabetes (T2D) and its progression. Non-Hispanic Blacks bear a disproportionate burden of T2D and are highly susceptible to inflammation. This cross-sectional study assessed and compared the serum levels of established adipocytokines; interleukin-6 (IL-6), C-reactive protein (CRP), leptin, and novel adipocytokines; chemerin and omentin in Haitian and African Americans with and without T2D. The relationships of these adipocytokines with metabolic syndrome (MetS), anthropometric and HOMA2 measures by ethnicity and diabetes status were also assessed. Serum levels of IL-6, CRP, leptin, chemerin and omentin were determined by the ELISA method. HOMA2 measures were calculated for insulin sensitivity (HOMA2-IS) and insulin resistance (HOMA2-IR). Analyses of available data for 230 Haitian Americans and 241 African Americans (240 with and 231 without T2D) for the first study showed that Haitian Americans with and without MetS had lower levels of IL-6 and CRP compared to African Americans with and without MetS (P Ethnic-specific diabetes intervention and treatment programs must be designed to target Haitian Americans and African Americans as separate unique groups, in order to reduce the burden of T2D among the non-Hispanic Black community. Further research is needed to gain better understanding of the role of inflammation and T2D in this population.