Medicine and Health Sciences Commons^™

Effect Of Dolphin Kick Timing On Breaststroke Pullout Performance, Taylor L. Adams, Mickey B. Scharbrough, Scott P. Mclean

International Journal of Exercise Science: Conference Proceedings

Breaststroke pullouts are now permitted to include a dolphin kick. Two variations of the pullout are distinguished by the timing of the dolphin kick within the movement. One variation uses an early-initiation of the dolphin kick (performed before the initiation of the arm pull) while a second variation uses a late-initiation of the dolphin kick (performed at the completion of the arm pull). PURPOSE: To compare the performance of two variations of breaststroke pullouts that incorporate a dolphin kick. METHODS: Fourteen collegiate swimmers (18.9 ± 1.17 years, 73.7 ± 8.54 kg, 174.5 ± 9.88 cm) who compete in breaststroke or …

Actual Versus Predicted Vo2max: A Comparison Of 4 Different Methods, David J. Buckley, James R. Rowe Jr

International Journal of Exercise Science: Conference Proceedings

ABSTRACT

Measuring expired gases (EGs) while performing a maximal (max) effort exercise test is considered the most accurate evaluation of VO₂ max. This methodology is not applicable for all populations. Submaximal (sub-max) protocols not measuring expired gases are more applicable, however their ability to accurately predict VO₂max is not clear. PURPOSE: To compare VO₂max results from 1) University of Houston Non-Exercise Test (UHNET), 2) McArdle Step Test (MST), 3) Bruce Protocol measuring EGs to max (Bruce-EGs), and 4) Bruce Protocol using time to max (Bruce-TM). METHODS: Recreationally active men and women {n= 24 (16M/8W); age …

A Family History Of Type 2 Diabetes Does Not Impact Maximal Aerobic Capacity In Normoglycemic, Hispanic Males, Mario Garcia, Manuel Amador, Cesar Meza, Christopher Figueroa, Andrew Mcainch, Sudip Bajpeyi

International Journal of Exercise Science: Conference Proceedings

A family history of type 2 diabetes (FH+) is considered a risk factor for insulin resistance and poor cardiorespiratory fitness. However, it is not known if a FH+ impedes exercise-induced improvements in maximal aerobic capacity (VO₂max). Purpose: The purpose of this study was to determine if normoglycemic, sedentary, Hispanic men with FH+ have a lower VO₂max compared to those without a family history of type 2 diabetes (FH-) and if the improvement in VO₂max after 8-weeks of combined exercise training is comparable between FH- and FH+. Methods: 20 participants underwent 8 weeks of combined …

The Dose Effect Of Whey Protein On Insulin Responses In Pre-Diabetics And Type 2 Diabetics, Todd Castleberry Mr., Christopher Irvine 5098522, Michael Oldham, Matthew F. Brisebois, Sarah E. Deemer, Ryan Gordon, Aubrien Henderson, Vic Ben-Ezra

International Journal of Exercise Science: Conference Proceedings

People with pre-diabetes and type 2 diabetes have shown an increase in insulin secretion after ingesting 55 g of whey protein coupled with a glycemic challenge. However, the effect of lower amounts of whey protein on insulin responses remains unclear. Our hypothesis was that both 20 g and 30 g of whey consumption prior to an oral glucose tolerance test (OGTT) would produce an increase in insulin secretion, with 30 g producing the greatest increase compared to a control. PURPOSE: The purpose of this study was to examine the effect of two different doses of whey protein ingested 30 min …

Dose Effect Of Whey Protein On Gut Hormone Responses In Pre-Diabetics And Type 2 Diabetics, Christopher Irvine, Todd Castleberry, Michael Oldham, Matthew Brisebois, Sarah E. Deemer, Ryan Gordon, Aubrien Henderson, Vic Ben-Ezra

International Journal of Exercise Science: Conference Proceedings

GLP-1 and GIP have been shown to increase following a 50 g dose of whey protein prior to a high glycemic load in type 2 diabetics. However, this increase is reduced in diabetics compared to healthy individuals. Pancreatic polypeptide (PP) and peptide tyrosine tyrosine (PYY) also increase, while ghrelin decreases after the consumption of whey protein; however, it is not known if a similar hormone response occurs with a lower dose of whey protein prior to a glycemic load or if there is a dose effect. Our hypothesis was that 20 g and 30 g of whey protein would increase …

Validity Of Four-Compartment Models When Estimating Bone Mineral Content And Total Body Water With Single-Frequency Bioimpedance, Kassandra A. Jaramillo, Alexandra Loredo, Grant M. Tinsley, Brett S. Nickerson

International Journal of Exercise Science: Conference Proceedings

Bone mineral content (BMC) and total body water (TBW) are commonly assessed via dual energy X-ray absorptiometry (DXA) and bioimpedance spectroscopy (BIS), respectively, for a criterion 4-compartment body composition model (4C_CRITERION). However, single-frequency bioelectrical impedance analysis (SF-BIA) has been proposed as an alternative for calculating BMC and TBW. PURPOSE: The purpose of this study was to compare 4C models for body fat percent (BF%), fat-free mass (FFM), and fat mass (FM) when using SF-BIA individually for the estimation of BMC (4C_BMC) and TBW (4C_TBW) or in combination (4C_BMC+TBW). METHODS: Seventy-one men and …

3-Dimensional Biomechanical Comparison Of Spinal Posture In Yoga Practitioners And Non-Practitioners During A Seated And Standing Position, Savannah V. Wooten

International Journal of Exercise Science: Conference Proceedings

Yoga has been claimed to be beneficial for helping a series of clinical populations and improving ailments such as, but not limited to, stress, chronic back pain, muscle endurance, flexibility, balance, and posture. Whereas many of the above listed assertions have been scientifically investigated, there is a lack of objective evidence that supports the claim that yoga improves posture. PURPOSE: The purpose of this study is to compare a 3-D biomechanical analysis of spinal posture among yoga practitioners (YP) and Non yoga practitioners (NP) during seated and standing positions. METHODS: 10 yoga practitioners (M= 3, F=7) and 10 …

A Family History Of Type 2 Diabetes May Impair Glucose Area Under The Curve In Young, Healthy Hispanics, Cesar Meza, Manuel Amador, Mario Garcia, Christopher Figueroa, Andrew Mcainch, Sudip Bajpeyi

International Journal of Exercise Science: Conference Proceedings

Obesity and type 2 diabetes are associated with impaired glucose homeostasis and blood lipid profiles. Further, a family history of diabetes (FH) increases the risk for development of insulin resistance. However, it is unclear whether a FH impairs glucose tolerance, blood glucose and lipid profiles in young, healthy, normoglycemic adults. PURPOSE: To investigate whether a FH impairs glucose tolerance and blood lipid profile in healthy, sedentary Hispanic males. METHODS: 22 sedentary, normoglycemic, Mexican American males (mean±SEM: age:23±0.56 yrs; BMI: 26.9±0.98 kg/m²) with/without FH participated in the study. Glucose tolerance was assessed by calculating glucose area under …

Relative Energy Deficit (Female Triad), Prystyn M. Covington

International Journal of Exercise Science: Conference Proceedings

ABSTRACT CLINICAL PRESENTATION & EXAM: The relative energy deficit also known as RED-S or the Female Triad, is a common occurrence with females. RED-S occurs due to many factors such as increased energy output, decreased energy intake, or can sometimes be caused by both. RED-S in females is diagnosed by three symptoms: abnormal eating habits, osteoporosis, and functional hypothalamic amenorrhea. The patient does not need to experience all three symptoms to be diagnosed with RED-S. The energy deficit affects physiological functions such as cardiovascular health, immunity, protein synthesis, along with menstrual functions in females. ANATOMY & PATHOLOGY: Osteoporosis is a …

A Preschool Obesity Prevention Program Is Associated With Improvements On Physical Activity Quality, Fernando Juarez Jr., Azeem A. Hussain, Shiyu Li, Vanessa Estrada, Jill Johnstone, Zenong Yin, Erica Sosa

International Journal of Exercise Science: Conference Proceedings

The Míranos! Look at Us We Are Healthy (Míranos!) is an eight-week pilot intervention to promote healthy weight gain in low-income preschool Latino children aged 3-5 years. A major focus is to increase time spent in physical activity level, especially moderate to vigorous physical activity (MVPA) during play time and improve class instruction quality. According to one published study, preschool children spent only 14% of play session time in MVPA and 73% in sedentary activity (Tandon, 2015). PURPOSE: To assess the effectiveness of the Míranos! pilot intervention on the quality (lesson context, and health promotion interactions) and level of …

Effects Of A Head Start Obesity Prevention Pilot On Preschoolers’ Physical Activity, Shiyu Li, Azeem A. Hussain, Fernando Juarez, Vanessa Estrada, Erica Sosa, Derek P. Hales, Zenong Yin

International Journal of Exercise Science: Conference Proceedings

Regular participation in physical activity (PA) is important for the healthy growth and development of preschoolers. The Míranos! Look at Us We Are Healthy (Míranos!) is an obesity prevention intervention with age-appropriate structured and unstructured outdoor/indoor play and classroom activities led by teacher. As an objective instrument to provide information on human movements, accelerometer can accurately identify the levels of physical activity and assess the effects of physical activity intervention. PURPOSE: to evaluate the effects of an 8-week Míranos! pilot intervention on increasing physical activity levels during school time in preschoolers. METHODS: Study participants were children aged 3-5 years enrolled …

Racial Differences In Vascular Function In Response To Mental Stress, Bryon Matthew Curtis, John Akins, Jordan C. Patik, Guillermo Olvera, Aida Nasirian, Jeremiah Campbell, R Matthew Brothers

International Journal of Exercise Science: Conference Proceedings

African Americans (AA) have a higher prevalence of hypertension and other cardiovascular (CV) complications compared to other populations. While the reasons for this elevated CV disease risk are multifactorial, vascular dysfunction is a key contributing factor. It has been previously shown that mental stress, induced by mental arithmetic, results in a significant increase in forearm blood flow (FBF). This response has been predominantly attributed to the release and vasodilatory effect of Nitric Oxide (NO). In this regard, a previous study has reported that AA have an attenuated increase in FBF as compared to Caucasians (CA) in response to mental stress, …

An Eight-Week Physical Activity Intervention Is Associated With Gross Motor Skills In Preschool Children, Azeem A. Hussain, Fernando Juarez Jr., Shiyu Li, Vanessa Estrada, Jill Johnstone, Erica T. Sosa, Zenong Yin

International Journal of Exercise Science: Conference Proceedings

The preschool age (three to five years old) is critical in developing gross motor skills. Additionally, children with higher fundamental movement skills are more likely to participate in high levels of physical activity (Han, Fu, Cobley, & Sanders, 2018). PURPOSE: To determine if the eight-week physical activity (PA) pilot intervention program is associated with gross motor development in preschool children ages three to five years old. METHODS: Study participants were 35 children (average age=3.74 (SD 0.74); 82.67% Hispanics, 8.57% African American, 2.86% white, and 5.71% others) enrolled in two Head Start Centers in San Antonio, Texas. Gross motor …

Chronic Effects Of An Elevation Training Mask On Aerobic Capacity, Anaerobic Endurance, And Pulmonary Function, Tyler Heimdal, Lavan Rajan, Justin Vickery, Ujalashah Dhanani, Joshua Harris, Michael Moreno, David Huston, Patrick Mcculloch, Bradley Lambert

International Journal of Exercise Science: Conference Proceedings

Elevation training masks (ETM) have become popular in active/training populations to enhance performance via purported adaptations associated with altitude and respiratory muscle training. PURPOSE: To compare the effect of training with (TM) to without (CON) wearing the ETM. METHODS: 22 heathy adults (TM: ♂5, ♀6; 27.64±0.86 yr; 23.17±0.88 kg∙m² | CON: ♂5, ♀6; 29.91±1.63 yr; 24.75±1.03 kg∙m²) provided informed consent for this study. VO­₂max and time to exhaustion were assessed (Bruce protocol GXT, w/ & w/o ETM). Anaerobic endurance was assessed using two consecutive 300-yrd shuttle sprints (5min rest). Pulmonary function was assessed using …

Persistent Impairment In Cerebral Vasoreactivity In Subacute Phase Following Concussion, Sydney H. Lyng, Justin Frantz, Madeline Wainman, Tonia Sabo, Kathleen Bell, Sushmita Purkayastha

International Journal of Exercise Science: Conference Proceedings

Concussion diagnosis is characterized by a lack of objective markers, as there is a paucity of better understanding of the pathophysiology. Cerebral vasoreactivity (CVR), an important factor in cerebral blood flow (CBF) regulation with dynamic changes in metabolism can be assessed utilizing manipulation of arterial carbon dioxide. CVR utilizing transcranial Doppler ultrasonography may be a useful, objective vascular biomarker for physiological recovery. PURPOSE: To determine the link between clinical symptoms and CVR on Day-3, Day-21, and Day-90 following a concussion in comparison to the non-injured controls. METHODS: Twenty-seven male and female collegiate athletes (21 ±1years) sustaining a sports-related …

Dual Wavelength Diffuse Correlation Spectroscopy: A Novel Tool For Identifying Determinants Of Oxygen Consumption, Ryan Rosenberry, Chandan-Ganesh Bangalore-Yogananda, Susie Chung, Madison Munson, Wesley J. Tucker, Ye Zhu, Mark J. Haykowsky, Fenghua Tian, Michael Nelson

International Journal of Exercise Science: Conference Proceedings

Near-infrared diffuse correlation spectroscopy (DCS) is a novel method for measuring microvascular skeletal muscle blood flow. Our lab recently found excellent agreement between single wavelength DCS and Doppler ultrasound of the brachial artery during rhythmic handgrip exercise. PURPOSE: Here, we report new data utilizing a dual wavelength DCS system (785nm and 852nm), which extends our prior work by combining novel microvascular perfusion assessment with real-time quantification of tissue oxygenation. METHODS: We enrolled eight individuals (male/female: 3/5, mean: age 48±22 (range: 22-76 years), height 170±8cm, and weight 75±12kg). Subjects were instrumented with the DCS probe placed over the belly of …

Stress Testing For Diastolic Dysfunction: An Old Approach To A New Question, T. Jake Samuel, Rhys Beaudry, Mark J. Haykowsky, Satyam Sarma, Michael D. Nelson

International Journal of Exercise Science: Conference Proceedings

BACKGROUND: Currently, conventional cycle echocardiography is the recommended method for diagnosing diastolic dysfunction in patients with unexplained dyspnea upon exertion. However, this method has several underlying limitations including movement and respiratory artifact. These limitations are often exaggerated in patients who are obese and suffer from exertional dyspnea, and therefore limit its application in clinical diagnosis. Our group recently demonstrated that isometric handgrip echocardiography is a powerful sub-clinical diastolic discriminator that avoids the limitations of conventional cycle echocardiography and that can be easily implemented in the clinic. PURPOSE: However, to date it remains unclear how these two methodologies compare, and thus …

Exploiting Arm Swinging Dynamics To Reduce The Metabolic Cost Of Walking While Carrying Loads, Obioma B. Mcreynolds, Christopher J. Arellano

International Journal of Exercise Science: Conference Proceedings

Arm swing while walking at one’s optimal speed is primarily driven by passive pendulum mechanics, an energy saving mechanism that has been speculated to incur little to no metabolic cost. PURPOSE: In line with this idea, we set out to determine whether carrying loads on the swinging and non-swinging arms while walking would be less costly than carrying loads at other locations on the body. We hypothesized that carrying loads on the arms while restricted from swinging would demand a greater metabolic cost than carrying loads on the arms while naturally swinging. For relative comparisons, we also explored the cost …

Evidence Of Racial Differences In Microvascular Function Among College-Aged Women, Jordan C. Patik, Bryon M. Curtis, John D. Akins, Aida Nasirian, Guillermo Olvera, R Matthew Brothers

International Journal of Exercise Science: Conference Proceedings

Microvascular dysfunction contributes to the development of hypertension and insulin resistance. The black population is at an elevated risk of both conditions relative to other racial groups. Previous studies indicate that college-aged black men, compared to their white counterparts, have impaired microvascular function as assessed by post-occlusion reactive hyperemia (RH). It is unknown whether this racial disparity is present in healthy, young adult black (BW) and white women (WW). Furthermore, whether nitric oxide-mediated cutaneous microvascular hyperemia during local heating (LH) is different in these populations has not been determined. Purpose: The purpose of this study was to test the hypothesis …

Associations Between Leg Lean Mass And Arterial Function In Pre-Menopausal And Post-Menopausal Women., Stephen M. Fischer

International Journal of Exercise Science: Conference Proceedings

Vascular dysfunction has been associated to sarcopenia, the age-related impairment in skeletal muscle mass, strength, and performance, in postmenopausal women. Previous research has shown inverse relationships between leg lean mass (LM) and arterial stiffness (measured as carotid to femoral pulse wave velocity, cfPWV) or pressure wave reflection (augmentation index, AIx) in men and women. AIx is an appropriate vascular marker in young but not middle-age/older adults, especially in women.

Purpose: To examine the associations between leg LM and arterial function (cfPWV and aortic AIx adjusted to 75bpm (AIx@75)) in pre-menopausal (PRE-M) and post-menopausal (POST-M) women. Methods: 47 women (24 PRE-M, …

Skeletal Muscle Oxygenation During Plantarflexion Exercise In Young-Old And Older-Old Adults, Arun Maharaj, Salvador J. Jaime, Justin Mason, Patrick Saracino, Arturo Figueroa

International Journal of Exercise Science: Conference Proceedings

The aging process is associated with a gradual decrease in exercise performance, leg muscle blood flow and oxygenation, and endothelial vascular reactivity. Purpose: To examine potential differences in femoral artery flow-mediated dilation (fa-FMD) and calf muscle oxygenation (HbO₂) during low-intensity plantarflexion exercise in older adults. Methods: 43 young-old (YO; n=24, 67 ± 1 years) and older-old (OO: n=19, 70 ± 1 years) individuals were included in this study. We measured body fat % and leg lean mass (LLM) by DEXA and handgrip maximal voluntary contraction (MVC) using a dynamometer. VO_2max was estimated using a submaximal treadmill test. …

Accuracy Of Fitbit Surge And Smartphone Apps At Measuring Cycling Distance And Speed, Jose L. Gamez Jr., Ivan A. Figueroa, Merrill D. Funk

International Journal of Exercise Science: Conference Proceedings

There are many smartphone apps that measure distance and speed of cycling, however, there is no research on the accuracy of this cycling apps. PURPOSE: To determine the accuracy of Fitbit Surge and two smartphone applications at measuring distance and speed while cycling outside. METHODS: Thirteen college-aged students (Mean±SD; BMI: 25.2±3.0kg/m²; 10 males, 3 females) consented to participate in one measurement session. A 0.75 mile route along a sidewalk around the university campus was used for 3 separate trials using a mountain bike. A Fitbit (FB) along with an Android smartphone running Google-Fit (G-Fit) and S-Health (SH) were …

Ability Of The Functional Movement Screen (Fms) To Predict Injury In Ncaa Division Ii Track And Field Athletes And The Association Between The Fms, Eccentric Hip Abduction Strength, And Injury Risk, Shane Purser, Collin Brown, Teresa Huckaby, Shelly Weise

International Journal of Exercise Science: Conference Proceedings

A high injury rate is present in the collegiate cross country and track population. Currently no gold standard measurement exists to predict future injury. The FMS and eccentric hip strength are two potential measures to predict future injury risk. PURPOSE: To establish if the 100 point FMS and 21 point FMS scores are correlated with injury risk among NCAA Division II cross country and track and field athletes, as well as determine if hip strength is associated with injury risk or FMS score. METHODS: This investigation was an exploratory prospective cohort study of eight Division II cross country …

Assessment Of Travis County Health Disparities And Child Obesity Rates, David Rodriguez

International Journal of Exercise Science: Conference Proceedings

BACKGROUND: The youth obesity epidemic in the United States represents a prevalence of health challenges that can potentially lead to future preventable diseases. There are many factors that contribute to the ongoing obesity epidemic in America. PURPOSE: This study investigated the correlation between environmental factors, behavioral factors, socioeconomic status (SES), and obesity/overweight rates among school grade children within Travis County. We aimed to identify risk factors that contribute to obesity rates on the national, state, and Travis County levels. METHODS: We researched, contacted school district representatives, and photographed two Travis County school districts on opposite ends of the SES …

Long-Term Results Of Protocol Kidney Biopsy Directing Steroid Withdrawal In Simultaneous Pancreas-Kidney Transplant Patients, Nemin Zhu, Neal E. Rowe, Paul R. Martin, Sean S. Luke, Thomas B. Mcgregor, Frank Myslik, Vivian C. Mcalister, Alp Sener, Patrick P. Luke

Anatomy and Cell Biology Publications

Introduction: We sought to determine whether protocol biopsies could be used to guide treatment and improve outcomes in simultaneous pancreas-kidney (SPK) patients.

Methods: Between 2004 and 2013, protocol biopsies were performed on SPK patients at 3–6 months and one year post-transplant. Maintenance immunosuppression consisted of a calcineurin inhibitor, anti-proliferative agent, and corticosteroid. Corticosteroid was withdrawn in negative early biopsies, maintained in subclinical/ borderline biopsies, and increased if Banff IB or greater rejection was identified. Endpoints included presence of interstitial fibrosis and tubular atrophy on biopsy at one year (IF/TA), rejection episodes, and renal and pancreas function at five years’ followup. …

Lipidomic Analysis Of Immune Activation In Equine Leptospirosis And Leptospira-Vaccinated Horses, Paul L. Wood, Margaret Steinman, Erdal Erol, Craig Carter, Undine Christmann, Ashutosh Verma

Veterinary Diagnostic Laboratory Faculty Publications

Currently available diagnostic assays for leptospirosis cannot differentiate vaccine from infection serum antibody. Several leptospiral proteins that are upregulated during infection have been described, but their utility as a diagnostic marker is still unclear. In this study, we undertook a lipidomics approach to determine if there are any differences in the serum lipid profiles of horses naturally infected with pathogenic Leptospira spp. and horses vaccinated against a commercially available bacterin. Utilizing a high-resolution mass spectrometry serum lipidomics analytical platform, we demonstrate that cyclic phosphatidic acids, diacylglycerols, and hydroperoxide oxidation products of choline plasmalogens are elevated in the serum of naturally …

Rural Family Physicians Have A Broader Scope Of Practice Than Urban Family Physicians, Lars E. Peterson, Bo Fang

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Little is known about whether rural family physicians provide a broader scope of practice, defined as the range of clinical and procedural services that they provide, than metropolitan family physicians.
• Using data from 18,846 family physicians, we examined variations in the provision of 21 clinical services (e.g., inpatient care, home visits, and obstetrics) and 18 procedural services (e.g., prenatal ultrasound, endoscopy, and office skin procedures) across metropolitan, large rural, small rural, and frontier areas.
• We found that the percentage of family physicians providing each type of clinical and procedural service rises with increasing rurality.

Manual Therapy Interventions In A Complex Case Of Upper Quarter Symptoms In A Professional Violinist, Paul Howard, Pt, Dpt, Phd, Ocs, Faaompt

Department of Pathology, Anatomy, and Cell Biology Posters

This poster illustrates how knowledge of clinical anatomy, biomechanics, and orthopaedic manual therapy can be applied to the examination and treatment of a violinist.

Patient Perceptions Of Text Messaging To Improve Antiretroviral Therapy Adherence: A Qualitative Study Of Patients In A Ryan White Clinic, Elizabeth Sherman, Kevin A. Clauson, Shara Elrod, Paula Eckardt, Fadi Alkhateeb, Robin Jacobs

Pharmacy Faculty Publications and Presentations

Evidence on the use of short message service (SMS) to improve medication adherence in people living with HIV (PLHIV) is mounting, yet qualitative research on patient perceptions regarding SMS content and utility for HIV/AIDS remains nascent. To explore the experience of receiving medication reminders via SMS among PLHIV, 45 uninsured and underinsured PLHIV nested within the intervention arm of a larger study received daily, 1-way SMS adherence reminders. Qualitative data were collected by face-to-face, structured interview and were analyzed using conventional content analysis methods. Three main themes emerged from the data: (1) reminders helping with adherence, (2) concerns about delivery …

The Lived Experience Of Afghan Women Refugees In Three Metropolitan Areas Of The Southeastern Us: A Phenomenological Study, Brenda Brown Dns, Rn, Cne

Doctorate of Nursing Science Dissertations

The global refugee crisis has reached epic proportions. Statistics from the United Nations High Commissioner for Refugees (UNHCR, 2016) reported that in 2015 a record 65.3 million people worldwide, or 39,976 people per day, were displaced, either within their native countries or as asylees and refugees. Afghanistan, from 1980-2014, was the country with the largest number of outgoing refugees and it now ranks third in the world. At the opposite end of the continuum the United States remains the primary host country for refugees, asylees, and resettled refugees from all countries, including Afghanistan. The refugee experience is fraught with challenges …