Abstract: Social Determinants of Health in Belize Free Clinic Introduction: To determine the most appropriate ways to serve patients in rural Belize through medical mission work, it is important to assess social determinants of health (SDOH). It has long been agreed that a variety of factors affect health, including environment, community and social context, access to healthcare, stress, income, mental health, education, and transportation. Many people in Roaring Creek, Belize, a village with a population of approximately 2,000, use Body and Soul Ministries, a nonprofit that invites medical teams from all over to deliver medical care, as their primary source of healthcare. During one of these trips, a medical team from East Tennessee State University (ETSU) provided medical care and employed the TeamCare survey, already used in several clinics in east Tennessee to assess the SDOH needs of the patient population in Roaring Creek. The purpose of this study was to use a survey that assesses several SDOH to determine better ways to address health needs in the community of Roaring Creek as well as connect patients with resources to meet those needs. Methods: A team of ETSU medical students, a resident, and five physicians served in a free clinic in Roaring Creek, Belize in October 2017. The team saw approximately 500 patients. Some patients were randomly selected to take the TeamCare survey to assess for six SDOH, including literacy, financial needs, drug use, abuse, transportation, and mental health. Based on the results of the survey, patients were connected with their local community health worker to assist in locating resources for patients. Using SPSS, results from the survey were arranged for frequencies and measures of central tendency. Results: Overall, a total of 106 patients responded to the TeamCare survey. Based on the survey results, 83.2% of patients responded “yes” to at least one question regarding needs related to SDOH. In fact, 7.9% of patients answered “yes” to five questions. Of note, 53.5% of patients responded positively for financial need, 46.5% positive for mental health needs, 37.6% positive for environmental alcohol or drug abuse, and 32.7% positive for transportation needs. More women stated positively for physical or verbal abuse compared to men (-1.48, p=0.001). Discussion and Conclusion: Roaring Creek, Belize is a rural community that illustrates how SDOH can impact health outcomes. There has been a recent effort for clinicians to address SDOH, especially in rural areas, but perhaps not enough globally. One way this can be done is by surveying for SDOH at clinic visits and then linking patients with relevant community resources. However, resources are not always readily available in Roaring Creek, Belize. Many patients are positive for SDOH, but with an overall lack of resources, it is important to do more research to determine how global health efforts can best serve these populations. Perhaps the best way for SDOH needs to be addressed is for Body and Soul to collaborate with community health workers and mission teams to establish ongoing programs and longstanding resources for the community.

As shallow reefs continue to decline, scientists are searching for the key to their persistence; as it turns out, they may just need to look deeper. Below many shallow tropical reefs, there exist healthy and more stable mesophotic coral reef communities. The ability of these reefs to act as a refuge for declining shallow populations has garnered significant interest among the scientific community; however, the reproductive and larval aspects necessary for this to occur are unknown. This study assesses the ability of deep reefs to act as a reproductive refuge for shallow counterparts by examining gametic compatibility, viability and larval settlement preferences. Gametes from Orbicella franksi inhabiting the shallow (14-20m) and the upper mesophotic (27-32m) were introduced in a series of inter- and intra-depth crosses and found to be compatible. Larval settlement experiments found no natal depth preference, with deep larvae significantly preferring to settle on shallow conditioned substrate. Our findings support the plausibility of healthy mesophotic reefs acting as a refuge for depauperate shallow populations by (1) providing gametes to mix with limited shallow gametes resulting in increased fertilization and (2) providing larvae that recruit and repopulate shallow reefs. This is the first study to comprehensively evaluate the Deep Reef Refugia Hypothesis from a reproductive and larval settlement standpoint. Our results suggest a close coupling between shallow and mesophotic reefs through gamete and larval export and illustrate the current and future importance of these mesophotic reefs.

No description available.

ABSTRACT OBJECTIVES: The objectives of this project are to review current literature regarding conjunctivitis including the pathogens that cause conjunctivitis, how to diagnose and differentiate between viral and bacterial conjunctivitis, and the different modalities to treating the disease with limited resources in rural communities. Then examine an outbreak of viral hemorrhagic conjunctivitis in rural Belize in October of 2017. This includes examining data collected by ETSU Family Medicine Department during health outreach clinics regarding diagnosis made, treatment provided, and comparing this information to a survey collected about social determinants of health. Finally, discuss the importance of disseminating public health education regarding how to limit the spread of contagious infections to a rural population with limited health literacy and access to resources. METHODS: In October of 2017 East Tennessee State University (ETSU) Quillen College of Medicine medical students, primary care physicians, and residents traveled to rural Belize to provide free primary care. The clinics consisted of seeing patients at both an established clinic in Roaring Creek, Belize and at remote health clinics in even more rural locations. Many of the patients who presented to the clinics had similar complaints of itchy, red, and productive eyes. Quantitative data was recorded from patient charts regarding their presenting symptoms, diagnosis, and the treatment. The data was organized utilizing microsoft excel and evaluated using SPSS and measures of central tendency. Qualitative data was also collected from interactions with patients and newspaper articles published in Belize about the conjunctivitis outbreak. RESULTS: The results showed that a total of 431 patients received care and 52% of them were diagnosed with conjunctivitis. 46.9% of the patients were determined to have viral conjunctivitis, while 2.8% of them had bacterial conjunctivitis. It was discovered that many patients utilized one reusable cloth to wipe their children's eyes repeatedly thus spreading the disease across and throughout the rural communities. It was found through careful conversations with patients that they were putting urine and breast milk into their eyes in hopes that it would help their pink eye. The Belize Ministry of Health Reported that there were 5,343 cases of pink eye countrywide, with a viral strain being more predominant than bacterial. CONCLUSION: In conclusion, extremely contagious diseases like conjunctivitis are dangerous in rural developing countries because of lack of education about hygiene and limited resources necessary to contain such diseases. While medication is not effective for viral conjunctivitis, it can have devastating consequences (e.g blindness) if a superinfection is not caught early in the course. Education can be the best medicine especially in cases of viral diseases. Patients were also provided with resources to wash their hands often, sterilized water to flush their eyes, and single use towels. A lesson on conjunctivitis, its complications, and how to prevent the spread of the disease was aired on public television. This reports provides examples of both practice creative ways to spread health literacy in rural populations with limited access to resources.

Obsidian is one of the most common materials preserved in the archaeological record of Mesoamerica. Because of this and obsidian's unique chemical properties, it has become one of the most common means by which to explain ancient exchange and production. Northern Belize has largely been absent from discussions of Postclassic Mesoamerican economies. The limited amount of obsidian research that has been done is unable to draw comparisons to the region's primary site during this period, Santa Rita Corozal. This thesis remedies this by exploring the importation, production, and distribution of obsidian at the Postclassic Maya primary center of Santa Rita Corozal, Belize. Through the application of the lithic technology approach and the use of pXRF (portable X-ray fluorescence) spectrometry, it is possible to establish the sources of obsidian being exploited, the stage of reduction of obsidian imports, the major obsidian industry, and obsidian distribution for Santa Rita Corozal's Postclassic Period.

The purpose of this thesis is to show that stable isotope analysis can be used to predict K’inich Yax K’uk Mo’s stable isotope measures based on Stuart’s (2007) hypothesis that K’inich Yax K’uk Mo’, the dynastic founder of the Copan royal lineage, was a Caracol lord. There is significant and convincing evidence that K’inich Yak K’uk Mo’ had a non-Copanec origin. Stable isotope analysis is a tested and reliable method for detailing diets and migratory paths of ancient humans and this theory is applied as a predictor of the stable isotope measures of K’inich Yax K’uk Mo’, if he did in fact originate in Caracol. The literature is rich with explanations of stable isotopes and the writings of a few stalwarts in the field were utilized to gain an understanding of the associated technologies and techniques utilized in its analysis. Data from the Copan (Whittington and Reed 1997) and Caracol (Chase and Chase 2001) stable isotope studies were utilized to show the application of stable isotope analysis in areas “associated” with K’inich Yax K’uk Mo’ and to illustrate how the palace diet identified by Chase and Chase (2001; Chase et al. 2001) could be aligned with the Stuart hypothesis to predict the stable isotope ranges for K’inich Yax K’uk Mo’.

Multiple scholars have briefly discussed the Maya use of the atlatl. Yet, there has never been a decisive encompassing discussion of prevalence and use of the atlatl in the Maya region with multiple lines of support from iconographic and artifactual analyses. This thesis explores the atlatl at Chichén Itzá, Tikal, and Caracol Maya sites to prove that atlatl prevalence can be interpreted primarily based on projectile point “classification function” analysis with support from iconographic and artifactual remains. The classification functions are derived from creating mutually exclusive groups of dart points and arrow points by using discrete functional analysis. Discerning between dart and arrow points can be completed with a high degree of accuracy based on maximum shoulder width of lithic points in an assemblage. Because the atlatl and bow complexes have been primarily constructed of perishable materials, the best method to determine the prevalence of atlatl use is by identifying the launcher based on projectile point identification. Using a cross-site comparison of projectile point size, the Maya use and prevalence of the atlatl will be elucidated

The sexing of human skeletal remains is important for identification and demographic purposes. It is made more difficult when elements such as the skull and pelvis are not recovered or are in too poor of a condition to assess. Previous studies have used carpal (wrist) bones of contemporary populations to assess the viability of these skeletal elements exhibiting sexual dimorphism, as these bones are small, compact elements that are usually recovered in good condition. This study evaluates the use of carpal bones recovered from an ancient Maya population from Belize to determine the biological sex of individuals. The study sample is part of the Maya Archaeological Skeletal Collection (MASC), which contains individuals from the sites of Lamanai, San Pedro, Altun Ha, and Marco Gonzalez and dates from the Late Maya Pre-Classic (400 BC-AD 250) to the Spanish Colonial period (AD 1521-1821). Multiple measurements were taken on 36 capitate, 34 lunate, 34 scaphoid, 27 trapezium, 24 hamate, 22 triquetral, 22 trapezoid, and 16 pisiform bones from several individuals. Discriminant function analysis was used to determine if sexual dimorphism is measurable in this population using these elements. Previous studies used populations with known identities, assessing individuals from crypts, graveyards, or medical collections from the last few centuries. This study varies from previous studies as it utilizes archaeological remains, making this study one of the first to evaluate non-contemporary remains with unknown sex. Results of this study demonstrate that this population exhibits sexual dimorphism and discriminant function analysis can be used to distinguish between two groups. This demonstrates that carpals could be used to help determine biological sex of archaeological populations as well as a tool to help with identification in forensic cases.

No description available.

No description available.