Opportunity for development or necessary nuisance? The case for viewing working with interpreters as a bonus in therapeutic work

This paper explores the central role a language interpreter can play in the process of the therapeutic relationship. Although others have described the changes to the therapeutic dyad that the presence of a third party (an interpreter) brings, little attention has been paid to the advantages and additional opportunities of this altered therapeutic situation. This paper details these gains and further argues that clinicians who are willing to gain experience of working with interpreters will find that benefits accrue at the micro and macro levels: at the micro level, through enhancement of their work with individual non English speaking clients, and at the macro level through learning about different cultural perspectives, idioms of distress and the role of language in the therapeutic endeavour. This is in addition to developing skills to fulfil legal and professional requirements relating to equity of service provision. Some ideas are offered to explain the negative slant than runs throughout the literature in this area and tends to colour the overall discussion of therapeutic work with interpreters and, before the final section, makes some specific suggestions which may help maximise the gains possible in such work while reducing difficulties

Coupling Lattice Boltzmann and Molecular Dynamics models for dense fluids

We propose a hybrid model, coupling Lattice Boltzmann and Molecular Dynamics models, for the simulation of dense fluids. Time and length scales are decoupled by using an iterative Schwarz domain decomposition algorithm. The MD and LB formulations communicate via the exchange of velocities and velocity gradients at the interface. We validate the present LB-MD model in simulations of flows of liquid argon past and through a carbon nanotube. Comparisons with existing hybrid algorithms and with reference MD solutions demonstrate the validity of the present approach.Comment: 14 pages, 5 figure

Multiscale modelling and simulation: a position paper

We argue that, despite the fact that the field of multiscale modelling and simulation has enjoyed significant success within the past decade, it still holds many open questions that are deemed important but so far have barely been explored. We believe that this is at least in part due to the fact that the field has been mainly developed within disciplinary silos. The principal topics that in our view would benefit from a targeted multidisciplinary research effort are related to reaching consensus as to what exactly one means by ‘multiscale modelling’, formulating a generic theory or calculus of multiscale modelling, applying such concepts to the urgent question of validation and verification of multiscale models, and the issue of numerical error propagation in multiscale models. Moreover, we believe that this would, in principle, also lay the foundation for more efficient, well-defined and usable multiscale computing environments. We believe that multidisciplinary research to fill in the gaps is timely, highly relevant, and with substantial potential impact on many scientific disciplines

Measuring human-error probabilities in drug preparation: a pilot simulation study

Objectives: Designing a safe medication process requires the ability to model its reliability using methods such as probabilistic risk assessment (PRA). However, lack of data, especially on human-error probabilities (HEPs), limits its use. To assess whether small-scale simulations could help generate HEP data, a pilot study was conducted among nurses and anaesthetists. It focused on two core activities, namely, the manual preparation of medications and the arithmetic necessary to prepare drugs. Its specific objectives were to evaluate whether HEPs could be high enough to be measurable and to determine whether these HEPs could be sensitive to individuals and task details. These would give some insight into the level of detail required by PRA analysis. Methods: Thirty nurse and 28 anaesthetist volunteers were involved in the experiment. Nurses and anaesthetists had to prepare medications for 20 patients and 22 syringes of various drugs, respectively. Both groups had to perform 22 calculations relating to the preparation of drugs. HEPs, distribution of HEPs and dependency of HEPs on individuals and task details were assessed. Results: In the preparation tasks, overall HEP was 3.0% for nurses and 6.5% for anaesthetists. In the arithmetic tasks, overall HEP was 23.8% for nurses and 8.9% for anaesthetists. A statistically significant difference was noted between the two groups. In both preparation and arithmetic tasks, HEPs were dependent on individual nurses but not on individual anaesthetists. In every instance, HEPs were dependent on task details. Conclusion: Our study illustrates that small-scale simulations represent an interesting way of generating HEPs. HEPs are, indeed, in the range of 10−2 and 10−1. But in most cases, HEPs depend heavily on operators and task details. This dependency means that the influence of these parameters must be determined before advanced PRA analysis. There is therefore an urgent need to develop experimental research into assessing this influence by means of randomised controlled trial

Histomorphometry of encephalic meninges of Wistar rats in different bands

O desenvolvimento do sistema nervoso é bastante complexo, existindo poucos estudos sobre a organização dos envoltórios cerebrais relacionados ao crescimento encefálico. Utilizando como modelo experimental o rato, analisaram-se os diferentes aspectos estruturais e morfométricos da paquimeninge e leptomeninge durante o processo de envelhecimento. Foram utilizados quatro grupos de ratos em diferentes faixas etárias e analisadas as meninges em microscopias de luz e eletrônica. Verificamos que o grupo de ratos adultos apresentou uma maior área de fibras colágenas tanto do tipo I e quanto do tipo III, em relação aos outros grupos. Encontramos também que as fibras colágenas do tipo III em todos os grupos analisados ocupam uma maior área quando comparados com as fibras do tipo I. Os resultados revelam que a coloração de Weigert Oxona, que mostra fibras elásticas, elaunínicas e oxitalânicas, apresentou uma diferença estatisticamente maior de fibras quando comparados com as colorações de Weigert e Verhoeff, que mostra fíbras elaunínicas e elásticas, respectivamente. Os resultados ultra-estruturais demonstraram a presença de muitos fibroblastos e mitocôndrias tanto na paquimeninge como nas leptomeninges dos grupos de ratos neonatos e adultos, indicativo de alta atividade celular e conseqüentemente, intensa formação de tecido conjuntivo. Como as fibras colágenas do tipo III atuam na manutenção da estrutura de tecidos delicados e expansíveis, o estudo mostra que as funções das meninges encefálicas não estão relacionadas apenas com a resistência a trações e tensões a que estão sujeitas o encéfalo. Mas também a função relacionada com a distensibilidade dos vasos meníngeos e cerebrais de acordo com a necessidade do aporte sanguíneo em diversas funções específicas regionais do tecido nervoso.The development of the nervous system is very complex and there are few studies about the organization of the brain envoltories related to the encephalus growing. Using the rat as an animal model, it was proposed to evaluate the several structural aspects of paquimeninge and leptomeninge in different ages. It was used 4 groups of different ages and processed according to the techniques of the light and transmission microscopy. It was verified that the adult rats present a higher area of collagen fibers of type I and III, if compared to the others groups. It was found that, the collagen fibers of type III occupy, in all analyzed groups, a higher area when compared to type I fibers. The results reveal that the Weigert Oxona's staining, which shows elastics, elauninics, and oxitalanics fibers, showed a statistically difference when compared to the Weigert's staining and Verhoeff's staining that show elauninics and elastics fibers, respectively. The ultra-structural aspects demonstrated the presence of many fibroblasts and mitochondria in the paquimeninge and also in the leptomeninges of the neonats and adults groups, indicating the high cellular activity and consequently, an intense formation of conjunctive tissue. As collagen fibers of type III acting on the structural maintenance of delicate and expansive tissues, the study shows that the function of the encephalic meninges are not only related to the to resistance to tractions and tensions that the encephalus is subjected. But also the function related to the distensibility of the meningeos and brain vases according to the sanguineous apport in several specific functions of the nervous system

Multi-species pair annihilation reactions

We consider diffusion-limited reactions A_i + A_j -> 0 (1 <= i < j <= q) in d space dimensions. For q > 2 and d >= 2 we argue that the asymptotic density decay for such mutual annihilation processes with equal rates and initial densities is the same as for single-species pair annihilation A + A -> 0. In d = 1, however, particle segregation occurs for all q < oo. The total density decays according to a $q$ dependent power law, rho(t) ~ t^{-\alpha(q)}. Within a simplified version of the model \alpha(q) = (q-1) / 2q can be determined exactly. Our findings are supported through Monte Carlo simulations.Comment: 4 pages, revtex; two figures include

Kinetics and scaling in ballistic annihilation

We study the simplest irreversible ballistically-controlled reaction, whereby particles having an initial continuous velocity distribution annihilate upon colliding. In the framework of the Boltzmann equation, expressions for the exponents characterizing the density and typical velocity decay are explicitly worked out in arbitrary dimension. These predictions are in excellent agreement with the complementary results of extensive Monte Carlo and Molecular Dynamics simulations. We finally discuss the definition of universality classes indexed by a continuous parameter for this far from equilibrium dynamics with no conservation laws

Age and quality of in-hospital care of patients with heart failure

Background: Elderly patients may be at risk of suboptimal care. Thus, the relationship between age and quality of care for patients hospitalized for heart failure was examined. Methods: A cross-sectional study based on retrospective chart review was performed among a random sample of patients hospitalized between 1996 and 1998 in the general internal medicine wards, with a principal diagnosis of congestive heart failure, and discharged alive. Explicit criteria of quality of care, grouped into three scores, were used: admission work-up (admission score); evaluation and treatment during the stay (evaluation and treatment score); and readiness for discharge (discharge score). The associations between age and quality of care scores were analysed using linear regression models. Results: Charts of 371 patients were reviewed. Mean age was 75.7 (±11.1) years and 52% were men. There was no relationship between age and admission or readiness for discharge scores. The evaluation and treatment score decreased with age: compared with patients less than 70 years old, the score was lower by −2.6% (95% CI: −7.1 to 1.9) for patients aged 70 to 79, by −8.7% (95% CI: −13.0 to −4.3) for patients aged 80 to 89, and by −19.0% (95% CI: −26.6 to −11.5) for patients aged 90 and over. After adjustment for possible confounders, this relationship was not significantly modified. Conclusions: In patients hospitalized for congestive heart failure, older age was not associated with lower quality of care scores except for evaluation and treatment. Whether this is detrimental to elderly patients remains to be evaluate