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\"The civil rights movement and immigration reform transformed American politics in the mid-1960s. Demographic diversity and identity politics raised the challenge of e pluribus unum anew, and multiculturalism emerged as a new ideological response to this dilemma. This book uses national public opinion data and public opinion data from Los Angeles to compare ethnic differences in patriotism and ethnic identity and ethnic differences in support for multicultural norms and group-conscious policies. The authors find evidence of strong patriotism among all groups and the classic pattern of assimilation among the new wave of immigrants. They argue that there is a consensus in rejecting harder forms of multiculturalism that insist on group rights but also a widespread acceptance of softer forms that are tolerant of cultural differences and do not challenge norms, such as by insisting on the primacy of English. There is little evidence of a link between strong group consciousness and a lack of patriotism, even in the most disadvantaged minority groups. The authors conclude that the United States is not breaking apart due to the new ethnic diversity\"-- Provided by publisher.

Despite predictions of the paperless office, global demand for printing and writing paper remains strong, and paper appears to be here to stay for some time. Not only firms, but also governments, libraries, and archives are in possession of large collections of legacy documents that still must be sorted and scanned. In this study, terahertz-based techniques are demonstrated to address several routine tasks related to the automated paper handling of unsorted legacy documents. Specifically, we demonstrate terahertz-based counting of the number of sheets in unconsolidated paper stacks, as well as locating stapled documents buried in paper stacks.

Terahertz imaging technology has been used to uncover hidden inscriptions on a 16th-century lead cross. The cross, brought to the researchers by an archaeology lab in France, had a barely visible inscription underneath a layer of corrosion. Previous attempts to reveal hidden features on corroded artifacts using terahertz waves had been unsuccessful. However, since the cross was made of lead, which allows terahertz waves to pass through, the researchers decided to give it a try. Initial scans did not show much, so the data was stored for a few years. Three years later, the researchers developed advanced image processing techniques and were able to read the prayer inscribed on the cross. The inscription turned out to be the Pater Noster, or the Lord's Prayer. The successful use of terahertz imaging in this study opens up new possibilities for analyzing archaeological artifacts and gaining insights into medieval attitudes towards death and Christian faith. The researchers emphasize the importance of multidisciplinary collaboration between scientists, engineers, art historians, and archaeologists in preserving and understanding our cultural heritage.

Optoelectronic oscillators produce microwave-modulated optical beams without external modulation. The most commonly studied types produces narrow-band output, i.e., optical output modulated by a sinusoid, in which case phase noise determines key figures of merit that limit device performance. Nonetheless, other types of modulated signals have been exhibited by optoelectronic oscillators, including square waves. In this work we provide a theoretical treatment of the power spectral density of a microwave self-modulated optical periodic, but non-sinusoidal, oscillator in the presence of timing noise (as phase noise is only defined for a single sinusoid) and focus on the case of square waves. We consider the effects of timing noise on the power spectral density and autocorrelation function of the modulation signal.

Digital images and video clips collected at construction jobsites are commonly used for extracting useful information. Exploring new applications for image processing techniques within the area of construction engineering and management is a steady growing field of research. One of the initial steps for various image processing applications is automatically detecting various types of construction materials on construction images. In this paper, the authors conducted a comparison study to evaluate the performance of different machine learning techniques for detection of three common categorists of building materials: Concrete, red brick, and OSB boards. The employed classifiers in this research are: Multilayer Perceptron (MLP), Radial Basis Function (RBF), and Support Vector Machine (SVM). To achieve this goal, the feature vectors extracted from image blocks are classified to perform a comparison between the efficiency of these methods for building material detection. The results indicate that for all three types of materials, SVM outperformed the other two techniques in terms of accurately detecting the material textures in images. The results also reveals that the common material detection algorithms perform very well in cases of detecting materials with distinct color and appearance (e.g., red brick); while their performance for detecting materials with color and texture variance (e.g., concrete) as well as materials containing similar color and appearance properties with other elements of the scene (e.g., ORB boards) might be less accurate.

Background Evidence-based medicines, technologies, and protocols exist to prevent many of the annual 300,000 maternal, 2.7 million neonatal, and 9 million child deaths, but they are not being effectively implemented and utilized in rural areas. Nepal, one of South Asia’s poorest countries with over 80% of its population living in rural areas, exemplifies this challenge. Community health workers are an important cadre in low-income countries where human resources for health and health care infrastructure are limited. As local women, they are uniquely positioned to understand and successfully navigate barriers to health care access. Recent case studies of large community health worker programs have highlighted the importance of training, both initial and ongoing, and accountability through structured management, salaries, and ongoing monitoring and evaluation. A gap in the evidence regarding whether such community health worker systems can change health outcomes, as well as be sustainably adopted at scale, remains. In this study, we plan to evaluate a community health worker system delivering an evidence-based integrated reproductive, maternal, newborn, and child health intervention as it is scaled up in rural Nepal. Methods We will conduct a type 2 hybrid effectiveness-implementation study to test both the effect of an integrated reproductive, maternal, newborn, and child health intervention and the implementation process via a professional community health worker system. The intervention integrates five evidence-based approaches: (1) home-based antenatal care and post-natal care counseling and care coordination; (2) continuous surveillance of all reproductive age women, pregnancies, and children under age 2 years via a mobile application; (3) Community-Based Integrated Management of Newborn and Childhood Illness; (4) group antenatal and postnatal care; and 5) the Balanced Counseling Strategy to post-partum contraception. We will evaluate effectiveness using a pre-post quasi-experimental design with stepped implementation and implementation using the RE-AIM framework. Discussion This is the first hybrid effectiveness-implementation study of an integrated reproductive, maternal, newborn, and child health intervention in rural Nepal that we are aware of. As Nepal takes steps towards achieving the Sustainable Development Goals, the data from this three-year study will be useful in the detailed planning of a professionalized community health worker cadre delivering evidence-based reproductive, maternal, newborn, and child health interventions to the country’s rural population. Trial registration ClinicalTrials.gov Identifier: NCT03371186 , registered 04 December 2017, retrospectively registered.

Although there are guidelines for transcultural adaptation and validation of psychometric tools, similar resources do not exist for translation of diagnostic and symptom terminology used by health professionals to communicate with one another, their patients, and the public. The issue of translation is particularly salient when working with underserved, non-English speaking populations in high-income countries and low- and middle-income countries. As clinicians, researchers, and educators working in cross-cultural settings, we present four recommendations to avoid common pitfalls in these settings. We demonstrate the need for: (1) harmonization of terminology among clinicians, educators of health professionals, and health policymakers; (2) distinction in terminology used among health professionals and that used for communication with patients, families, and the lay public; (3) linkage of symptom assessment with functional assessment; and (4) establishment of a culture of evaluating communication and terminology for continued improvement.

Background Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation. Partnerships network We describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community. Conclusions We propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal.

Background Reducing the maternal mortality ratio to less than 70 per 100,000 live births globally is one of the Sustainable Development Goals. Approximately 830 women die from pregnancy- or childbirth-related complications every day. Almost 99% of these deaths occur in developing countries. Increasing antenatal care quality and completion, and institutional delivery are key strategies to reduce maternal mortality, however there are many implementation challenges in rural and resource-limited settings. In Nepal, 43% of deliveries do not take place in an institution and 31% of women have insufficient antenatal care. Context-specific and evidence-based strategies are needed to improve antenatal care completion and institutional birth. We present an assessment of effectiveness outcomes for an adaptation of a group antenatal care model delivered by community health workers and midwives in close collaboration with government staff in rural Nepal. Methods The study was conducted in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible . We implemented group antenatal care as a prospective non-randomized, cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allowed for iterative improvement in design by making changes to improve the quality of the intervention. We evaluated effectiveness through a difference in difference analysis of institutional birth rates between groups prior to implementation of the intervention and 1 year after implementation. Additionally, we assessed the change in knowledge of key danger signs and the acceptability of the group model compared with individual visits in a nested cohort of women receiving home visit care and home visit care plus group antenatal care. Using a directed content and thematic approach, we analyzed qualitative interviews to identify major themes related to implementation. Results At baseline, there were 457 recently-delivered women in the six village clusters receiving home visit care and 214 in the seven village clusters receiving home visit care plus group antenatal care. At endline, there were 336 and 201, respectively. The difference in difference analysis did not show a significant change in institutional birth rates nor antenatal care visit completion rates between the groups. There was, however, a significant increase in both institutional birth and antenatal care completion in each group from baseline to endline. We enrolled a nested cohort of 52 participants receiving home visit care and 62 participants receiving home visit care plus group antenatal care. There was high acceptability of the group antenatal care intervention and home visit care, with no significant differences between groups. A significantly higher percentage of women who participated in group antenatal care found their visits to be ‘very enjoyable’ (83.9% vs 59.6%, p  = 0.0056). In the nested cohort, knowledge of key danger signs during pregnancy significantly improved from baseline to endline in the intervention clusters only (2 to 31%, p  < 0.001), while knowledge of key danger signs related to labor and childbirth, the postpartum period, and the newborn did not in either intervention or control groups. Qualitative analysis revealed that women found that the groups provided an opportunity for learning and discussion, and the groups were a source of social support and empowerment. They also reported an improvement in services available at their village clinic. Providers noted the importance of the community health workers in identifying pregnant women in the community and linking them to the village clinics. Challenges in birth planning were brought up by both participants and providers. Conclusion While there was no significant change in institutional birth and antenatal care completion at the population level between groups, there was an increase of these outcomes in both groups. This may be secondary to the primary importance of community health worker involvement in both of these groups. Knowledge of key pregnancy danger signs was significantly improved in the home visit plus group antenatal care cohort compared with the home visit care only group. This initial study of Nyaya Health Nepal’s adapted group care model demonstrates the potential for impacting women’s antenatal care experience and should be studied over a longer period as an intervention embedded within a community health worker program. Trial registration ClinicalTrials.gov Identifier: NCT02330887 , registered 01/05/2015, retroactively registered.