⒈ Brom Island Research Paper

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Brom Island Research Paper



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The bus ride was long and uncomfortable, but I was as bouncy and ecstatic. When I stepped out of the Port Authority Bus Terminal and on to 8th Avenue, there was only one word that could accurately describe the feeling; home. Even though I was only able to be in the city. Medina describes how his first impressions differed from what he thought he would encounter. He faced new challenges, involving his race, that never occurred back in Cuba. By reflecting on this experience in a first person point of view, Medina depicts the disappointment that he and other immigrants face while adapting to their new world. When Medina arrives in New York he is shocked by what surrounds him. He steps off the. The system optimizes the collection procedures of agents with appreciation.

Summary: This book describes how European settlers colonized America and founded the first colony of the New World, Jamestown. The book explores the life of the settlers in Jamestown and the. Rochester, New York has a lot of history. Rochester is known for poverty, especially when the great depression arrived. However there is a whole lot more to New York than just the city. Rochester, New York is located in upstate New York. When immigrants and refugees come to the country they dispersed across the country and many of them land in Rochester, New York. The poverty population has always been high. Rochester is known for the. Other New England colonies sprouted up, due to a religious dissent from Plymouth and Massachusetts as with Rhode Island, b the constant search for more farmland as in Connecticut, and c just due to natural growth as in Maine.

The Middle Colonies emerged as the literal crossroads of the north and south. Peripheral home municipality described the location of the survivor's home municipality at T1 in relation to communities of a certain size according to Statistics Norway's classification of centrality [23]. Municipalities that were located more than 45 minutes' travelling time from communities with at least inhabitants were defined as peripheral Additional files 1 and 2.

We applied Pearson Chi Square tests categorical variables and independent t-tests continuous variables to test group differences between survivors who used MHS and those who did not. The Fisher's exact test was used for number of primary care services at T1 due to low number of expected count. Due to sample size considerations, we restricted the number of independent variables to six factors. The six variables were selected by an a priori approach based on factors considered as relevant in the guidelines for proactive follow-up after the attack. Two models were tested. Model 1 adjusted for age; gender; predisaster MHS utilization; and posttraumatic stress reactions, mental distress, and somatic symptoms measured at T1.

Model 2 adjusted for age; gender; predisaster MHS utilization; and posttraumatic stress reactions, mental distress, and somatic symptoms measured at T2. The statistical inferences were based on a two-sided significance level of 0. We reported the crude and adjusted. Altogether Figure 1 illustrates the prevalence and perceived usefulness of different types of care. Table 1 shows the survivors' characteristics by MHS utilization at T2. MHS utilization was associated with female gender and being injured. Otherwise no significant differences were found with respect to sociodemographic and disaster-related characteristics. The mean age was MHS utilization did not significantly differ with respect to social support or exposure.

At T2 most survivors who did not use MHS had no contact with a designated contact person in Table 2. MHS utilization was associated with contact with the regular GP; at T2 MHS utilization was also associated with contact with other types of primary care services. In the multivariate analysis adjusting for symptom levels at T1 model 1 , only mental distress remained significantly associated with MHS utilization at T2. In the multivariate analysis adjusting for symptom levels at T2 model 2 , only somatic symptoms was associated with MHS utilization Table 3. In the wake of the Ut0ya massacre, the survivors' utilization of health services was extensive both immediately and at longer-term.

The grand majority received one or more types of primary health services both directly after the attack and the following year. Most survivors used specialized mental health services MHS in addition to the primary care based outreach. MHS utilization in the post-acute phase was more common in survivors who were injured, and those with high levels of posttraumatic stress, mental distress, and somatic symptoms, but differed little by sociodemographic characteristics.

The survivors' high symptom levels and extensive utilization of MHS emphasize the severity of the attack. They further. Figure 1 Health Service Utilization. The proactive outreach programme outlined that all survivors were assigned a contact person to organize screening assessments throughout at least a year. Yet one in six survivors reported that they did not have a contact person the first months, while nearly half had no contact with the contact person months after the attack. The high number of survivors without a contact person at T2 might represent a lack of continuity in the follow-up. The recommendations were not mandatory; some municipalities may therefore not have provided contact persons.

Furthermore, some survivors may have been proposed a contact person, and declined. The utilization frequency and perceived usefulness was higher for MHS compared to primary care services. Since access to MHS usually occurs through referral from primary care services, survivors who received MHS may have had both a greater need for care and willingness to undergo therapy. Referrals to MHS often involve participation in an intervention lasting several weeks or months which requires higher consultation frequency. Due to proactive follow-up, the contact person and other primary care practitioners may have been more likely to interact with survivors who did not want or need health care.

Contrarily, in the current paper survivors who did not use MHS the following year were less likely to have had concurrent contact with the contact person; more than half had no contact with the contact person Table 2. This may be of concern, considering that post-disaster psycho-pathology, such as PTSD, may have a delayed onset of more than six months [24]. Besides, the survivors were at risk for potential retraumatization for a prolonged period due to the trial and the high media coverage [25,26]. In contrast to prior findings, [8] MHS utilization differed little by sociodemographic background, except that MHS utilization was higher among female survivors. Contrarily, MHS utilization differed significantly by impaired mental and physical health.

This may indicate that a proactive outreach promotes that health care delivery primarily is based on needs rather than sociodemographic factors. In comparison, a minority of young survivors with severe posttraumatic stress. Table 1 Characteristics of survivors by mental health service MHS utilization months after the Utoya attack. Hence the majority were in contact with primary care services.

This could suggest a failure at the primary health care level to identify and meet the needs for treatment in an important minority of survivors. Contrary to former findings, [5,27] survivors with prior experience with MHS were not more likely to receive MHS after the Ut0ya attack. The proactive outreach may have rendered MHS more accessible also for survivors without prior experiences with MHS, since they did not have to initiate. Nonetheless, the consultation frequency was higher among survivors with predisaster MHS utilization. Many survivors moved away from home to start at university or college shortly after the attack.

Relocation was considered a potential risk factor for posttraumatic distress, as it could involve a loss of support from established social networks and family. Relocation was also considered as a potential risk factor for disruption of existing care or failure to initiate treatment; however, MHS utilization did not significantly differ by relocation. This could suggest that the MHS follow-up was maintained despite relocation.

Table 2 The survivors' health service utilization and unmet help needs by mental health service MHS utilization months after the Utoya attack. It is also possible that the initial therapy was more successful at identifying and treating posttraumatic stress reactions than depression and anxiety. When we adjusted for symptoms at T2, only somatic symptoms remained significantly associated with MHS utilization model 2. One possible explanation could be that somatization is. Furthermore, somatic ailments may have promoted counselling, and hence increased the likelihood for referral to MHS.

The somatic symptoms could also be directly related to the terrorist attack, and potentially induce, maintain or worsen mental illness at long-term. Yet somatic symptoms remained significantly. Table 3 Multivariate logistic regression analyses of survivor characteristics associated with mental health service utilization months after the Utoya attack. Somatic symptoms are associated with adverse psychosocial and academic consequences in adolescents [29]. It is therefore important that health care practitioners address somatic symptoms also in disaster-survivors who are not physically injured.

Moreover, it has been shown that the prevalence and co-occurrence of somatic and psychological symptoms in low income settings are similar to those in high income settings [30]. Accordingly, the importance of assessing somatic symptoms in addition to psychological symptoms is likely to be pertinent also for low income settings. A challenge with proactive outreach is to decide who should be included in the screening. The survivors in our study had been isolated on an islet, and may therefore have been easier to identify than survivors of other disasters.

Yet the survivors were dispersed over a large number of municipalities in the entire country after the attack. The geographical dispersion disfavoured a centralized screen and treat response, which has recently showed promising results [31]. Our study indicates that a proactive outreach is feasible also when survivors are geographically dispersed. External validity may nonetheless be limited by differences in how healthcare provision is organised and financed.

Norway is a country with universal healthcare, therefore access to specialized health care may depend less on personal economy than in countries with insurance-based healthcare. Furthermore, the study might not be representative for low-resource settings. A proactive outreach can be resource-demanding. A key challenge in low income settings is the limited availability of mental health resources. In accordance with recent WHO guidelines, access to mental health inventions could be improved by integrating the delivery of psychotherapy by non-specialists, such as community health workers in primary care [32].

A primary care based proactive outreach might thus be applicable also in low income settings. More research is needed to develop effective evidence-based outreach in low income settings, where the risk of disasters is highest [33]. The unpredictability and chaotic circumstances of terrorism make it challenging to execute studies. It is therefore important that researchers in advance plan how to implement studies after terror attacks. A linkage to registers could contribute objective and accurate measures of survivors' health and service utilization before and after the attack, and thus enable a prospective design with a baseline assessment.

The current study contributes new insight into the long-term delivery of different types of health services to young survivors of terrorism. Prior research on disaster-. Our study included data from in-depth interviews at two time points after the attack. The longitudinal perspective is essential to increase our understanding of how initial reactions and receipt of health care are related to later MHS utilization, and thus optimize post-disaster health care delivery. Furthermore, the Ut0ya shooting was geographically constricted to a small island where all survivors were exposed to a life-threatening event and could be identified. Former studies have commonly lacked information about the number and identity of directly affected survivors, and consequently met difficulties with selecting a representative sample.

The clear definition of our study population may therefore have yielded more reliable estimates. Yet the study had several limitations. Participation did not significantly differ by age, gender, or geographic region of residence, but survivors who participated in T1 only scored higher on exposure. Moreover, survivors who participated at T2 only had more severe posttraumatic stress reactions, mental distress, and somatic symptoms.

This may imply that non-participation was associated with poorer mental and physical health. However, survivors who participated at one wave did not significantly differ from two-wave participants with respect to MHS utilization. Study participation might have influenced health service utilization and recovery, as interviewers may have assisted in acquiring treatment for participants with unmet needs for help. Furthermore, the study lacked predisaster data and was based on self-reports, which could be inaccurate. Men from many nations have been trying to get to the moon since the middle of the cold war.

In the year , landing a person on the moon became one of the greatest scientific accomplishments ever. One of the reasons for being such a great accomplishment was the new technologies that needed to be made and utilized. One of the new technologies was the new F-1 rocket engines, developed by Pratt and Whitney Rocketdyne, that were needed for the Saturn V rocket. It is illogical to assume this because scientists have already proven that the moon 's composition is identical to Earth 's, which strongly supports the Sister Theory. The capture theory is less substantial because if the moon was once free floating through space before being captured by Earths gravity, then it stands to reason that the moon could break free at any point and continue to wander space.

As current research supports the moon highly effects the tides of Earths oceans and the moon 's disappearance would be detrimental; considering this outcome, by default the Sister Theory is deemed stronger than the capture theory. Additionally, if the moon was once wandering aimlessly through space, why is it that other large lunar and planetary bodies have not been found acting in the same way throughout human history?

The surface is battered and has many craters resulting from meteoroids and comets crashing into the surface. There are some areas which are smooth and some areas which are lobe-shaped scarps or cliffs, some are hundreds of miles long and soaring up to 1. It is about 1, kilometers miles in diameter. One faithful day NASA sent a satellite up into space. This angered him so much that he went down to earth to talk to Zeus. Not knowing a meeting was being held. When he got there the other gods and goddesses were very confused. Just for a second close your eyes and think about all of those cool space movies that intrigue you the most. For my Star Wars and Star Trek fans let me say this first.

Yes those movies were in fact science fiction; although, how cool would it be to have all of those cool gadgets and be able to travel off planet and see other stars and galaxies. I believe that the abandonment of NASA space program was a mistake for the reason that all of our problems that we have on in terms of wealth, resources and cultural conflict could be answered with what might be in space. Mars: the Red Planet. It has intrigued us as far back as the Babylonians, who called Mars Negral.

Over the next almost years, numerous astronomers did research and observed the planet trying to understand its atmosphere and what may be on the surface. So how did Venus escape unscathed? While Venus could have been extraordinarily lucky and missed any significant damage in the turbulent young system, it is more likely that the surface of Venus has been completely redone by volcanic activity, smoothing over the scars of its early life. The planet has significantly more volcanoes than Earth, several of them the size of Earth 's largest system, the Big Island of Hawaii.

Most of Venus is covered with smooth volcanic plains, with two large "continents" standing out. Ishtar Terra lies to the north, covering an area approximately the size of Australia, while the Africa-sized Aphrodite Terra lies just south of the equator. Unlike on Earth, these continents weren 't formed by plate tectonics, nor do they sit in a sea of water; the surface temperature of Venus is hot enough to melt lead. Instead, these continents make up the "rough" patches of Venus, with canyons, trenches, and mountains.

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