Language Differences as a Barrier to Quality and Safety in Health Care: The Joint Commission Perspective

Effective communication with patients is critical to the safety and quality of care. Barriers to this communication include differences in language, cultural differences, and low health literacy. Evidence-based practices that reduce these barriers must be integrated into, rather than just added to, health care work processes

Error-estimate-based adaptive integration for immersed isogeometric analysis

The Finite Cell Method (FCM) together with Isogeometric analysis (IGA) has been applied successfully in various problems in solid mechanics, in image-based analysis, fluid–structure interaction and in many other applications. A challenging aspect of the isogeometric finite cell method is the integration of cut cells. In particular in three-dimensional simulations the computational effort associated with integration can be the critical component of a simulation. A myriad of integration strategies has been proposed over the past years to ameliorate the difficulties associated with integration, but a general optimal integration framework that suits a broad class of engineering problems is not yet available. In this contribution we provide a thorough investigation of the accuracy and computational effort of the octree integration scheme. We quantify the contribution of the integration error using the theoretical basis provided by Strang's first lemma. Based on this study we propose an error-estimate-based adaptive integration procedure for immersed isogeometric analysis. Additionally, we present a detailed numerical investigation of the proposed optimal integration algorithm and its application to immersed isogeometric analysis using two- and three-dimensional linear elasticity problems

Critical time-step size analysis and mass scaling by ghost-penalty for immersogeometric explicit dynamics

In this article, we study the effect of small-cut elements on the critical time-step size in an immersogeometric context. We analyze different formulations for second-order (membrane) and fourth-order (shell-type) equations, and derive scaling relations between the critical time-step size and the cut-element size for various types of cuts. In particular, we focus on different approaches for the weak imposition of Dirichlet conditions: by penalty enforcement and with Nitsche's method. The stability requirement for Nitsche's method necessitates either a cut-size dependent penalty parameter, or an additional ghost-penalty stabilization term is necessary. Our findings show that both techniques suffer from cut-size dependent critical time-step sizes, but the addition of a ghost-penalty term to the mass matrix serves to mitigate this issue. We confirm that this form of `mass-scaling' does not adversely affect error and convergence characteristics for a transient membrane example, and has the potential to increase the critical time-step size by orders of magnitude. Finally, for a prototypical simulation of a Kirchhoff-Love shell, our stabilized Nitsche formulation reduces the solution error by well over an order of magnitude compared to a penalty formulation at equal time-step size

Residual-based error estimation and adaptivity for stabilized immersed isogeometric analysis using truncated hierarchical B-splines

We propose an adaptive mesh refinement strategy for immersed isogeometric analysis, with application to steady heat conduction and viscous flow problems. The proposed strategy is based on residual-based error estimation, which has been tailored to the immersed setting by the incorporation of appropriately scaled stabilization and boundary terms. Element-wise error indicators are elaborated for the Laplace and Stokes problems, and a THB-spline-based local mesh refinement strategy is proposed. The error estimation .and adaptivity procedure is applied to a series of benchmark problems, demonstrating the suitability of the technique for a range of smooth and non-smooth problems. The adaptivity strategy is also integrated in a scan-based analysis workflow, capable of generating reliable, error-controlled, results from scan data, without the need for extensive user interactions or interventions.Comment: Submitted to Journal of Mechanic

Indication of activated senescence pathways in the temporal arteries of patients with giant cell arteritis

OBJECTIVES: Giant cell arteritis (GCA) affects almost exclusively individuals above 50 years old, suggesting a role of aging-related changes such as cellular senescence in its pathobiology. p21 WAF1/CIP1 and p16/INK4A play key roles in two distinct pathways leading to senescence. The proinflammatory molecules Interleukin (IL)-6 and Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF), which are key components of the senescence-associated secretory phenotype (SASP), are effective targets of treatment in GCA. Here, we aim to investigate the presence of p21 and p16 positive cells producing these SASP cytokines in temporal artery biopsies (TABs) of patients with GCA.METHODS: Eight patients with GCA and 14 age-matched, non-GCA individuals who underwent a TAB were included. Immunohistochemical staining of p21, p16, IL-6 and GM-CSF was performed. Multiplex immunofluorescent staining was performed to investigate the colocalization of p21 and p16 with IL-6, GM-CSF, and immune cell markers (CD68, CD3, CD20).RESULTS: p16, p21, IL-6 and GM-CSF were elevated in the TABs of patients with GCA. Both p16 and p21 expressing cells were mainly found near the internal lamina elastica, especially among giant cells and macrophages, although p21 and p16 expression could be found in all three layers of the vessels. Expression of p16 and p21 was occasionally found in T cells but not B cells. p16+ and p21+ cells expressing GM-CSF/IL-6 were detected throughout the TABs.CONCLUSION: Our data suggests the presence of activated senescence pathways at the site of vascular inflammation in GCA and support further research into the role of senescence in the pathophysiology of GCA. This article is protected by copyright. All rights reserved.</p

Error-estimate-based Adaptive Integration For Immersed Isogeometric Analysis

The Finite Cell Method (FCM) together with Isogeometric analysis (IGA) has been applied successfully in various problems in solid mechanics, in image-based analysis, fluid-structure interaction and in many other applications. A challenging aspect of the isogeometric finite cell method is the integration of cut cells. In particular in three-dimensional simulations the computational effort associated with integration can be the critical component of a simulation. A myriad of integration strategies has been proposed over the past years to ameliorate the difficulties associated with integration, but a general optimal integration framework that suits a broad class of engineering problems is not yet available. In this contribution we provide a thorough investigation of the accuracy and computational effort of the octree integration scheme. We quantify the contribution of the integration error using the theoretical basis provided by Strang's first lemma. Based on this study we propose an error-estimate-based adaptive integration procedure for immersed isogeometric analysis. Additionally, we present a detailed numerical investigation of the proposed optimal integration algorithm and its application to immersed isogeometric analysis using two- and three-dimensional linear elasticity problems.Comment: To CAMW

Interference of flavonoids with enzymatic assays for the determination of free fatty acid and triglyceride levels

Flavonoids are bioactive food compounds with potential lipid-lowering effects. Commercially available enzymatic assays are widely used to determine free fatty acid (FFA) and triglyceride (TG) levels both in vivo in plasma or serum and in vitro in cell culture medium or cell lysate. However, we have observed that various flavonoids interfere with peroxidases used in these enzymatic assays, resulting in incorrect lower FFA and TG levels than actually present. Furthermore, addition of isorhamnetin or the major metabolite of the flavonoid quercetin in human and rat plasma, quercetin-3-O-glucuronide, to murine serum also resulted in a significant reduction of the detected TG levels, while a trend was seen for FFA levels. It is concluded that when applying these assays, vigilance is needed and alternative analytical methods, directly assessing FFA or TG levels, should be used for studying the biological effects of flavonoids on FFA and TG levels

English language proficiency and the accommodations for language non-concordance amongst patients utilizing chiropractic college teaching clinics

Background: The number of households in the United States that are not proficient in the English language is growing and presenting a challenge to the health care system. Over nineteen percent of the US population speak a language other than English in the home. This increase in language discordance generates a greater need to find and implement accommodations in the clinical setting to insure accurate and efficient diagnosis and treatment as well as provide for patient safety. Aim: The purpose of this study is to determine the percentage of patients accessing the chiropractic college teaching clinics who are not proficient in the English language and to what extent the colleges provide accommodations for that language disparity. Methods: The clinic directors and deans of the Association of Chiropractic Colleges were surveyed via an on-line survey engine. The survey queried the percentage of the patient population that is not English language proficient, the accommodations the college currently has in place, if the college has a language specific consent to treat document and if the college has a written policy concerning patients without English proficiency. Results: Fifty percent of the contacted chiropractic colleges responded to the survey. In the respondent college clinics 16.5% of the patient population is not proficient in English, with over 75% speaking Spanish. All but one of the respondents provide some level of accommodation for the language non-concordance. Forty five percent of the responding colleges employ a language specific consent to treat form. The implementation of accommodations and the use of a language specific consent to treat form is more prevalent at colleges with a higher percentage of non-English speaking patients. Conclusions: The percentage of patients with limited English proficiency accessing services at the teaching clinics of the chiropractic colleges mirrors the numbers in the general population. There is a wide disparity in the accommodations that the individual colleges make to address this language discordance. There is a need to further develop accurate and meaningful accommodations to address language disparity in the chiropractic teaching clinics.https://doi.org/10.1186/2045-709X-21-

Strange particle production in proton-proton collisions at s=0.9\sqrt{s}=0.9 TeV with ALICE at the LHC

The production of mesons containing strange quarks (K$^0_s$, $\phi$) and both singly and doubly strange baryons ($\Lambda$, Anti-$\Lambda$, and $\Xi$+Anti-$\Xi$) are measured at central rapidity in pp collisions at $\sqrt{s}$ = 0.9 TeV with the ALICE experiment at the LHC. The results are obtained from the analysis of about 250 k minimum bias events recorded in 2009. Measurements of yields (dN/dy) and transverse momentum spectra at central rapidities for inelastic pp collisions are presented. For mesons, we report yields () of 0.184 $\pm$ 0.002 stat. $\pm$ 0.006 syst. for K$^0_s$ and 0.021 $\pm$ 0.004 stat. $\pm$ 0.003 syst. for $\phi$. For baryons, we find = 0.048 $\pm$ 0.001 stat. $\pm$ 0.004 syst. for $\Lambda$, 0.047 $\pm$ 0.002 stat. $\pm$ 0.005 syst. for Anti-$\Lambda$ and 0.0101 $\pm$ 0.0020 stat. $\pm$ 0.0009 syst. for $\Xi$+Anti-$\Xi$. The results are also compared with predictions for identified particle spectra from QCD-inspired models and provide a baseline for comparisons with both future pp measurements at higher energies and heavy-ion collisions.Comment: 33 pages, 21 captioned figures, 10 tables, authors from page 28, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/387

Development and validation of a Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN) in a scarce resource setting: Response to the COVID‐19 pandemic

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163412/2/cncr33114_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163412/1/cncr33114.pd