Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions

Instabilities in the Envelopes and Winds of Very Massive Stars

The high luminosity of Very Massive Stars (VMS) means that radiative forces play an important, dynamical role both in the structure and stability of their stellar envelope, and in driving strong stellar-wind mass loss. Focusing on the interplay of radiative flux and opacity, with emphasis on key distinctions between continuum vs. line opacity, this chapter reviews instabilities in the envelopes and winds of VMS. Specifically, we discuss how: 1) the iron opacity bump can induce an extensive inflation of the stellar envelope; 2) the density dependence of mean opacity leads to strange mode instabilities in the outer envelope; 3) desaturation of line-opacity by acceleration of near-surface layers initiates and sustains a line-driven stellar wind outflow; 4) an associated line-deshadowing instability leads to extensive small-scale structure in the outer regions of such line-driven winds; 5) a star with super-Eddington luminosity can develop extensive atmospheric structure from photon bubble instabilities, or from stagnation of flow that exceeds the "photon tiring" limit; 6) the associated porosity leads to a reduction in opacity that can regulate the extreme mass loss of such continuum-driven winds. Two overall themes are the potential links of such instabilities to Luminous Blue Variable (LBV) stars, and the potential role of radiation forces in establishing the upper mass limit of VMS.Comment: 44 pages, 13 figures. Chapter to appear in the book "Very Massive Stars in the Local Universe", Springer, J.S. Vink, e

Particle Aggregation in a turbulent Keplerian flow

In the problem of planetary formation one seeks a mechanism to gather small solid particles together into larger accumulations of solid matter. Here we describe a scenario in which turbulence mediates this process by aggregating particles into anticyclonic regions. If, as our simulations suggest, anticyclonic vortices form as long-lived coherent structures, the process becomes more powerful because such vortices trap particles effectively. Even if the turbulence is decaying, following the upheaval that formed the disk, there is enough time to make the dust distribution quite lumpy.Comment: 16 pages, 9 figure

Sonoluminescence as a QED vacuum effect. II: Finite Volume Effects

In a companion paper [quant-ph/9904013] we have investigated several variations of Schwinger's proposed mechanism for sonoluminescence. We demonstrated that any realistic version of Schwinger's mechanism must depend on extremely rapid (femtosecond) changes in refractive index, and discussed ways in which this might be physically plausible. To keep that discussion tractable, the technical computations in that paper were limited to the case of a homogeneous dielectric medium. In this paper we investigate the additional complications introduced by finite-volume effects. The basic physical scenario remains the same, but we now deal with finite spherical bubbles, and so must decompose the electromagnetic field into Spherical Harmonics and Bessel functions. We demonstrate how to set up the formalism for calculating Bogolubov coefficients in the sudden approximation, and show that we qualitatively retain the results previously obtained using the homogeneous-dielectric (infinite volume) approximation.Comment: 23 pages, LaTeX 209, ReV-TeX 3.2, five figure

Uncertainties in stellar evolution models: convective overshoot

In spite of the great effort made in the last decades to improve our understanding of stellar evolution, significant uncertainties remain due to our poor knowledge of some complex physical processes that require an empirical calibration, such as the efficiency of the interior mixing related to convective overshoot. Here we review the impact of convective overshoot on the evolution of stars during the main Hydrogen and Helium burning phases.Comment: Proc. of the workshop "Asteroseismology of stellar populations in the Milky Way" (Sesto, 22-26 July 2013), Astrophysics and Space Science Proceedings, (eds. A. Miglio, L. Girardi, P. Eggenberger, J. Montalban

Coarse-grained model of entropic allostery

Many signaling functions in molecular biology require proteins to bind to substrates such as DNA in response to environmental signals such as the simultaneous binding to a small molecule. Examples are repressor proteins which may transmit information via a conformational change in response to the ligand binding. An alternative entropic mechanism of "allostery" suggests that the inducer ligand changes the intramolecular vibrational entropy, not just the mean static structure. We present a quantitative, coarse-grained model of entropic allostery, which suggests design rules for internal cohesive potentials in proteins employing this effect. It also addresses the issue of how the signal information to bind or unbind is transmitted through the protein. The model may be applicable to a wide range of repressors and also to signaling in trans-membrane proteins

A Continuum Description of Rarefied Gas Dynamics (I)--- Derivation From Kinetic Theory

We describe an asymptotic procedure for deriving continuum equations from the kinetic theory of a simple gas. As in the works of Hilbert, of Chapman and of Enskog, we expand in the mean flight time of the constituent particles of the gas, but we do not adopt the Chapman-Enskog device of simplifying the formulae at each order by using results from previous orders. In this way, we are able to derive a new set of fluid dynamical equations from kinetic theory, as we illustrate here for the relaxation model for monatomic gases. We obtain a stress tensor that contains a dynamical pressure term (or bulk viscosity) that is process-dependent and our heat current depends on the gradients of both temperature and density. On account of these features, the equations apply to a greater range of Knudsen number (the ratio of mean free path to macroscopic scale) than do the Navier-Stokes equations, as we see in the accompanying paper. In the limit of vanishing Knudsen number, our equations reduce to the usual Navier-Stokes equations with no bulk viscosity.Comment: 16 page

Public health equity in refugee situations

Addressing increasing concerns about public health equity in the context of violent conflict and the consequent forced displacement of populations is complex. Important operational questions now faced by humanitarian agencies can to some extent be clarified by reference to relevant ethical theory. Priorities of service delivery, the allocation choices, and the processes by which they are arrived at are now coming under renewed scrutiny in the light of the estimated two million refugees who fled from Iraq since 2003