title: Refugee health in the United States

text:
# Refugee health in the United States

Special considerations are needed to provide appropriate medical treatment for refugee migrants to the United States, who often face extreme adversity, violent and/or traumatic experiences, and travel through perilous regions. Such considerations include screenings for communicable diseases, vaccinations, posttraumatic stress disorder, and depression.

The United States has rigorous health screening guidelines for refugees and immigrants entering the country. The 1980 Federal Refugee Act enabled the US Public Health Service to facilitate health screenings for all immigrants and refugees before they depart their country of origin. The screening effort is overseen by the Office of Refugee Resettlement (ORR), housed in and funded by the U.S. Department of Health and Human Services (HHS).

Both in their countries of origin and after arriving in the U.S., refugees often face obstacles in accessing medical care. In their countries of origin, weak healthcare infrastructure and a scarcity of medical resources may prevent them from obtaining needed care prior to their departure. Often, that lack of adequate healthcare contributes to an increased likelihood of major diseases as compared to other immigrants. Upon arrival in the U.S., healthcare barriers including cognitive, structural, and financial barriers can limit access to timely, appropriate, and culturally competent care. Programs like video interpretation services, preventative care, and English language classes have been suggested to combat these barriers.

## Special health considerations for refugees

Because of the often hasty circumstances of their departures from their origin countries, refugees usually lose access to their medical records, and continuity of care is difficult to establish upon entry to the United States. In addition, the living conditions of resettlement or housing insecurity upon coming to the United States further impact refugees' health by inserting them into communities or situations where access to care is limited. This is a significant problem, especially for refugees with chronic and mental health conditions. Unlike most of the immigrant population, refugee health is of particular concern because the conditions of their immigration include experiences that may negatively impact their physical or mental health. Further, after arrival in the U.S., refugees may face obstacles to accessing care because of limited English proficiency and uncertainty of how to navigate the U.S. healthcare system. Once accessing care, ensuring that the treatment refugees receive is culturally appropriate may serve as another obstacle to maintaining a healthy life after resettlement.

There are various barriers to both accessing healthcare and achieving treatment or services that many refugees experience upon entering the country. In efforts to access care, having the correct documentation may make it difficult to qualify for care in the first place. With documentation, navigating the healthcare system and their health insurance policies can make obtaining treatment confusing and difficult. The US health insurance system is complicated - especially for refugees - in that they only receive 8 months of general care after resettlement and there are many different federal, private, and nonprofit organizations that are involved in this process. If individuals need any form of more specialized care, it is difficult to obtain.

Once gaining coverage, utilizing the available care introduces other obstacles. Language may serve as another complication, because if an individual is unable to communicate with their medical provider, receiving appropriate treatment is difficult. Having access to an interpreter and one that speaks the appropriate language is generally uncommon. Many find it difficult to have the money and the means of transportation to get coverage and treatment, as well. In the case of treatment, especially among individuals with chronic or mental health conditions, having care that is culturally appropriate can impact the refugee experience with healthcare too. Differences in cultural background and experience can mean that refugees may have different ideas about when to ask for care, assessing health concerns and associated treatment. As a result, many refugees are less inclined to access care because the United States healthcare model may not align with their cultural beliefs or values. In a 2017 study, a Somali woman's struggle to get pills that were Kosher in order to respect her religious beliefs is an example of how culturally appropriate care and treatment is a barrier to refugee individuals adequately being treated by the healthcare system.

With these barriers in mind, there are steps being taken to improve the process for acquiring care and promote a positive healthcare experience. For instance, there are individuals who act as "cultural brokers" to help refugees to access medical services, locate pharmacies, learn about their medications, and schedule follow-up treatment. Establishing communication between policymakers, frontline providers of refugee medical care, and refugees can allow for improvements in refugee health policy outcomes. Also, making sure that refugees receive continuing, thorough assessments of their mental and physical health, health promotion materials in their own language, and access to specialist services (especially in cases of torture or violence) can improve the standard of health among refugee populations. The main healthcare refugees receive is public insurance rather than private, and the majority of this healthcare is available immediately upon arrival and resettlement, but is harder to access later down the line.

### Mental health

As of 1997, states are required to provide a comprehensive health screening for all newly arrived refugees in the United States, which includes a mental evaluation, as well as a physical examination. This approach has resulted in a significant number of mental health referrals and treatments, indicating a need for increased psychological support for newly arrived refugees. The most frequently diagnosed mental condition in refugee populations is post-traumatic stress disorder (PTSD), which is commonly a result of violence. Experts have found that drug therapy, through the use of serotonin uptake inhibitors, as well as cognitive therapy have been effective treatments during resettlement. However, there still exists a lack of culturally appropriate psychiatric care that prevents adequate treatment.

The mental health of refugees remains an issue long after their resettlement in the United States. **Resettled clients commonly face stressors categorized into two main groups within the refugee population: Pre-migration stressors and Post-migration stressors. Pre-migration stressors typically involve potentially traumatic experiences in the individual's country of origin, often encompassing the compelling reasons for seeking asylum. On the other hand, Post-migration stressors comprise experiences and stressors within their host country.** Refugees often experience further mental trauma after migrating due to hostility from native citizens, or even authorities at detention centers and ports of entry, which is further exacerbated by long wait times for asylum application decisions. This process generally takes anywhere from 18 months to well over two years. In a study of Cambodian refugees (one of the largest refugee groups in the United States), it was found that, despite the passage of more than two decades since the end of the Cambodian civil war and refugee resettlement in the US, members of the group continue to have high rates of psychiatric disorders associated with trauma. Within the Cambodian refugee group, higher rates of PTSD and major depression were associated with factors such as old age, having poor English-speaking proficiency, unemployment, being retired or disabled, and living in poverty. Researchers have identified a number of factors contributing to mental illness in refugee populations, including language barriers, family separation, hostility, social isolation, and trauma prior to migration. However, few doctors in the US are equipped to address these issues, and thus, there have been calls for a refugee-specific strategy for health care that ensures equal access to services for refugees, as well as universal training for physicians to handle refugee-specific conditions and circumstances. Several barriers prevent Western mental health protocols and categorizations from effectively evaluating and treating refugees. For example, bereavement and demoralization are often labeled as depression in Western mental health. Moreover, access to mental health resources is often time-limited for newly arrived refugees, which poses another challenge for health professionals attempting to deliver effective and culturally appropriate care, which takes into account the unique history and cultural diversity of the refugee population. **Approaches in addressing specific mental health needs amongst resettled refugees have focused on trauma-informed frameworks with centered themes in "enabling safety, trust, choice, empowerment, and collaboration" While intentionally a holistic framework, trauma-informed care has been critiqued for its neoliberal constraints that often depoliticizes refugee experiences into individual medicalized needs.** **This is especially prevalent in relation to post-migration stressors, where the majority of trauma-informed focuses have targeted war exposure on mental health.** **Experts have also tied connections between post-migration stressors or "daily stressors" to exacerbated mental health challenges among refugee individuals. These critiques have brought to the rise of incorporating "trauma and violence informed" approaches to refugee mental health services that aim in acknowledging the sources of psychological stressors within structural, cultural, and systemic inequities. This includes acknowledging experiences of racism, colonization, and other systemic injustices.**

According to a study in 2013, Latino (Mexican, Cuban, Puerto Rican, or Other) women were significantly affected by pre-migration measures (migration itself and unplanned migration) that resulted in higher levels of psychological distress, but not Latino men. The study also found that both men and women were more likely to report fair or poor physical health if they migrated to the United States in an unplanned manner.

### Dental health

Poor oral health is the most common health-related issue among refugee children and is the second most common health issue among refugee adults. Poor oral health has a negative effect on quality of life and can increase the risk for chronic diseases through common risk factors mechanism Dental caries, or tooth decay puts refugee children at a higher risk for experiencing oral pain, abnormal eating patterns, slow weight gain, speech issues, and learning difficulties. Refugees from Hispanic and Asian origins are at the highest risk for dental caries, followed by those from African, Eastern European and Middle Eastern countries. Refugee children in the U.S. have been shown to have poorer oral health on average, due to many factors including country of origin, parent knowledge, inevitable diet change, access to traditional oral health tools from their home country, time spent in refugee camps, English language skills, and access to dental care once in the U.S. In the larger U.S. population, access to preventative and restorative dental services plays an important role in oral health status. Due to the complexity of these barriers, oral health problems are often diagnosed late and children receive little aftercare. Health access is influenced by factors such as limited literacy, socioeconomic status and insurance. There is limited evidence supporting current oral health interventions for refugee children in the United States, with lack of participation being a major barrier.

### Lead poisoning

Lead poisoning is an important health issue for children all around the world. The prevalence of elevated blood lead levels (i.e., BLLs ≥ 10 μg/dL) among newly resettled refugee children is substantially higher than the 2.2% prevalence for US children. A 2001 Massachusetts study found as many as 27% of newly arrived refugee children with elevated BLLs, making refugees one of the highest risk groups. Refugees may be exposed to lead from a number of sources which can include: leaded gasoline, herbal remedies, cosmetics, spices that contain lead, cottage industries that use lead in an unsafe manner, and limited regulation of emissions from larger industries. The detrimental effects of lead on children may occur with no overt symptoms and blood lead testing is the only way to determine exposure or poisoning. Lead poisoning is typically treated by identifying the lead source, eliminating that source, and regularly receiving testing to ensure that blood lead levels are decreasing. For extremely high blood lead levels (i.e., BLLs ≥ 45 μg/dL), chelation therapy may recommended for refugee children. The CDC recommends lead testing for newly arrived refugee children younger than 16 years of age. Guidelines for testing vary among states, ranging from testing children younger than six years of age to the CDC age limits of testing those younger than 16 years of age.

### Infant mortality

A study done in 2007 found that infants born to Mexican-immigrant women in the United States had a 10% lower mortality rate than infants born to non-Hispanic women in the United States. This research further support for the Hispanic paradox. Although Palestine refugee communities face socioeconomic hardship and have high fertility rates, their infant and childhood mortality rates are among the lowest in the Arab world. The causes of neonatal mortality among Palestine refugees are proportionally similar to those found in the most developed regions of the world. Non-communicable diseases are the leading causes of infant, and particularly neonatal deaths, among Palestine refugees, as they are among industrialized countries in Europe and North America.

Poor oral health has a negative effect on quality of life and can increase the risk for chronic diseases through common risk factors mechanism. Poor oral health has a negative effect on quality of life and can increase the risk for chronic diseases through common risk factors mechanism.

### Diet

US refugees have elevated rates of chronic diseases, including obesity, diabetes, hypertension, malnutrition, and anemia, compared with US-born residents or first-generation immigrants. First, refugees encounter language barriers: they need time to acculturate to unfamiliar language and food environments in the United States. Second, refugee beliefs and home-country culture, in conjunction with postresettlement socioeconomic status (SES; which is often lower), influence what types of food can be purchased and consumed. Third, limited information about foods, shopping, and recipes in the United States creates another barrier to purchasing healthy foods. Fourth, high intake of processed and energy-dense foods in the United States contributes to chronic disease risk. A study that based its research on the New Immigrant Survey (NIS) found that Hispanic immigrants that have been in the United States the longest have experienced greater changes in their diet. Of these Hispanics with the greater change in their diet since moving to the U.S., the ones who have reported the worst health are the ones who have spent more time in the United States. Also, Hispanic immigrants who have spent the most time in the U.S. and reported worse health were also more likely to report the use of English language in their workplace. These findings demonstrate some correlation between Hispanic-immigrant health and their assimilation to American behavior in the United States. Another study reported that only 13% of refugees studied felt they ate generally healthy diets in the United States. They also reported difficulties locating preferred foods. Lack of healthy food options in the past shaped their dietary habits and food choices poorly after resettlement. For example, 32% of Bhutanese refugees had vitamin B-12 deficiencies, likely due to a scarcity of meat, eggs, and dairy in their Nepal diets.

### Women's health

Refugee women have unique and challenging concerns in terms of accessing healthcare after resettlement in the United States. This includes reproductive and maternal health, mental health, and domestic violence. Culturally influenced gender roles may influence health concerns and access to treatment for female refugees, especially within the realm of reproductive, domestic violence, and psychological care. It can be difficult to obtain appropriate preventative or specialized care to treat these medical concerns with the limited healthcare options available to refugee women.

This is especially apparent in terms of reproductive healthcare, where there is a low number of women screened for cervical and breast cancer compared to the large women with reproductive health needs. These screenings, in addition to other preventative services like STD testing and birth control options are important ways to assess sexual health, but many women are not able to receive these services for cultural or systemic reasons and may develop more serious health conditions as a result. In addition to birth control, female refugees were less likely to access prenatal and maternal care than native-born or other immigrant US populations despite receiving equal coverage in the United States. While refugee mothers are less likely to access prenatal and maternal services due to social and economic barriers, they are often more susceptible to cesarean sections, low birth rates, and other health issues.

Mental health is another issue faced by many refugee women which may result from their experience in their home country and the process of migrating and settling in the US. In a study conducted by Chris Brown in 2010, the results highlight that language proficiency, economic stress, and maternal stress all impact the mental health of Vietnamese female refugees. They also point out that much of this stress can be associated with the traumatic experiences or the stress to adapt and conform to the new culture of the United States that these women have experienced. While many men, women, and children are exposed to traumatic situations, women are more likely to experience PTSD, anxiety and other mental health conditions as a result because they are more prone to inter-personal trauma such as family separation, domestic violence or rape.

Another health issue that affects refugee women disproportionately is sexual and gender-based violence. While men also experience sexual violence, women are an especially vulnerable population because of shifting gender roles and power dynamics as they flee their home country and migrate and resettle in a new place. Gender-based violence is prevalent in both the home country and the country of resettlement as an instrument of war, in resettlement camps, and in families and communities throughout the resettlement process. This sexual violence is also present for refugee women through the form of trafficking during migration from their home country. Refugee women are exposed to many forms of gender-based violence in addition to the experience of domestic violence, and attaining care can be difficult due to failure to report these issues because of cultural taboo or unstable home life and the lack of support and service related to domestic violence and receiving help as reported by the refugee women. In addition to personal and social barriers to reporting their experiences, refugee women simply do not have access to appropriate medical and psychological services needed for treatment, which continues to make them a vulnerable population after resettlement.

## Medical screening for entry to the United States

The Centers for Disease Control and Prevention provides two major categories of refugee health guidelines:

* The **overseas medical screening guidelines** provide panel physicians guidance on the overseas pre-departure presumptive treatments for malaria and intestinal parasites. These screenings are usually conducted days to weeks before the refugee departs from his or her country of asylum.
* The **domestic medical screening guidelines** are provided for state public health departments and medical providers in the United States who conduct the initial medical screening for refugees. These screenings are usually conducted 30–90 days post-arrival in the United States.

### Overseas protective actions

Three medical interventions are either required or recommended in order to contain infectious diseases and reduce the medical burdens that may be associated with refugee resettlement. First is a mandatory overseas screening for all refugees and immigrants, then a recommended domestic screening for refugees, and finally a required medical component to the Adjustment of Status (Green Card) process.

These medical exams are performed by approximately 400 physicians (called Panel Physicians) selected by the US Department of State (DOS) consular officials. The CDC Division of Global Migration and Quarantine (DGMQ) provides technical instructions and guidance to the physicians conducting overseas exams. The screening is primarily aimed at detecting infectious diseases of public health concern. The overseas exam includes a medical history inquiry, physical exam, chest x-ray for persons older than 14 years of age (Southeast Asian refugees older than 2 years of age), and specific lab tests. Testing routinely includes screening for syphilis and HIV in people over 15 years of age.

#### Laws

The CDC's Division of Global Migration and Quarantine is responsible for providing the US Department of State and the United States Citizenship and Immigration Services (USCIS) with medical screening guidelines. The guidelines are developed in accordance with Section 212(a)(1)(A) of the Immigration and Nationality Act (INA), which outlines the reasons an alien is ineligible for a visa or admission to the United States, specifically based on health grounds. "The health-related grounds include those aliens who have a communicable disease of public health significance, who fail to present documentation of having received vaccination against vaccine-preventable diseases, who have or have had a physical or mental disorder with associated harmful behavior, and who are drug abusers or addicts." Medical conditions recognized in refugees are categorized as Class A or Class B and are described below. If a refugee is found to have an inadmissible health-related condition, a waiver is required for the applicant to come to the US.

#### Class conditions

The health-related grounds for the exclusion of refugees and immigrants set forth in the law are implemented by a regulation, "Medical Examination of Aliens" (42 CFR, Part 34). The regulation lists certain disorders that, if identified during the overseas medical examination, are grounds for exclusion (Class A condition) or represent such significant health problems (Class B condition) that they must be brought to the attention of consular authorities.

The purpose of the medical examination is to determine whether an alien has 1) a physical or mental disorder (including a communicable disease of public health significance or drug abuse/addiction) that renders him or her ineligible for admission or adjustment of status (Class A condition); or 2) a physical or mental disorder that, although not constituting a specific excludable condition, represents a departure from normal health or well-being that is significant enough to possibly interfere with the person's ability to care for themselves, or to attend school or work, or that may require extensive medical treatment or institutionalization in the future (Class B condition).

| Class A conditions | Class B conditions |
| --- | --- |
| Conditions which preclude entry to the US, including communicable diseases of public health significance, mental illnesses associated with violent behavior, and drug addiction | Conditions identified as amounting to a substantial departure from normal well-being. |
| If a Class A condition is indicated, refugees must undergo treatment before they are eligible for entry to the U.S. | If a Class B condition is indicated, refugees will likely receive treatment prior to departure from their country of origin, as well as follow-up care upon arrival in the U.S. |
|  |  |

### Domestic preventative actions

When refugees enter the United States, they must enter through one of the authorized ports of entry that have Quarantine Stations. At these locations, US Public Health Service personnel review refugees' medical documents and perform limited inspections to look for obvious signs of illness. Through an electronic notification system maintained by the CDC, state health officials in the destination state are notified and sent copies of the overseas medical exam.

Upon arrival in the US, it is recommended that refugees complete a domestic health screening that seeks to reduce health-related barriers to successful resettlement and protect the health of the US population. Domestic health exams focus on infectious disease screening, but can also offer diagnosis and treatment for other health conditions identified. The parameters of the screening are based upon the 1995 Office of Refugee Resettlement Medical Screening Protocol, but new guidance is forthcoming.

#### Laws

The Refugee Act of 1980, which amended the Immigration and Nationality Act to establish a domestic refugee resettlement program, has outlined several public health activities with regards to refugee resettlement. First, all state or local health officials are to be notified of each refugee's arrival so that they can provide timely treatment for health conditions of public health significance identified overseas. The Director of ORR has the authority to make grants to state or local health agencies to help them meet the costs of providing medical screening and initial medical treatment to refugees. In this way, states can provide domestic health assessment services with federal refugee funding support. To qualify for this funding, the state health assessments need to be in accordance with ORR requirements and approved by the ORR director. It is recommended that a refugee receive a health screening within 90 days of entering the United States. The screening protocols are left to state health officials with the approval of ORR.

#### Domestic health assessment

A Medical Screening Protocol for Newly Arriving Refugees was developed by ORR in collaboration with CDC in 1995. Many states have added requirements in addition to the ORR protocol. DHHS is now drafting guidance for an expanded domestic protocol for screening refugees. The scope of the domestic health exam includes:

* Follow up (evaluation, treatment and/or referral) of Class A and B conditions identified during the overseas medical exam
* Identification of persons with communicable diseases of potential public health importance that were not identified during, or developed subsequent to the overseas exam
* Introduction of incoming refugees and eligible clients to the US healthcare system, and
* Identification of conditions that could present a barrier to self-sufficiency

### Adjustment of status exam

Refugees are eligible to apply for adjustment of status after one year in the US. While most immigrants are required to have a full medical exam at the time of applying for adjustment of status, refugees are an exception. Refugees who arrived without a Class A condition only require vaccinations with their adjustment of status; the full medical examination is not required. A full medical exam is only required for refugees if a Class A condition existed prior to arrival in the US.

## Sample U.S. programs

Because each state is responsible for coordinating refugee health screenings, protocols vary by state. A sampling of information about various state Refugee Health Programs is listed below:

## Healthcare barriers

Resettled refugee communities find themselves particularly vulnerable to healthcare barriers and are often unable to attain and sustain health and wellbeing for themselves and their families due to structural inequities, poor social determinants of health, and a lack of access to health care resources. According to a 2009 study by Morris et al., refugees face a higher risk of low birth weight, poor educational outcomes, and higher rates of chronic physical and mental illnesses compared to United States Citizens.

A 2012 study conducted by Kullgren et al. found that the most prevalent reasons for delayed and/or unmet healthcare for adults in the United States were lack of affordability and accommodation. For example, worries about cost and inability to make time due to work or other commitments serve as the most and second most prevalent reasons for inadequate adult healthcare. The study also found that non-financial barriers including those in accommodation, availability, accessibility, and acceptability create more delays in adult healthcare than barriers in affordability.

According to a 2011 paper by Carrillo et al., healthcare disparities between races and ethnic groups affect health status and access, and healthcare access barriers can play a role in understanding the reasons behind these disparities. The paper described how healthcare barrier models like the Health Care Access Barriers (HCAB) model provide a framework for analyzing, categorizing, and detailing the determinants of health status. The HCAB model categorizes measurable healthcare barriers into financial, structural, and cognitive groups. Researchers have used this model to analyze the root causes for refugee health barriers and aid in interventions. For example, a 2016 study conducted by researchers in Jordan found that the common perceived structural barriers for Syrian refugees in Jordan included long waiting times, extensive service procedures and long distances. According to the study, financial barriers consisted of high costs of medical service, medicine and transportation. Cognitive barriers consisted of lack of trust, discrimination, and knowledge of the location and structure of the health care systems. These barriers are also stated in refugee studies in the United States and other countries as well. The paper by Carrillo et al. also detailed other health care access models like the Anderson's Behavioral Model of Health Services Use and its variations which have also been used to model access barriers.

According to a health assessment report based in San Diego, the five most major perceived health care barriers consisted of language, transportation, lack of insurance, cultural barriers, and lack of knowledge of the U.S. healthcare system. A 2011 clinical review stated how those barriers apply to many of the three million refugees who have entered the United States over the past three decades. And in just the last decade, around 600,000 refugees have arrived in the United States. A 2018 patient-centered review stated that poor health care access before arrival, discrimination, and trauma have contributed to the increased likelihood of major health issues in refugees as compared to other immigrants. The 2011 study by Asgary and Segar, which involved interviews with asylum seekers and expert providers/representatives of advocacy organizations, proposed that all levels of the healthcare system from the refugees and providers to the policymakers should work together to address healthcare barriers. To do so, the paper suggested that governmental, non-governmental, medical and legal organizations all work together to provide accessible medical care for refugees. A Metropolitan Policy Program has suggested that the maintenance and formation of local, state, and nationwide health assistance should include health care access and language skills.

As a result of the COVID-19 pandemic, a survey conducted in 2021 found that refugee communities primarily composed of African and Southeast Asian were suffering disproportionately from the effects of the pandemic. Specifically, 76% reported difficulty paying for food, housing and healthcare, 70% reported lost income, and 58% indicated concern about paying bills.

### Cognitive barriers

Cognitive Barriers include but are not limited to insufficient knowledge, language, communication and health literacy. A 2009 study conducted by Morris et al. in California, found that unawareness of the cause and effect relationship between lifestyle choices, preventative actions, and health consequences can also lead to an unhealthy mentality towards health. Refugees unfamiliar to the culture and language of the United States face cognitive barriers at all levels of health care access. A 2019 review on healthcare challenges for refugees stated that communication is a prevalent issue. According to the review, adequate communication is needed to understand the reason for patient arrival, the underlying symptoms, the diagnosis, the future diagnostic tests required, and the prognosis and treatment plan. Results from a 2011 interview centered study has shown that linguistic and cultural cognitive barriers constitute the biggest hurdles in providing equitable care for refugees. The paper recommended an increase of professional interpreters and intercultural mediators into existing routines is recommended.

The 2019 review on refugee healthcare challenges also found that interpreter availability and quality can be directly associated with improved and increased health care use by refugees. The paper recommended professional interpreters for their knowledge on the healthcare system and health care vocabulary over using family and friends due to privacy reasons as well as biases that could impact patient decisions. The 2009 study by Morris et al. found that most refugees rely on family and friends for interpretation rather than professional services which can lead to misinterpretation issues. As a solution, refugee serving organizations have proposed that healthcare providers and clinics provide professional interpretation services. Both healthcare providers and refugee serving organizations face difficulties in establishing this service due to factors like cost and inconvenience. Other suggestions include AT&T language line services, improved interpretation quality, increased English language classes, and video interpretation services to name a few.

According to multiple studies on refugee language proficiency, language barriers can hinder appointment scheduling, prescription filling, and clear communications, and have been associated with health declines, which can be attributed to reduced compliance and delays in seeking care. Doctor patient interactions can become strained through the use of unfamiliar medical jargon. The Immigrant Access to Health and Human Services project states that the persistence of these cognitive barriers may be due in part to the lack of strong health care, social, and provider networks. It found that knowledge of services is primarily spread through word of mouth, so limited networks can constitute a significant barrier. A 2019 public health review found that the limited networks and lack of knowledge that refugees have on the U.S. healthcare system leave them with inequalities in healthcare access. Currently, it states that there are not many policies or practices aimed at overcoming these cognitive barriers for refugees. It recommends that communication strategies and services targeted at these inequalities should be put in place.

The United States does have federal legislation on Culturally and Linguistically Appropriate Standards (CLAS), which is legislation aimed at reducing healthcare inequities through culturally competent care. The 2011 study by Asgary and Segar stated that even with this legislation, many refugees are hesitant to access those resources for fear of being misunderstood or being unable to access quality interpretation services for their language. It also found that no legislative bodies hold hospitals up to the standards of CLAS, and the enforcement of laws relies on complaints.

The 2019 review on healthcare challenges for refugees and migrants found that health care and health literacy could be compromised without knowledge on the healthcare system. A 2019 study on healthcare access barriers found that many refugees do not understand the structure of western medical appointments and thus are unfamiliar with what concerns to bring up and when to conclude their session with their healthcare provider. In terms of health literacy, many refugees don't understand the importance of a healthy diet and exercise in managing and preventing chronic diseases like Diabetes. The study recommended programs emphasizing preventative care through cultural and age appropriate means can improve health literacy.

### Structural barriers

A qualitative 2018 study by Sian et al. stated that structural barriers include transportation, geographical distance, waiting times, service availability, and general health infrastructure and organization. All of those barriers could physically hinder health access. A 2012 research brief found that structural barriers could also overlap with economic and cognitive barriers. For example, lack of interpretation services and the literacy to pass a drivers test would constitute as both structural and cognitive barriers.

The Immigrant Access to Health and Human Services project found that both rural and urban areas may lack adequate public transportation systems or be too expensive to navigate through taxis. According to the study conducted by Asgary and Segar, patients often do not have the time off work to access healthcare services. They found that refugees often prioritize employment, shelter and food over healthcare services. A book on nursing research states that clinic structure and hours constitute a structural barrier because they overlap with working hours and require long waiting times that exceed what refugees can set aside. The immigrant health project stated that providers are often unable to understand a refugee's specific experiences and style and language of communication. They suggest the inclusion of research based education for providers to better empathize with their patients.

Common characteristics of refugee communities include larger families living in crowded housing, low-paid front line workers in a variety of industries, limited English skills, poor access to and use of healthcare services, high degrees of financial and food insecurity, low rates of health insurance and high degrees of stress. Factors such as these exemplify the poor social determinants of health that may lead to adverse health outcomes in resettled refugee populations.

#### The Healthy Migrant Effect

The "healthy migrant effect" is a phenomenon wherein first-generation born immigrants arrive in the United States with an overall better quality of health than U.S. born citizens of the same racial or ethnic background. A longitudinal study conducted in 2001 by Singh et al. found that immigrant men and women had significantly lower risks of mortality than their U.S. born counterparts. A 2002 study that compared the hospital utilization records and mortality rates of foreign born and U.S. born New York residents discovered that immigrants were healthier and had longer life expectancies than U.S. born citizens. However, structural inequities faced by refugees such as lack of access to housing, employment, education, and healthcare eventually reduce the immigrant health advantage, leaving them with worse health outcomes than the general population.

### Financial barriers

Resettled refugees face financial barriers to food, housing, and healthcare which can result in adverse health outcomes. Data has shown that approximately 21 percent of immigrant children in the U.S. live in poverty as opposed to 14 percent of native-born children. The low socioeconomic status of refugees is associated with numerous health risks such as malnutrition, smoking, injuries, unemployment, family dysfunction, psychosocial stress, and more.

A 2016 study on refugee insurance access stated that financial barriers for refugees made healthcare less accessible and affordable and could include differing state health insurance coverage policies, inadequate income, and insurance restrictions by employers. For the first eight months, most refugees have access to a health insurance called Refugee Medical Assistance (RMA). Other refugees may be eligible for more long term coverage through health insurance plans like Medicaid or the Children's Health Insurance Program, which last for several years. To allow refugees to look for cheaper health insurances, The Affordable Care Act created the Marketplace. According to the 2016 study, policies like the Patient Protection Act and Affordable Care Act have aimed at expanding health insurance coverage to refugees through the Medicaid program or health insurance marketplaces, but healthcare access differ between states because the states have implemented their health insurance programs differently. The paper suggests that the Department of Health and Human Services could provide subsidies to refugees seeking to purchase health exchanges, and during the screening process, federal agencies could also consider health status when resettling refugees and place them into states with more suitable health insurance policies. According to a 2018 study on healthcare access barriers, though refugees have access to free healthcare services from federally qualified health centers (FQHCs), nonprofit hospitals and General Assistance (GA), specialist care like dentist and eye care are often unaffordable.

Moreover, lack of insurance is associated with reduced access to healthcare and according to data from the National Survey of American Families, 22 percent of immigrant children are uninsured, more than twice the rate for U.S. born citizens.

,


title: Nemo (American band)

abstract: Nemo was an American indie rock band formed in Brooklyn, New York in 2002 by Luke McCartney and Dennis Tyhacz. The band took their name from the character Captain Nemo in Jules Verne's 1870 novel Twenty Thousand Leagues Under the Seas. Their debut album Signs of Life was released in June 2004 on Binge Records. The album was notable for its blend of new wave, ethereal acoustic sounds, and inspired indie rock. It was recorded entirely in an apartment in Williamsburg, Brooklyn in 2003 prior to becoming one of the final LPs to be mastered at the Vic Thrill Salon in Brooklyn. The title track "Signs of Life" was featured in Season 2 of the PBS show Roadtrip Nation in 2005, and several of the songs on Signs of Life were also used as the backing music for NPR's Morning Edition show for several years after the album's initial release. McCartney and Tyhacz later recorded in a group in 2006 called The Sound Mirrors, and they released one LP The Calling in 2007, also on Binge Records.

text:
# Nemo (American band)

**Nemo** was an American indie rock band formed in Brooklyn, New York in 2002 by Luke McCartney and Dennis Tyhacz. The band took their name from the character Captain Nemo in Jules Verne's 1870 novel *Twenty Thousand Leagues Under the Seas*.

Their debut album ***Signs of Life*** was released in June 2004 on Binge Records. The album was notable for its blend of new wave, ethereal acoustic sounds, and inspired indie rock. It was recorded entirely in an apartment in Williamsburg, Brooklyn in 2003 prior to becoming one of the final LPs to be mastered at the Vic Thrill Salon in Brooklyn (shortly before the Salon was closed in 2004). The title track "Signs of Life" was featured in Season 2 of the PBS show Roadtrip Nation in 2005, and several of the songs on *Signs of Life* were also used as the backing music for NPR's Morning Edition show for several years after the album's initial release. McCartney and Tyhacz later recorded in a group in 2006 called The Sound Mirrors, and they released one LP *The Calling* in 2007, also on Binge Records.

## Members

Luke McCartney, Dennis Tyhacz

Additional members (touring and/or recording): Chris Plyem, Sam McCall

## Albums

## Track listing

1. Metropolitan - 3:11
2. Northern Light - 2:39
3. The Burn - 1:59
4. Aviator - 2:23
5. Signs of Life - 3:05
6. Lunar Ship to Mars -2:33
7. Fiction of Reality - 2:34
8. Hampshire Brush - 2:39
9. Odyssey - 3:13
10. The Chariot - 2:20
11. Swimming in the Rhine - 2:33
12. Fall Away - 2:23
13. Killer Bees - 1:17
14. Eternity of This - 2:40
15. The Sun of Ulee - 2:58
16. Ether - 1:53
17. Harbor - 2:34

1. Independent Clauses Archived 2007-09-27 at the Wayback Machine
2. "Nemo Interview". 2 November 2005.
3. "Roadtrip Nation | Find your career roadmap".
4. "Morning Edition for August 22, 2007". *NPR*.
5. "Morning Edition for July 28, 2006". *NPR*.
6. nemony.com/bio.html
7. nemony.com/press.html
8. CD Baby: NEMO: Signs Of Life
9. allmusic ((( Nemo \> Overview )))
10. "Independent Clauses". Archived from the original on 2007-09-27. Retrieved 2007-05-09.
11. allmusic ((( Nemo \> Discography \> Main Albums )))
12. "Signs of Life — Nemo".

## InfoBox

| Nemo | |
| --- | --- |
| Origin | Brooklyn, NY |
| Genres | Indie rock, rock |
| Years active | 2002-2005 |
| Labels | Binge Records |
|  | |
| Members | Dennis Tyhacz, Luke McCartney |


title: Monagas (surname)

abstract: The last name Monagas is a Hispanicized version of the Irish surname Monaghan

text:
# Monagas (surname)

The last name *Monagas* is a Hispanicized version of the Irish surname Monaghan

## Origins

The Monagas family originated in County Monaghan in Ireland, the first use of the last name Monagas was in the 1600s when Irish officials immigrated to the Canary Islands (Spain), to aid Spanish soldiers in defending the new colony from pirates. After Spanish colonies were set up in South America, many of the descendants of Monaghan emigrated from the Canary Islands and settled in the Viceroyalty of New Granada. When Spanish emigration peaked in the late 19th and early 20th centuries, many *Monagases* moved to Latin America, as a result their descendants can be found throughout South America and the Caribbean, particularly in Venezuela, Cuba and Puerto Rico.

## People

Notable people with the surname include:

1. "Where does the surname Monagas come from originally?". Retrieved 10 February 2019.


title: Heritage King

abstract: Heritage King, formerly the King Local Architectural Conservation Advisory Committee, is a conservation committee in King Township, Ontario, Canada. Consisting of between five and eleven members, with at least one township councillor, the committee advises council on local heritage matters. Founded in 1982, Heritage King exists by township by-law under the Ontario Heritage Act, which "provides a framework within which municipalities can ensure the conservation of properties of cultural heritage value or interest"

text:
# Heritage King

**Heritage King**, formerly the *King Local Architectural Conservation Advisory Committee*, is a conservation committee in King Township, Ontario, Canada. Consisting of between five and eleven members, with at least one township councillor, the committee advises council on local heritage matters. Founded in 1982, *Heritage King* exists by township by-law under the *Ontario Heritage Act*, which "*provides a framework within which municipalities can ensure the conservation of properties of cultural heritage value or interest*"


title: Wen Ping

abstract: Wen Ping, courtesy name Zhongye, was a military general who lived during the late Eastern Han dynasty and Three Kingdoms period of China. During his tenure as a general under the warlord Cao Cao, he was credited with defeating the enemy general Guan Yu and defending Cao Cao's interests in Jiangxia Commandery from the eastern warlord Sun Quan.

text:
# Wen Ping

**Wen Ping** (Chinese: 文聘; pinyin: *Wén Pìn*; fl.208 - 240s), courtesy name **Zhongye**, was a military general who lived during the late Eastern Han dynasty and Three Kingdoms period of China. During his tenure as a general under the warlord Cao Cao, he was credited with defeating the enemy general Guan Yu and defending Cao Cao's interests in Jiangxia Commandery from the eastern warlord Sun Quan.

## Early life

Wen Ping was from Wan County (宛縣), which is in present-day Nanyang, Henan. He originally served under Liu Biao, the Governor of Jing Province, and was tasked with defending the province's northern frontier, stationed at Xiangyang. In 208, after Liu Biao's death, his younger son and successor Liu Cong surrendered to the warlord Cao Cao, who was the *de facto* head of the Han central government. When Liu Cong went to greet Cao Cao, he passed by Wen Ping's camp and urged him to come with but Wen Ping replied "I could not defend the province, and must go face my failure and nothing more". Once when Cao Cao crossed the Han River did Wen Ping go to meet the warlord. When Cao Cao asked him why he surrendered so late, he weepingly replied "In former days, I failed to assist Liu Biao serve the state. Though Liu Biao is dead, I was still hoping to hold the line of the Han and maintain that territory intact. That way, if I lived I would not be turning my back on the orphaned and weak, and if I died there would be no shame below the ground. The decision, however, has been taken out of my hands, and so we come to this. Indeed, I am sad and ashamed and I could not face coming to audience any earlier". Cao Cao praised Wen Pin's loyalty and returned his military command though the later commentator Sun Sheng was critical, wondering how the former officer of Lü Bu, Zang Ba and Wen Ping could retain their reputation for loyalty yet change loyalty after one meeting with Cao Cao.

## Service under Cao Cao

Wen Ping was sent with cavalry commander Cao Chun to pursue Cao Cao's fleeing rival, Liu Bei, and caught up with him at the Battle of Changban. However, Liu Bei managed to escape and form an alliance with the eastern warlord Sun Quan. In the winter of 208–209, the allied forces of Sun Quan and Liu Bei defeated Cao Cao's forces at the decisive Battle of Red Cliffs. After his defeat, Cao Cao was concerned about local loyalties with concerns about Eastern Wu's expansion so appointed Wen Ping as the Administrator of Jiangxia Commandery (commandery capital in present-day Xinzhou District, Wuhan, Hubei), which was located strategically near the border between Cao Cao and Sun Quan's territories and rivaled veteran Sun general Cheng Pu's claim to the area. Cao Cao also had Emperor Xian, the figurehead Han emperor, enoff Wen Ping as a Secondary Marquis (關內侯), the lowest among the marquis ranks of the Han dynasty.

In 209, Wen Ping joined Cao Cao's general Cao Ren at the Battle of Jiangling against Sun Quan's forces led by the general Zhou Yu. When Liu Bei's general Guan Yu attempted to cut off Cao Ren's communication lines, Wen Ping and his colleague Yue Jin, station at Xiangyang, defeated Guan Yu at Xunkou (尋口) and drove him back. In recognition of his contributions in battle, the Han imperial court promoted Wen Ping to a village marquis under the title "Marquis of Yanshou Village" (延壽亭侯) and awarded him the appointment of General Who Attacks Rebels (討逆將軍). Wen Ping launched further raids, destroying Guan Yu's supply train at Han Ford (漢津) and burnt his fleet at Jingcheng. At the time, Wen Ping and Yue Jin successfully secured the supply and communication lines of Jiangling; however, the casualties on Cao Cao's forces were beyond affordable level after nearly a year of intense fighting, so Cao Cao admitted defeat and ordered his generals to forfeit Jiangling. From then on Wen Ping entered into a defensive position in the eastern flank at Jiangxia Commandery against Sun Quan and rival claimant Cheng Pu.

## Service under Cao Pi

After Cao Cao's death in 220, his eldest living son Cao Pi became emperor of the Cao Wei state after Emperor Xian abdicated, as part of the rewards of the new regime Wen Ping was given a staff of authority and raised in fiefdom to "Marquis of Chang'an District" (長安鄉侯). In 222, with Lu Xun's victory against Liu Bei at the Battle of Xiaoting removing a threat from King Sun Quan's borders, the Wu ruler refused to send his son Sun Deng as hostage to Wei court. Cao Pi formulated a plan for a three-pronged attack on Sun Quan, ordering Wen Ping to join the generals Zhang He, Xu Huang, Xiahou Shang and Cao Zhen in attacking Sun Quan's stronghold at Jiangling.

Like the last battle at Jiangling, the Wei forces enjoyed numerical advantage, but this time, they were on the offensive. However, the Wei forces ultimately did not make much progress because the defenders under Zhu Ran put up a strong resistance. Wu sent a series of reinforcements and against one (commander unknown) of those waves, Wen Ping was sent with his detachment to defend Miankou, a key chokepoint of the Mian River, with his warships, winning at Shifan. Cao Pi eventually called off the attack on Jiangling due to epidemic through Wei ranks and rewarded Wen Pin with a promotion to General of the Rear (後將軍), in addition to elevating him from a district marquis to a county marquis under the title "Marquis of Xinye" (新野侯).

## Service under Cao Rui and legacy

Wu had avoided attacking Wen Ping's position at his capital of Shiyang (石陽), something Wei recorded credited due to his fame shaking Wu after decades of good service. There was one exception, in the autumn of 226 after the death of Cao Pi with his son Cao Rui new to the throne. Sun Quan sought to take advantage on hearing the news and led 50,000 troops against Wei Ping's capital. There are two versions of what exactly happened. In the main *Sanguozhi*, Wen Ping was besieged for over twenty days but put up a resilient defence. Word reached the Cao Wei court but Cao Rui was confident since he believed Sun Quan had only attacked in the hopes of catching the defenders by surprise and wouldn't dare stay too long, now that he was engaged in a siege with Wen Ping. The official Xun Yu was dispatched with a thousand troops and he gathered more from the counties he passed through on the way to Jiangxia. On arrival, Xun Yu and his army took to the hills, setting fires as a show of force. Sun Quan retreated and Wen Ping pursued during the night, inflicting casualties with the isolated enemy general Pan Zhang having to be rescued by Zhu Ran. For his victory, Wei Ping's fief was increased by 500 households.

The Cao Wei historian Yu Huan provides an alternative account in his *Weilüe*. Sun Quan led tens of thousands against Shiyang where heavy rains had damaged the walls while the people were scattered among the fields so repairs could not be carried out in time. Without the walls and outnumbered, Wen Ping was in a bind but then thought that, if it seemed nobody was in the city, Sun Quan would get suspicious and expect a ploy. Wen Ping had everyone hide and remained in his residence. Sun Quan was puzzled since the Cao Wei court would not leave such an important post in the hands of a figure they did not trust so Wei Ping's lack of reaction to an invading army must be due to a ploy or knowing reinforcements were coming so Sun Quan ordered an immediate withdrawal. Pei Songzhi notes the account contradicts the base text of Chen Shou.

It would be his last known battle. It is not known when Wen Ping died. After his death, he was honored with the posthumous title "Marquis Zhuang" (壯侯) by the Wei government. His adopted son, Wen Xiu (文休), inherited his marquis title ("Marquis of Xinye") because his biological son, Wen Dai (文岱), died early. Wen Xiu was in turn succeeded by his son, Wen Wu (文武), after his death. Wen Ping also had a nephew, Wen Hou (文厚), who was enfeoffed as a secondary marquis. In August 243, with the young Cao Fang on the throne under the regency of Cao Shuang and Sima Yi, sacrifices were made at Cao Cao's temple to a select group of former officers, including Wen Ping.

## In *Romance of the Three Kingdoms*

Wen Ping first appears in chapter 34, he and Wang Wei recommended by Kuai Yue to hold a banquet for military officers so Zhao Yun would have to attend, allowing Cai Mao to attempt to kill Liu Bei without his bodyguard though, thanks to a tip off, the attempt to kill Liu Bei would fail. He next appears after Liu Cong surrenders, Liu Bei appears at the regime's capital of Xiangyang to seek a meeting and Wei Yan opens the gates. Wen Ping takes some horsemen to stop him and fights Wei Yan, Liu Bei is concerned by this reception and leaves. The battle between Wei Yan and Wen Ping lasts for some hours with most combatants dead before Wei Yan flees. Refuses to go to Cao Cao, then the weeping submission scene, immediately made Governor of Jiangxia and enoffed.

Takes part in pursuit of Liu Bei at Changban, intercepting Liu Bei but is ashamed when Liu Bei calls him a turncoat and retreats. When Zhao Yun rescues the infant Liu Shan and fights his way back to Liu Bei, Wen Ping pursues but halts when they come against Zhang Fei's fierce appearance on the bridge and what they fear is an ambush. At Chibi, as a man used to the waters, given command of the left squadron of the naval forces, dispatched with thirty ships to support Jiao Chu and Zhang Neng's unsuccessful attack, battles the naval forces of Han Dang and Zhou Tai but soon discovers his forces are outmatched so retreat. Sent to intercept Huang Gai's approaching ships as Cheng Yu realizes the defection is fake, however Wen Ping is injured by an arrow to the arm and his forces collapse with Huang Gai launching his fire attack on the main fleet. Is able to escape with Mao Jie and a few horsemen to rejoin Cao Cao on the troubled march home.

Takes part in archery contest to celebrate opening of the Bronze Bird Terrace in Ye, impressing as he hits bulls-eye at full gallop. Takes part in the defense of Hanzhong, when Huang Zhong attempts to raid the supply lines the attackers are surrounded and Zhang Zhu's attempt to return to camp is intercepted by Wen Ping but Zhao Yun arrives to drive off Wei Ping's men with subordinate Murong Lie killed. In 224, with Cao Cao dead and Cao Pi having taken the throne, made a chief commander for campaign against Eastern Wu who were negotiating to restore alliance with Shu-Han. Cao Pi's forces arrive at Guangling but are shocked as opposing commander Xu Sheng builds fake-walls overnight. As Cao Pi considers his options, his capital ship is hit by a storm and Cao Zhen sends Wen Ping to rescue those on the ship. Wen Ping's sailors were too scared by the storm so, with the great ship seeming likely to capsize, Wen Ping leapt on board and got Cao Pi to the safety of a small boat that took the Emperor to a creek to stay out the storm. With news coming of an attack by Zhao Yun in the north-west, Cao Pi retreats and Wen Ping's time in the novel ends.

## InfoBox

| Wen Ping | |
| --- | --- |
| 文聘 | |
|  | |
| Administrator of Jiangxia (江夏太守) | |
| **In office**
220 (220)–? (?) | |
| Monarch | Cao Pi |
| **In office**
c. 208 (c. 208)–220 (220) | |
| Monarch | Emperor Xian of Han |
| Chancellor | Cao Cao |
| Preceded by | Liu Qi |
| General Who Attacks Rebels (討逆將軍) | |
| **In office**
c. ? (c. ?)–222 (222) | |
| General of the Rear (後將軍) | |
| **In office**
c. 222 (c. 222)–? (?) | |
| Monarch | Cao Pi |
|  | |
| Personal details | |
| Born | Unknown
Nanyang, Henan |
| Died | between October 226 and August 243 |
| Relations | Wen Hou (nephew) |
| Children | * Wen Dai * Wen Xiu (adopted son) |
| Occupation | General |
| Courtesy name | Zhongye (仲業) |
| Posthumous name | Marquis Zhuang (壯侯) |
| Peerage | Marquis of Xinye
(新野侯) |
|  | |


title: PTPN13

abstract: Tyrosine-protein phosphatase non-receptor type 13 is an enzyme that in humans is encoded by the PTPN13 gene. The protein encoded by this gene is a member of the protein tyrosine phosphatase (PTP) family. PTPs are known to be signaling molecules that regulate a variety of cellular processes including cell growth, differentiation, mitotic cycle, and oncogenic transformation. This PTP is a large protein that possesses a PTP domain at C-terminus, and multiple noncatalytic domains, which include a domain with similarity to band 4.1 superfamily of cytoskeletal-associated proteins, a region consisting of five PDZ domains, and a leucine zipper motif. This PTP was found to interact with, and dephosphorylate Fas receptor, as well as IkappaBalpha through the PDZ domains, which suggested its role in Fas mediated programmed cell death. This PTP was also shown to interact with GTPase-activating protein, and thus may function as a regulator of Rho signaling pathway. Four alternatively spliced transcript variants, which encode distinct proteins, have been reported.

text:
# PTPN13

**Tyrosine-protein phosphatase non-receptor type 13** is an enzyme that in humans is encoded by the *PTPN13* gene.

The protein encoded by this gene is a member of the protein tyrosine phosphatase (PTP) family. PTPs are known to be signaling molecules that regulate a variety of cellular processes including cell growth, differentiation, mitotic cycle, and oncogenic transformation. This PTP is a large protein that possesses a PTP domain at C-terminus, and multiple noncatalytic domains, which include a domain with similarity to band 4.1 superfamily of cytoskeletal-associated proteins, a region consisting of five PDZ domains, and a leucine zipper motif. This PTP was found to interact with, and dephosphorylate Fas receptor, as well as IkappaBalpha through the PDZ domains, which suggested its role in Fas mediated programmed cell death. This PTP was also shown to interact with GTPase-activating protein, and thus may function as a regulator of Rho signaling pathway. Four alternatively spliced transcript variants, which encode distinct proteins, have been reported.

## Interactions

PTPN13 has been shown to interact with PKN2.

## Further reading

## InfoBox

| PTPN13 | | | |
| --- | --- | --- | --- |
|  | | | |
| Available structures  PDB Ortholog search: PDBe RCSB | | | |
| Identifiers | | | |
| Aliases | PTPN13, FAP-1, PNP1, PTP-BAS, PTP-BL, PTP1E, PTPL1, PTPLE, hPTP1E, protein tyrosine phosphatase, non-receptor type 13, protein tyrosine phosphatase non-receptor type 13 | | |
| External IDs | OMIM: 600267; MGI: 103293; HomoloGene: 7909; GeneCards: PTPN13; OMA:PTPN13 - orthologs | | |
|  | | | |
|  | | | |
|  | | | |
|  | | | |
| Orthologs  Species **Human** **Mouse**  Entrez   Ensembl   UniProt   RefSeq (mRNA)     NM\_006264
NM\_080683
NM\_080684
NM\_080685   NM\_011204   RefSeq (protein)     NP\_006255
NP\_542414
NP\_542415
NP\_542416   NP\_035334   Location (UCSC) Chr 4: 86.59 – 86.82 Mb Chr 5: 103.57 – 103.75 Mb  PubMed search | | | |
| Wikidata | | | |
| View/Edit Human View/Edit Mouse | | | |


title: Muchnice Nowe

abstract: Muchnice Nowe is a village in the administrative district of Gmina Strzelce, within Kutno County, Łódź Voivodeship, in central Poland. It lies approximately 4 kilometres (2 mi) south-east of Strzelce, 10 km (6 mi) north-east of Kutno, and 58 km (36 mi) north of the regional capital Łódź.

text:
# Muchnice Nowe

**Muchnice Nowe** \[muxˈnit͡sɛ ˈnɔvɛ\] is a village in the administrative district of Gmina Strzelce, within Kutno County, Łódź Voivodeship, in central Poland. It lies approximately 4 kilometres (2 mi) south-east of Strzelce, 10 km (6 mi) north-east of Kutno, and 58 km (36 mi) north of the regional capital Łódź.

## InfoBox

| Muchnice Nowe | |
| --- | --- |
| Village | |
| Muchnice Nowe | |
| Coordinates: 52°17′55″N 19°27′17″E / 52.29861°N 19.45472°E / 52.29861; 19.45472 | |
| Country | Poland |
| Voivodeship | Łódź |
| County | Kutno |
| Gmina | Strzelce |


title: Hemorrhois algirus

abstract: Hemorrhois algirus, the Algerian whip snake, is a species of non-venomous snake in the family Colubridae. The species is found in Morocco, Algeria, Tunisia, Libya, Mauritania, Western Sahara, and Egypt.

text:
# Hemorrhois algirus

***Hemorrhois algirus***, the **Algerian whip snake**, is a species of non-venomous snake in the family Colubridae. The species is found in Morocco, Algeria, Tunisia, Libya, Mauritania, Western Sahara, and Egypt.

## InfoBox

| *Hemorrhois algirus* | |
| --- | --- |
|  | |
| Conservation status | |
|
Least Concern  (IUCN 3.1) | |
| Scientific classification | |
| Domain: | Eukaryota |
| Kingdom: | Animalia |
| Phylum: | Chordata |
| Class: | Reptilia |
| Order: | Squamata |
| Suborder: | Serpentes |
| Family: | Colubridae |
| Genus: | *Hemorrhois* |
| Species: | ***H. algirus*** |
| Binomial name | |
| ***Hemorrhois algirus***
(Jan, 1863) | |
|


title: Sainte-Geneviève, Aisne

abstract: Sainte-Geneviève is a commune in the Aisne department in Hauts-de-France in northern France.

text:
# Sainte-Geneviève, Aisne

**Sainte-Geneviève** is a commune in the Aisne department in Hauts-de-France in northern France.

## Population

Historical population
| Year | Pop. | ±% |
| --- | --- | --- |
| 1962 | 133 |  |
| 1968 | 117 | −12.0% |
| 1975 | 95 | −18.8% |
| 1982 | 95 | +0.0% |
| 1990 | 85 | −10.5% |
| 1999 | 63 | −25.9% |
| 2008 | 75 | +19.0% |

## InfoBox

| Sainte-Geneviève | |
| --- | --- |
| Commune | |
| The town hall and school of Sainte-Geneviève | |
| Location of Sainte-Geneviève | |
| Sainte-GenevièveSainte-Geneviève | |
| Coordinates: 49°43′11″N 4°04′20″E / 49.7197°N 4.0722°E / 49.7197; 4.0722 | |
| Country | France |
| Region | Hauts-de-France |
| Department | Aisne |
| Arrondissement | Vervins |
| Canton | Vervins |
| Intercommunality | Portes de la Thiérache |
| Government | |
| Mayor (20202026) | Guy Labroche |
| Area**1** | 4.53 km2 (1.75 sq mi) |
| Population (2021) | 67 |
| Density | 15/km2 (38/sq mi) |
| Time zone | UTC+01:00 (CET) |
| Summer (DST) | UTC+02:00 (CEST) |
| INSEE/Postal code | 02678 /02340 |
| Elevation | 126–211 m (413–692 ft)
(avg. 187 m or 614 ft) |
| **1** French Land Register data, which excludes lakes, ponds, glaciers \> 1 km2 (0.386 sq mi or 247 acres) and river estuaries. | |


title: Red Dragon (comics)

abstract:
Red Dragon, in comics, may refer to:
  - Red Dragon, a DC Comics supervillain
  - Red Dragon, a character from Grant Morrison's series Zenith
  - Red Dragon, a Comico Comics character who was connected to the Elementals
  - Red Dragon, the personification of the symbol of Wales who appeared in the Marvel MAX limited series Wisdom
  - Red Dragon, a Tower Comics character who appeared in T.H.U.N.D.E.R. Agents

text:
# Red Dragon (comics)

**Red Dragon**, in **comics**, may refer to:

* Red Dragon, a DC Comics supervillain
* Red Dragon, a character from Grant Morrison's series *Zenith*
* Red Dragon, a Comico Comics character who was connected to the Elementals
* Red Dragon, the personification of the symbol of Wales who appeared in the Marvel MAX limited series *Wisdom*
* Red Dragon, a Tower Comics character who appeared in *T.H.U.N.D.E.R. Agents*


title: Henri Rochefort (physician)

abstract: Henri Rochefort is a French biochemical doctor, born on 20 November 1935 in Paris, who studied the influence of various hormones and their antagonists on breast and ovarian cancers. He is a corresponding member of the French Academy of sciences.

text:
# Henri Rochefort (physician)

**Henri Rochefort** is a French biochemical doctor, born on 20 November 1935 in Paris, who studied the influence of various hormones and their antagonists on breast and ovarian cancers. He is a corresponding member of the French Academy of sciences.

## Biography

### Training

He was born on 20 November 1935 in Paris to Fernande Bernhart, a decorator and Marcel Rochefort, a photographer.

After secondary studies in Paris (lycée Carnot) where he became a laureate of the Concours Général des lycées en Sciences Naturelles, he followed a university education with a doctorate in medicine in 1968, a *licence ès sciences* in 1965, a doctorat ès sciences 3e cycle endocrinologie\- in 1966, then a doctorat ès sciences in 1972.

He was a medical intern in the Paris hospitals in the 1961 competition in clinical endocrinology departments and trained in research as an associate and then as a research fellow in Étienne-Émile Baulieu's Inserm Unit from 1964 to 1970.

### Career

He was recruited at the Faculty of Medicine of Montpellier as Associate Professor, Hospital Biologist in 1970, then Professor of Biochemistry in 1981, then as Professor of Cell Biology from 1984 to 2004, and finally Professor Emeritus since 2005.

At the hospital as a Hospital Biologist, (1970-2001) he developed assays for steroid hormones, hormone receptors and prognostic and predictive tissue markers for response to targeted therapies in breast cancer. He continues his research as founding director of Unit 148 of the Inserm Cellular and Molecular Endocrinology Unit and then Hormones and Cancers Unit (1970-2000).

He is married and has 3 children.

## Main scientific contributions

Henri Rochefort's scientific work has focused on the influence of sex steroid hormones and their antagonists in breast and ovarian cancer.

1. **Pharmacology of sex steroid receptors**. Some androgens are estrogenic when they interact with estrogen receptors (ER) (1-3). As early as 1972, Henri Rochefort showed that antiestrogens inhibit tumor growth via ERs, which then facilitated their routine use in the treatment of positive ER breast cancers. Discovery of a metabolite with a high affinity for RE, 4-hydroxytamoxifen, which is produced in vivo and accumulated in RE positive cancers. A mutation of the enzyme activating tamoxifen by hydroxylation is responsible for some innate tamoxifen resistance in patients treated for breast cancer. Antiestrogens also inhibit the effect of growth factors in the absence of estrogens. RU 486, a progesterone antagonist, inhibits the growth of breast cancer via the progesterone receptor, suggesting the value of anti-progestins for the treatment of antiestrogen-resistant breast cancers expressing this receptor.

2. By specifying the mechanism of estrogen mitogenic action in breast cancer lines, Henri Rochefort and his team discovered **cathepsin D (cathe D) as an actor in tumor progression**. (17-33) As early as 1980, H. Rochefort with F Vignon introduced the notion of autocrine regulation by mitogenic factors secreted and induced by estrogens. He focused the activity of his research unit on a 52 kilo-dalton glycoprotein, induced by estrogens and growth factors; secreted in excess by breast cancer cells and endowed with autocrine mitogenic activity. With monoclonal antibodies, developed with Sanofi, an assay of 52 K protein in breast cancer extracts in several retrospective double-blind studies showed in a totally unexpected way that high concentrations of this protein in the primary tumor predicted the subsequent development of clinical metastases (an example of serendipity).

The 52k protein was then identified as the precursor of cathepsin D (cathept D) a lysosomal protease diverted into the extracellular matrix.

Henri Rochefort has clarified the mechanism of its transcriptional regulation by estrogens and its deregulation in breast cancers leading to its secretion. Pro cath D acts, depending on the pH of the extracellular tumor medium, as a protease or as the ligand of a membrane receptor to facilitate the survival and growth of micro-metastases that have escaped from the tumor before its removal. After confirmation in many Centres around the world, Cathedral D has become the first example of a protease, the measurement of which in the primary tumor has a prognostic value. Its overexpression after transfection of the D-cath gene into tumor cells increases their metastatic power in athymic mice. Conversely, the inhibition of its production by transfection of anti-sense RNA into breast cancer cells inhibits their growth and metastatic power in these mice. (29-32) Thus, cath D is a potential therapeutic target for breast cancers, mainly triple-negative cancers as well as other solid tumors that overexpress it, such as colorectal cancer and melanoma.

3. **Other novel pathways have been opened**, such as transcriptional interference between RE and transcriptional factors (AP1), and variations in tissue expression by immunohistochemistry of ovarian hormone receptors (including estrogen beta receptor) in pre-cancerous breast lesions. Fibulin 1, induced by estrogens, is secreted in excess by ovarian cancer cells and accumulated *in vivo* in the extracellular matrix. Progestogen-induced fatty acid synthase (also a potential therapeutic target. Its early overexpression may partly explain the increase in breast cancer incidence by progestins in women treated for menopause.

Hypersensitivity to estrogens in "at risk" breast lesions may be due to a decrease in the estrogen beta receptor.

In total, starting from fundamental research on human breast cancer lines and after having prepared original specific molecular probes, H. Rochefort has transferred some of his results to the clinic and contributed internationally to the understanding of the mechanisms of hormonal carcinogenesis and to the therapeutic management of breast and ovarian cancers.

4. **Since 2000, as Professor Emeritus of Cell Biology and Member of the National Academies of Medicine and Science,**

As research was no longer funded in France after retirement, Henri Rochefort reoriented himself towards general topics more directly useful in public health by leading several working groups.

* Reports to the National Academy of Medicine on the Prevention of Breast and Ovarian Cancer.
* Activities at the Academy of Sciences: Organizer of the conference debate in plenary session: "Estrogens, health and environment" (2000).

Henri Rochefort also participated in the creation of the Institut de Cancérologie de Montpellier (IRCM) by transferring the Inserm Hormones and Cancer Unit, and is currently a volunteer consultant in this Institute to facilitate transfer research, close to clinical oncologists.

5. **Main books**

1989 - Les Antiœstrogènes, with T. Maudelonde, Flammarion, Médecine-Sciences, Paris.

2006 - Hormonal Control of Cell Cycle, in collaboration with S. Mehmed, P. Chanson, Y. Christen. Springer (Heidelberg).

2008 - Hormonal Carcinogenesis V co Publisher with J Li. (Springer- New York) Proceeding of the Vth international symposium in La Grande Motte France. (pj flyer 2005)

2018 - H Rochefort: Hormones et Cancers du sein: Des mécanismes aux thérapies ciblées et à la Prévention. (European University Publishing, Berlin)

Henri Rochefort is the author of numerous scientific articles

## Functions and distinctions

### National

* Former President of the Cell Biology Section of the National Committee of Universities,
* Corresponding member of the French Academy of sciences since 1993 (Human Biology and Medical Sciences section).
* Member of the French Academy of Medicine 3rd Division since 2001, President of the Cancer Commission of this academy (2006-2011).

### International

## Prices

* 1984 - Gaston Rousseau Prize from the French Academy of sciences
* 1988 - Joannidès Grand Prize of the French Academy of sciences
* 1990 - Léon Baratz Prize from the French Academy of Medicine.


title: Monagh River

abstract: The Monagh River is a river in Ireland. The river flows through three counties Westmeath. Offaly and Meath. The river is also connected to other rivers in the area including Milltown River in Westmeath, and the Yellow River on the Meath, Offaly border. The mouth of the river is about 0.7 miles south of Castlejordan while the head of the river is about 0.2 miles east of Smithstown.

text:
# Monagh River

The **Monagh River** is a river in Ireland. The river flows through three counties Westmeath. Offaly and Meath. The river is also connected to other rivers in the area including Milltown River in Westmeath, and the Yellow River on the Meath, Offaly border. The mouth of the river is about 0.7 miles (1.12 km) south of Castlejordan while the head of the river is about 0.2 miles (0.32 km) east of Smithstown.

52°08′N 10°17′W / 52.133°N 10.283°W / 52.133; -10.283


title: Herb Woodhead

abstract: Herbert Kirkland Woodhead was an Australian rules footballer who played with Richmond in the Victorian Football League (VFL).

text:
# Herb Woodhead

**Herbert Kirkland Woodhead** (2 April 1888 – 16 June 1961) was an Australian rules footballer who played with Richmond in the Victorian Football League (VFL).

## InfoBox

| Herb Woodhead | | | |
| --- | --- | --- | --- |
| Personal information | | | |
| Full name | Herbert Kirkland Woodhead | | |
| Date of birth | (1888-04-02)2 April 1888 | | |
| Place of birth | Richmond, Victoria | | |
| Date of death | 16 June 1961(1961-06-16) (aged 73) | | |
| Place of death | Sydney, New South Wales | | |
| Original team(s) | Richmond Juniors | | |
| Playing career1 | | | |
| Years | **Club** | **Games (Goals)** |
| 1910–12 | Richmond | 7 (0) |
| 1 Playing statistics correct to the end of 1912. | | | |
| Sources: AFL Tables, AustralianFootball.com | | | |


abstract: National Ambassador for Young People's Literature is a literary honor presented bi-annually by the Library of Congress to an author or illustrator who is a U.S. citizen and who has made a substantial contribution to young people's literature. The position was established in 2008. More than receiving an award, during their tenure ambassadors help communicate to children about books and reading, so the selection criteria include being an effective communicator, having a dynamic personality and the ability to work with children. The position is modeled on the British Children's Laureate, which was established in 1999. The position is currently sponsored by the Center for the Book and the Children's Book Council. The ambassadorship includes a $15,000 expense stipend. A similar honor is awarded bi-annually by the Poetry Foundation for the Young People's Poet Laureate.

text:
# National Ambassador for Young People's Literature

**National Ambassador for Young People's Literature** is a literary honor presented bi-annually by the Library of Congress to an author or illustrator who is a U.S. citizen and who has made a substantial contribution to young people's literature. The position was established in 2008. More than receiving an award, during their tenure ambassadors help communicate to children about books and reading, so the selection criteria include being an effective communicator, having a dynamic personality and the ability to work with children. The position is modeled on the British Children's Laureate, which was established in 1999. The position is currently sponsored by the Center for the Book and the Children's Book Council. The ambassadorship includes a $15,000 expense stipend. A similar honor is awarded bi-annually by the Poetry Foundation for the Young People's Poet Laureate (formerly the Children's Poet Laureate).

## Ambassadors


title: Ivan Vargić

abstract: Ivan Vargić is a Croatian former footballer who last played as a goalkeeper for Krk. He had played for Slovenian club FC Koper in the years before returning to Croatia.

text:
# Ivan Vargić

**Ivan Vargić** (Croatian pronunciation: \[ǐʋan ʋâːrɡitɕ\]; born 15 March 1987) is a Croatian former footballer who last played as a goalkeeper for Krk. He had played for Slovenian club FC Koper in the years before returning to Croatia.

## Club career

### Osijek

Following two loans to HNK Vukovar '91 in Croatia's 2. HNL and FC Honka in Finland's Veikkausliiga, Vargić made his debut with NK Osijek in 1. HNL in April 2009. He earned 36 league caps before he left the club in 2013.

### Rijeka

On 5 February 2013, HNK Rijeka announced that they have signed Vargić on a 4+12-year contract. During the 2015–16 1. HNL season, Vargić broke two Rijeka records: the longest streak without conceding a goal and goalkeeper who kept most clean sheets in one season. From 2 August 2015 to 4 October 2015, he did not concede a goal for 783 consecutive minutes, which is the second longest streak in the history of 1. HNL. During the 2015–16 1. HNL season, he conceded only 13 goals in 32 appearances, keeping 21 clean sheets. With 23 appearances, Vargić is also the club's most capped goalkeeper in Europe.

### Lazio and loans

On 1 February 2016, both Croatian and Italian press reported that Lazio have signed Vargić for a fee of €2.7 million. Lazio immediately sent Vargić on loan to Rijeka until 30 June 2016.

On 3 September 2018, Vargić joined Cypriot club Anorthosis Famagusta on a season-long loan.

On 6 February 2020, he joined Koper in Slovenia on loan until the end of the 2019–20 season. Koper activated buyout clause and he stayed in the club until June 2021.

### Return to Croatia

After spending two seasons in 3rd-tier Croatian club Krk, he retired from professional football in June 2024.

## International career

Vargić was a member of Croatia under-21 national team. On 12 November 2014, he made his senior national team debut in a friendly game against Argentina, entering as a substitute for Lovre Kalinić. Vargić went on to cap his national side for two more times, and the last match of his national career being against Northern Ireland in 2016.

## Honours

Rijeka Lazio

## InfoBox

Ivan Vargić
| Personal information | | | |
| --- | --- | --- | --- |
| Date of birth | (1987-03-15) 15 March 1987 | | |
| Place of birth | Osijek, SR Croatia, Yugoslavia | | |
| Height | 1.92 m (6 ft 4 in) | | |
| Position(s) | Goalkeeper | | |
| Youth career | | | |
|  | Đakovo | | |
| 2005–2006 | Osijek | | |
| Senior career\* | | | |
| Years | **Team** | **Apps** | **(Gls)** |
| 2006–2013 | Osijek | 36 | (0) |
| 2006–2007 | Vukovar '91 (loan) | 30 | (0) |
| 2008 | Honka (loan) | 0 | (0) |
| 2013–2016 | Rijeka | 95 | (0) |
| 2016–2020 | Lazio | 1 | (0) |
| 2018–2019 | Anorthosis (loan) | 10 | (0) |
| 2020–2021 | Koper | 30 | (0) |
| 2022–2024 | Krk | 35 | (0) |
| International career | | | |
| 2006 | Croatia U19 | 2 | (0) |
| 2007 | Croatia U20 | 2 | (0) |
| 2007 | Croatia U21 | 6 | (0) |
| 2014–2016 | Croatia | 3 | (0) |
| \*Club domestic league appearances and goals, correct as of 19:48, 14 February 2021 (UTC) | | | |


title: Muchlis Ibrahim

abstract: Muchlis Ibrahim is an Indonesian politician and former military officer who served as the governor of West Sumatra between 1997 and 1999 and previously as the province's vice governor between 1993 and 1997. He resigned as governor in 1999 due to disagreements with the central government over the appointment of his deputy.

text:
# Muchlis Ibrahim

**Muchlis Ibrahim** (born 13 October 1942) is an Indonesian politician and former military officer who served as the governor of West Sumatra between 1997 and 1999 and previously as the province's vice governor between 1993 and 1997. He resigned as governor in 1999 due to disagreements with the central government over the appointment of his deputy.

## Early life and education

Ibrahim was born in the village of Tanjung Medan within what is today Agam Regency on 13 October 1942. He completed elementary school in his home village and then continued to middle school, briefly being interrupted by the Revolutionary Government of the Republic of Indonesia's revolt. He then completed high school in Bukittinggi. Moving to Java, he was accepted at both the veterinary department of the University of Indonesia and the Indonesian Military Academy, and he enrolled in the latter.

## Career

After graduating from the academy, he joined the air defense artillery unit, first stationed in Malang and then in Palembang. He was reassigned to Jakarta in 1969, and briefly received training as an artillery officer in Australia the following year. He was then appointed head of the army's data gathering and processing unit, and enrolled at SESKOAD in 1978. He was then posted to Pekanbaru as a battalion commander, and promoted to lieutenant colonel. He continued to rise up the army's ranks, with a brief stint as head of the artillery department at the Indonesian Military Academy, until he became the inspector of Kodam I/Bukit Barisan in 1991.

In 1993, sitting governor of West Sumatra Hasan Basri Durin appointed Ibrahim to be his deputy to replace the retiring Sjoerkani. Ibrahim was sworn in in October 1993, and along with this appointment he was promoted to brigadier general in early 1994. He was later elected by the provincial legislature to replace Hasan, and was sworn in as governor on 29 December 1997. He was given a post-retirement honorary promotion to major general on 16 February 1998.

Ibrahim's tenure coincided with the 1997 Asian financial crisis and the fall of Suharto, with frequent student protests during his term. Due to this, the post of vice governor under him remained vacant for some time. Only in late 1998 did Ibrahim nominate the Head of the Regional Development Body, Nurmawan, to be his deputy. However, Zainal Bakar, previously provincial secretary, was instead appointed by home affairs minister Syarwan Hamid. Ibrahim felt slighted by this, and thus he submitted his resignation on 13 March 1999, taking effect two days later. Bakar was sworn in as governor in his place in 2000.

During the early 2000s, the newly formed Democratic Party offered Ibrahim a position as the party's provincial chairman in West Sumatra. However, by that time Ibrahim had moved to Jakarta, and thus rejected the offer.

## Personal life

He is married to Widianingsih, whom he met in Palembang, and the couple has three children.

## InfoBox

| Muchlis Ibrahim | |
| --- | --- |
|  | |
| Governor of West Sumatra | |
| **In office**
29 December 1997  15 March 1999 | |
| Preceded by | Hasan Basri Durin |
| Succeeded by | Zainal Bakar |
|  | |
| Personal details | |
| Born | (1942-10-13) 13 October 1942
Agam, Japan-occupied Dutch East Indies |
| Military service | |
| Allegiance | Indonesia |
| Branch/service | Indonesian Army |
| Rank | Major general (honorary) |
|  | |


title: Helenium apterum

abstract: Helenium apterum is a North American perennial plant in the sunflower family. It has been found only in the state of Durango in northwestern Mexico. Turner, B. L. 2013. The comps of Mexico. A systematic account of the family Asteraceae. Phytologia Memoirs 16: 1–100 Helenium apterum is an perennial herb up to 100 cm tall with thick rootstocks producing only one stem with a single flower head. Leaves at the base can be up to 30 cm long, the leaves higher on the stem much smaller. The head is about 4 cm across, with a hemispherical yellow disc surrounded by about 14 yellow ray flowers.

text:
# Helenium apterum

***Helenium apterum*** is a North American perennial plant in the sunflower family. It has been found only in the state of Durango in northwestern Mexico. Turner, B. L. 2013. The comps of Mexico. A systematic account of the family Asteraceae (chapter 11: tribe Helenieae). Phytologia Memoirs 16: 1–100

*Helenium apterum* is an perennial herb up to 100 cm (40 inches) tall with thick rootstocks producing only one stem with a single flower head. Leaves at the base can be up to 30 cm (1 foot) long, the leaves higher on the stem much smaller. The head is about 4 cm (1.6 inches) across, with a hemispherical yellow disc surrounded by about 14 yellow ray flowers.

## InfoBox

| *Helenium apterum* | |
| --- | --- |
|
| Scientific classification | |
| Kingdom: | Plantae |
| *Clade*: | Tracheophytes |
| *Clade*: | Angiosperms |
| *Clade*: | Eudicots |
| *Clade*: | Asterids |
| Order: | Asterales |
| Family: | Asteraceae |
| Genus: | *Helenium* |
| Species: | ***H. apterum*** |
| Binomial name | |
| ***Helenium apterum***<br>(S.F.Blake) Bierner 1972 | |
|
| Synonyms | |
| * *Hecubaea aptera* S.F.Blake 1924 | |


title: Sainte-Geneviève, Manche

abstract: Sainte-Geneviève is a commune in the Manche department in Normandy in north-western France.

text:
# Sainte-Geneviève, Manche

**Sainte-Geneviève** is a commune in the Manche department in Normandy in north-western France.

## InfoBox

| Sainte-Geneviève | |
| --- | --- |
| Commune | |
| The church of Sainte-Geneviève | |
| Location of Sainte-Geneviève | |
| Sainte-GenevièveSainte-Geneviève | |
| Coordinates: 49°39′27″N 1°18′40″W / 49.6575°N 1.3111°W / 49.6575; -1.3111 | |
| Country | France |
| Region | Normandy |
| Department | Manche |
| Arrondissement | Cherbourg |
| Canton | Val-de-Saire |
| Intercommunality | CA Cotentin |
| Government | |
| Mayor (20202026) | Gilbert Lepetit |
| Area**1** | 4.95 km2 (1.91 sq mi) |
| Population (2021) | 309 |
| Density | 62/km2 (160/sq mi) |
| Time zone | UTC+01:00 (CET) |
| Summer (DST) | UTC+02:00 (CEST) |
| INSEE/Postal code | 50469 /50760 |
| Elevation | 9–60 m (30–197 ft)
(avg. 15 m or 49 ft) |
| **1** French Land Register data, which excludes lakes, ponds, glaciers \> 1 km2 (0.386 sq mi or 247 acres) and river estuaries. | |


title: Reginald Teague-Jones

abstract: Reginald Teague-Jones MBE was a British political and intelligence officer. He was active in the Caucasus and Central Asia during the Russian Civil War. For the last 66 years of his life he was known as Ronald Sinclair. Under that assumed name, he authored two published accounts of his travels and adventures in Asia and the Middle East.

text:
# Reginald Teague-Jones

**Reginald Teague-Jones** MBE (30 July 1889 – 16 November 1988) was a British political and intelligence officer. He was active in the Caucasus and Central Asia during the Russian Civil War. For the last 66 years of his life he was known as Ronald Sinclair. Under that assumed name, he authored two published accounts of his travels and adventures in Asia and the Middle East.

## Early life

Teague-Jones was born in Lancashire. He was brought up in St. Petersburg, capital of Imperial Russia. His father was a language teacher and died when Reginald was still a child. He was educated at a German-run school that specialised in languages where he learned French, German and Russian, and at Bedford School between 1905 and 1907. He later spent two years studying at King's College London, but left without taking a degree.

## Indian intelligence officer

In 1910, at the age of 21, he joined the Indian Police and was soon transferred to the (British) Indian government's Foreign and Political Department, an organisation that had trained earlier players in the so-called Great Game, the clandestine struggle for influence in Central Asia between the Russian and British empires during the 19th and early 20th centuries.

Here he became involved in intelligence work on the North West Frontier, undertaking missions in disguise and adding Persian to his knowledge of languages.

## World War I and the Russian Civil War

In 1917 he was moved to military intelligence at G.H.Q. Delhi and given responsibility for the Persian Gulf. The war in the Middle East was now entering a critical stage with the collapse of Russian forces following the October Revolution and the creation of a power vacuum in the Caucasus.

As 1918 dawned, a reinvigorated Turkish force, the Ottoman Army of Islam under Enver Pasha began advancing on Baku, much to the alarm of the British, who envisaged Enver's army crossing the Caspian, sweeping through Transcaspia (Russia's southernmost Central Asian possession) and on to India by way of Afghanistan.

Teague-Jones was now despatched on an intelligence-gathering mission to Transcaspia via the British garrison commanded by Wilfrid Malleson at Meshed to find out what resistance to the Turks could be expected. Crossing the Kopet Dagh mountains in disguise in July, he spent the next six months between Meshed, Baku and the Transcaspian capital Ashkhabad, where he found the Bolsheviks had been overthrown days earlier and replaced by the Transcaspian Government, claiming allegiance to the Social Revolutionaries.

He was appointed British political representative in Ashkhabad as a small British force, the Malleson Mission, arrived from Persia to aid resistance against the Turks and to fend off attacks by the Bolsheviks from Tashkent. Here he remained until the withdrawal of this force began early in 1919

## The 26 Baku Commissars

As a result of his involvement in Transcaspian politics, his name became linked to the murder of the 26 Baku Commissars. The commissars had escaped across the Caspian after the fall of Baku in September 1918, and had been taken prisoner by White Russians at Krasnovodsk. They were then shot in the desert between Krasnovodsk and Ashkhabad in mysterious circumstances on 20 September.

In 1919, and again in 1922, the Social Revolutionary lawyer Vadim Chaikin claimed these murders had been carried out under the direct orders of Teague-Jones. In November 1922 Teague-Jones produced a 1,500-word rebuttal of Chaikin's claims which was passed by the British Foreign Office to the Soviet Commissariat for Foreign Affairs.

However, Chaikin's version of events was later endorsed by Trotsky  and was upheld by Soviet historians until the collapse of the USSR.

## Change of identity

Teague-Jones changed his name in 1922 and all reference to him in Foreign Office files ceased after the end of 1922. For the next 66 years until his death, he was known as Ronald Sinclair.

In 1926 he undertook a trip by car across Persia, ostensibly in the interests of a British business consortium. The trip is widely held to have been undertaken in a Ford Model A, although this fact is disputed as the model did not go on sale until December 1927. His account of this trip, *Adventures in Persia: To India by the Back Door*  was published in 1988 just before his death. As Ronald Sinclair, he later served as Vice-Consul in New York from 1941 until his retirement shortly after the war, possibly in collaboration with the newly-formed Office of Strategic Services.

It has been suggested that his change of identity was intended either to protect him from Soviet vengeance for the death of the Baku commissars, or to provide cover for future intelligence operations. Evidence that he had worked for MI5 was found in his possessions at the time of his death, and it seems likely that both his 1926 Persian trip and his diplomatic position in New York were fronts for intelligence work.

## Death

He died on 16 November 1988, as Ronald Sinclair at a private nursing home in Plymouth, England. An obituary appeared in *The Times* on 22 November, alerting Peter Hopkirk, a historian of the Great Game, who was researching Teague-Jones at the time. As a result, Hopkirk immediately wrote a second obituary for *The Times* revealing his true identity.

## References / Bibliography

* Hopkirk, Peter (1990): *The Spy Who Disappeared* (Introduction and epilogue), Victor Gollancz
* Hopkirk, Peter (1994): *On Secret Service East of Constantinople*, Oxford University Press
* Teague-Jones, Reginald (1988): *Adventures in Persia: To India by the Back Door*, Victor Gollancz
* Teague-Jones, Reginald (1990): *The Spy Who Disappeared*, Victor Gollancz
* Ter Minassian, Taline (2012): *Reginald Teague-Jones*, Paris: Grasset (a new work by a professor of Russian history at the INALCO (Institut national des langues et civilsations orientales) in France, which is dedicated to Brian Pearce for his help with the research).
* Ter Minassian, Taline (2014): *The Most Secret Agent of Empire: Reginald Teague-Jones, Master Spy of the Great Game*, translated from the French by Tom Rees, London: Hurst Publishers.
* Ter Minassian, Taline (2014). "Some fresh news about the 26 commissars: Reginald Teague-Jones and the Transcaspian episode". *Asian Affairs*. **45** (1): 65–78. doi:10.1080/03068374.2013.872360. S2CID 159979990.
* Trotsky, Leon *Between Red and White*

A large number of Teague-Jones's papers are in the British Library, under various headings, and can be found via the Access to Archives website.


title: Monagas State Anthem

abstract: The anthem for the Monagas State, Venezuela, was written by Idelfonso Núñez; it has music by Carlos Mohle.

text:
# Monagas State Anthem

The **anthem for the Monagas State, Venezuela**, was written by Idelfonso Núñez; it has music by Carlos Mohle.

## Lyrics

| Himno del Estado Monagas (Himno Patriótico a Maturín) | State Anthem of Monagas (Patriotic Hymn to Maturin) |
| --- | --- |
| Coro: Por la patria haya toques de diana;
por la patria resuene el clarín;
Y conserve la paz siempre ufana
de su historia la fiel Maturín.

Estrofa #1:
Maturín, tus llanuras y vegas,
altas cumbres y bosques umbríos,
tus hermosas palmeras y ríos,
son de dicha tu gran porvenir.
Ignorada del mundo, tú eres,
lo que expresa orgulloso tu escudo:
"haz de bienes y gloria que pudo
tu derecho a ser libre reunir".

Estrofa #2:
De Monagas el nombre que llevas
Maturín, otros mil enaltece:
fue tu hijo preclaro y merece
que Ribas, Bermúdez y Piar.
Entre todos resaltan aquellos
que con Sanz, Paz Castillo y Zaraza,
por el timbre debido a tu raza,
fueron héroes de ella a la par.

Estrofa #3:
Cinco acciones campales libraron:
tres de gloria, las otras de duelo;
y en todas le cupo a tu suelo
el renombre, la fama, el honor.
Jamás quiso rendirse tu plaza
al feroz español, al canario,
ni al de América, vil mercenario
que, sirviéndole al rey, fue traidor.

Estrofa #4:
De tus propias cenizas alzada,
como el fénix tornaste a la vida:
y ya puedes del lampo atraído,
a más altos destinos volar.
Alas tienes: las armas guerreras
vuelve un hacha, un arado, una sierra,
y veras que tus hijos la tierra
pan les brinda, ventura y hogar. | Ref: There are touches of diana for the Homeland;
For the Homeland resonates the clarion;
And always keep this peace proud
Of its history, the Faithful of Maturin.

Stanza #1:
Maturin, your Plains and Alluvial plains,
High summits and dark forests,
Your beautiful palm trees and rivers,
Such are grace of your great future.
You are ignored in the world,
What your shield it expresses with proud:
"Make wealth and honor what would
Your Right to be free for a gather".

Stanza #2:
You carry the name of Monagas,
Maturin, thousand people exalts you:
It was your illustrious and honorable sons
Like Ribas, Bermudez and Piar.
Among those that stand out
As Sanz, Paz Castillo and Zaraza,
By the bell, because of your race,
They were heroes for her at par.

Stanza #3:
They fought five actions of battles:
Three of glory and the others of mourning;
And all came to your land
The renown, fame and honor.
They never wanted to surrender in the places,
To the Spanish Fierce, the Canary,
Neither to America, vile mercenary
And he, that serving the king, was a traitor.

Stanza #4:33
You made the life like the phoenix
Who revives from its own ashes,
And you can fly to destinies very higher
As the attracted lightning.
You have wings: the warrior weapons
Becomes an ax, a plow, a saw,
And you will see your children of Earth,
Will give you the bread, fortune and home. |

## InfoBox

Monagas State Anthem
| ---  State anthem of Monagas, Venezuela  --- | |
| --- | --- |
| Lyrics | Idelfonso Núñez |
| Music | Carlos Mohle |