Displaced twice? Talking about resilience with a cohort of men from refugee backgrounds who were affected by the 2011 Queensland floods

What can we learn from people from refugee backgrounds who have been affected by an environmental disaster? This paper presents the first year findings of a study that is investigating the impact of the 2011 Queensland floods on a cohort of men from refugee backgrounds living in Brisbane and the Toowoom- ba–Gatton region of Southeast Queensland. Between 2008 and 2010, the SettleMEN study yielded pre-disaster measures of health and settlement among 233 refugee men. The current 2012−2013 follow-up study offers a rare opportunity to investigate and describe the impact of an environmental disaster on the health and wellbeing of a group of resettled refugee men who were affected by the 2011 Queensland floods. Using a mixed-method approach and a peer interviewer model, this paper reports on the exposure to and impact of the floods on the first 100 respondents who were interviewed between September 2012 and March 2013. Overall, we have found that the floods had a considerable economic and psychosocial impact on this group of men, their families and communities in terms of being forced to evacuate their homes, work disrup- tion, loss of income and personal belongings, and emotional distress. Many of these men reported that their previous refugee experience helped them to cope better during and after the floods, and for some, providing assistance to others during the floods impacted positively on their relationship with their neighbours. These findings challenge the Western deficits model that defines former refugees as traumatised victims. Refugee people’s strengths and capabilities should be taken into consideration when developing disaster response strategies at the neighbourhood and community levels.

Characterization of EhaJ, a new autotransporter protein from enterohemorrhagic and enteropathogenic Escherichia coli

Enterohemorrhagic Escherichia coli (EHEC) and enteropathogenic E. coli (EPEC) are diarrheagenic pathotypes of E. coli that cause gastrointestinal disease with the potential for life-threatening sequelae. While certain EHEC and EPEC virulence mechanisms have been extensively studied, the factors that mediate host colonization remain to be properly defined. Previously, we identified four genes (ehaA, ehaB, ehaC, and ehaD) from the prototypic EHEC strain EDL933 that encode for proteins that belong to the autotransporter (AT) family. Here we have examined the prevalence of these genes, as well as several other AT-encoding genes, in a collection of EHEC and EPEC strains. We show that the complement of AT-encoding genes in EHEC and EPEC strains is variable, with some AT-encoding genes being highly prevalent. One previously uncharacterized AT-encoding gene, which we have termed ehaJ, was identified in 12/44 (27%) of EHEC and 2/20 (10%) of EPEC strains. The ehaJ gene lies immediately adjacent to a gene encoding a putative glycosyltransferase (referred to as egtA). Western blot analysis using an EhaJ-specific antibody indicated that EhaJ is glycosylated by EgtA. Expression of EhaJ in a recombinant E. coli strain, revealed EhaJ is located at the cell surface and in the presence of the egtA glycosyltransferase gene mediates strong biofilm formation in microtiter plate and flow cell assays. EhaJ also mediated adherence to a range of extracellular matrix proteins, however this occurred independent of glycosylation. We also demonstrate that EhaJ is expressed in a wild-type EPEC strain following in vitro growth. However, deletion of ehaJ did not significantly alter its adherence or biofilm properties. In summary, EhaJ is a new glycosylated AT protein from EPEC and EHEC. Further studies are required to elucidate the function of EhaJ in colonization and virulence.

Development and integration of a solar powered unmanned aerial vehicle and a wireless sensor network to monitor greenhouse gases

Measuring gases for environmental monitoring is a demanding task that requires long periods of observation and large numbers of sensors. Wireless Sensor Networks (WSNs) and Unmanned Aerial Vehicles (UAVs) currently represent the best alternative to monitor large, remote, and difficult access areas, as these technologies have the possibility of carrying specialized gas sensing systems. This paper presents the development and integration of a WSN and an UAV powered by solar energy in order to enhance their functionality and broader their applications. A gas sensing system implementing nanostructured metal oxide (MOX) and non-dispersive infrared sensors was developed to measure concentrations of CH4 and CO2. Laboratory, bench and field testing results demonstrate the capability of UAV to capture, analyze and geo-locate a gas sample during flight operations. The field testing integrated ground sensor nodes and the UAV to measure CO2 concentration at ground and low aerial altitudes, simultaneously. Data collected during the mission was transmitted in real time to a central node for analysis and 3D mapping of the target gas. The results highlights the accomplishment of the first flight mission of a solar powered UAV equipped with a CO2 sensing system integrated with a WSN. The system provides an effective 3D monitoring and can be used in a wide range of environmental applications such as agriculture, bushfires, mining studies, zoology and botanical studies using a ubiquitous low cost technology.

Balancing the books : an assessment of financial stress associated with social work and human service student placements

This report presents the findings from a study of the financial impact of work-integrated learning commonly referred to as 'placement' among social work and human services students. Based on a survey of 214 respondants, 14 in-depth interviews and two focus groups, the findings indicate that two thirds of the surveyed group felt tired and anxious about their experience of balancing paid work and placement, with 2 in 5 reporting their learning experience was compromised as a result. The significant implications and potential solutions are also discussed.

Leaving family behind: Understanding the irregular migration of unaccompanied asylum-seeking minors - A qualitative study

This qualitative study investigated the drivers and determinants of irregular maritime migration among 17 protection visa holders who arrived in Australia as unaccompanied asylum-seeking minors. Semi-structured interviews were also conducted with eight non-government service providers working with unaccompanied minors in the Greater Brisbane area.

Fine-mapping of the HNF1B multicancer locus identifies candidate variants that mediate endometrial cancer risk

Common variants in the hepatocyte nuclear factor 1 homeobox B (HNF1B) gene are associated with the risk of Type II diabetes and multiple cancers. Evidence to date indicates that cancer risk may be mediated via genetic or epigenetic effects on HNF1B gene expression. We previously found single-nucleotide polymorphisms (SNPs) at the HNF1B locus to be associated with endometrial cancer, and now report extensive fine-mapping and in silico and laboratory analyses of this locus. Analysis of 1184 genotyped and imputed SNPs in 6608 Caucasian cases and 37 925 controls, and 895 Asian cases and 1968 controls, revealed the best signal of association for SNP rs11263763 (P = 8.4 × 10−14, odds ratio = 0.86, 95% confidence interval = 0.82–0.89), located within HNF1B intron 1. Haplotype analysis and conditional analyses provide no evidence of further independent endometrial cancer risk variants at this locus. SNP rs11263763 genotype was associated with HNF1B mRNA expression but not with HNF1B methylation in endometrial tumor samples from The Cancer Genome Atlas. Genetic analyses prioritized rs11263763 and four other SNPs in high-to-moderate linkage disequilibrium as the most likely causal SNPs. Three of these SNPs map to the extended HNF1B promoter based on chromatin marks extending from the minimal promoter region. Reporter assays demonstrated that this extended region reduces activity in combination with the minimal HNF1B promoter, and that the minor alleles of rs11263763 or rs8064454 are associated with decreased HNF1B promoter activity. Our findings provide evidence for a single signal associated with endometrial cancer risk at the HNF1B locus, and that risk is likely mediated via altered HNF1B gene expression.

Factors affecting antihypertensive medications adherence among hypertensive patients in Saudi Arabia

Hypertension is a health problem that has increasing prevalence worldwide. Antihypertensive medications are the key for achieving controlled blood pressure. Little is known about predictors of antihypertensive medications adherence in Saudi Arabia. This is a cross-sectional study of 308 participants from a general hospital in Jeddah city, Saudi Arabia conducted between July 2013 and February 2014. Out of the 308 participants, the results showed that 27.9% were classified as perfect adherents and 72.1% were classified as non-perfect adherents to antihypertensive medications. Significant predictors of non-perfect antihypertensive medications in this study were having non-formal education (p=0.031, OR=2.3, 95%CI = [1.82-5]), reporting a poor relationship with physicians (p=0.004, OR=2.25, 95%CI= [1.29-3.9]), and having no co-morbidities (p=0.048, OR=1.86, 95%CI [1.00-3.46]). The outcome of this study highlights the need for policies and interventions that enhance the level of formal education at a population level and improve physician-patient relationships in health care settings.

The persistence of predictors of wellbeing among refugee youth eight years after resettlement in Melbourne, Australia

This short report assesses the predictors of subjective health and happiness among a cohort of refugee youth over their first eight years in Australia. Five waves of data collection were conducted between 2004 (n=120) and 2012–13 (n=51) using mixed methods. Previous schooling,self-esteem, moving house in the previous year, a supportive social environment, stronger ethnic identity and perceived discrimination were significant predictors of wellbeing after adjusting for demographic and pre-migration factors. When compared with a previous analysis of this cohort over their first three years of settlement, experiences of social exclusion still have a significant impact on wellbeing eight years after arriving in Australia. This study contributes to mounting evidence in support of policies that discourage discrimination and promote social inclusion and cultural diversity and which underpin the wellbeing of resettled refugee youth.

Through their eyes: Seeing experiences of Settlement in photographs taken by refugee background youth in Melbourne, Australia

Although “refugees” are frequently represented in visual media, it is predominantly as the central subject matter and rarely are they positioned as the photographers of their own journeys. In this article we present photographic images that have been taken by refugee background youth portraying their experiences of the first years of settlement in Australia. We consider how, in our longitudinal research conducted with 120 refugee background youth, visual materials can provide equally important yet different insights in comparison to written or spoken narratives on the experiences of refugee settlement. Through an examination of over 1,000 photos taken by these youth, we explore the ways in which they portrayed their early experiences of external suburban settlement environments and their depictions of interior spaces and home-making practices. We discuss how these visual insights capture an alternative way of seeing the experiences of becoming at home as the youth become emplaced post-resettlement in Australia. We argue that the photographs taken by these refugee background youth illustrate how visual methods and materials can provide equally important but often overlooked insights into early settlement experiences. Importantly, the photographic images offer a way of portraying the people, places and sentiments that are central to the everyday lives of refugee background youths in ways that oral and written narratives can not.

Genome-wide association study for radiographic vertebral fractures: A potential role for the 16q24 BMD locus

Vertebral fracture risk is a heritable complex trait. The aim of this study was to identify genetic susceptibility factors for osteoporotic vertebral fractures applying a genome-wide association study (GWAS) approach. The GWAS discovery was based on the Rotterdam Study, a population-based study of elderly Dutch individuals aged >55years; and comprising 329 cases and 2666 controls with radiographic scoring (McCloskey-Kanis) and genetic data. Replication of one top-associated SNP was pursued by de-novo genotyping of 15 independent studies across Europe, the United States, and Australia and one Asian study. Radiographic vertebral fracture assessment was performed using McCloskey-Kanis or Genant semi-quantitative definitions. SNPs were analyzed in relation to vertebral fracture using logistic regression models corrected for age and sex. Fixed effects inverse variance and Han-Eskin alternative random effects meta-analyses were applied. Genome-wide significance was set at p<5×10-8. In the discovery, a SNP (rs11645938) on chromosome 16q24 was associated with the risk for vertebral fractures at p=4.6×10-8. However, the association was not significant across 5720 cases and 21,791 controls from 14 studies. Fixed-effects meta-analysis summary estimate was 1.06 (95% CI: 0.98-1.14; p=0.17), displaying high degree of heterogeneity (I2=57%; Qhet p=0.0006). Under Han-Eskin alternative random effects model the summary effect was significant (p=0.0005). The SNP maps to a region previously found associated with lumbar spine bone mineral density (LS-BMD) in two large meta-analyses from the GEFOS consortium. A false positive association in the GWAS discovery cannot be excluded, yet, the low-powered setting of the discovery and replication settings (appropriate to identify risk effect size >1.25) may still be consistent with an effect size <1.10, more of the type expected in complex traits. Larger effort in studies with standardized phenotype definitions is needed to confirm or reject the involvement of this locus on the risk for vertebral fractures.

Design and flight testing of an integrated solar powered UAV and WSN for greenhouse gas monitoring emissions in agricultural farms

There is an increased interest in measuring the amount of greenhouse gases produced by farming practices . This paper describes an integrated solar powered Unmanned Air Vehicles (UAV) and Wireless Sensor Network (WSN) gas sensing system for greenhouse gas emissions in agricultural lands. The system uses a generic gas sensing system for CH4 and CO2 concentrations using metal oxide (MoX) and non-dispersive infrared sensors, and a new solar cell encapsulation method to power the unmanned aerial system (UAS)as well as a data management platform to store, analyze and share the information with operators and external users. The system was successfully field tested at ground and low altitudes, collecting, storing and transmitting data in real time to a central node for analysis and 3D mapping. The system can be used in a wide range of outdoor applications at a relatively low operational cost. In particular, agricultural environments are increasingly subject to emissions mitigation policies. Accurate measurements of CH4 and CO2 with its temporal and spatial variability can provide farm managers key information to plan agricultural practices. A video of the bench and flight test performed can be seen in the following link: https://www.youtube.com/watch?v=Bwas7stYIxQ

Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture

Bone mineral density (BMD) is the most widely used predictor of fracture risk. We performed the largest meta-analysis to date on lumbar spine and femoral neck BMD, including 17 genome-wide association studies and 32,961 individuals of European and east Asian ancestry. We tested the top BMD-associated markers for replication in 50,933 independent subjects and for association with risk of low-trauma fracture in 31,016 individuals with a history of fracture (cases) and 102,444 controls. We identified 56 loci (32 new) associated with BMD at genome-wide significance (P < 5 × 10−8). Several of these factors cluster within the RANK-RANKL-OPG, mesenchymal stem cell differentiation, endochondral ossification and Wnt signaling pathways. However, we also discovered loci that were localized to genes not known to have a role in bone biology. Fourteen BMD-associated loci were also associated with fracture risk (P < 5 × 10−4, Bonferroni corrected), of which six reached P < 5 × 10−8, including at 18p11.21 (FAM210A), 7q21.3 (SLC25A13), 11q13.2 (LRP5), 4q22.1 (MEPE), 2p16.2 (SPTBN1) and 10q21.1 (DKK1). These findings shed light on the genetic architecture and pathophysiological mechanisms underlying BMD variation and fracture susceptibility.

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition

Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Unpredictability, invisibility and vulnerability: Unaccompanied asylum-seeking minors’ journeys to Australia

This qualitative study investigated the refugee journey of 17 males who arrived in Australia as unaccompanied asylum-seeking minors between 2009 and 2013, and were granted protection visas. The paper focuses on the four conceptual challenges of refugee journeys, as identified recently by BenEzer and Zetter: temporal characteristics; drivers and destinations; the process/content of the journey; and the characteristics of the wayfarers. The findings indicate that their mental journey has not yet ended and transcends the physical departure-arrival voyage. Although the primary drivers for the refugee journey were protection reasons, their desire to find a “better life” free from violence and exclusion also played an important role. The irregular character of the journey made it highly unpredictable, exposed these minors to extreme levels of vulnerability and the need to remain invisible, prompted short lived friendships with other asylum seekers, and created a pervasive feeling of mistrust towards smugglers and other people they met along the way. The study has highlighted the need for interventions to protect unaccompanied minors during their refugee journey.