The Legal Framework for Language Access in Healthcare Settings: Title VI and Beyond

Over the past few decades, the number and diversity of limited English speakers in the USA has burgeoned. With this increased diversity has come increased pressure—including new legal requirements—on healthcare systems and clinicians to ensure equal treatment of limited English speakers. Healthcare providers are often unclear about their legal obligations to provide language services. In this article, we describe the federal mandates for language rights in health care, provide a broad overview of existing state laws and describe recent legal developments in addressing language barriers. We conclude with an analysis of key policy initiatives that would substantively improve health care for LEP patients

Exploring differential item functioning in the SF-36 by demographic, clinical, psychological and social factors in an osteoarthritis population

The SF-36 is a very commonly used generic measure of health outcome in osteoarthritis (OA). An important, but frequently overlooked, aspect of validating health outcome measures is to establish if items work in the same way across subgroup of a population. That is, if respondents have the same 'true' level of outcome, does the item give the same score in different subgroups or is it biased towards one subgroup or another. Differential item functioning (DIF) can identify items that may be biased for one group or another and has been applied to measuring patient reported outcomes. Items may show DIF for different conditions and between cultures, however the SF-36 has not been specifically examined in an osteoarthritis population nor in a UK population. Hence, the aim of the study was to apply the DIF method to the SF-36 for a UK OA population. The sample comprised a community sample of 763 people with OA who participated in the Somerset and Avon Survey of Health. The SF-36 was explored for DIF with respect to demographic, social, clinical and psychological factors. Well developed ordinal regression models were used to identify DIF items. Results: DIF items were found by age (6 items), employment status (6 items), social class (2 items), mood (2 items), hip v knee (2 items), social deprivation (1 item) and body mass index (1 item). Although the impact of the DIF items rarely had a significant effect on the conclusions of group comparisons, in most cases there was a significant change in effect size. Overall, the SF-36 performed well with only a small number of DIF items identified, a reassuring finding in view of the frequent use of the SF-36 in OA. Nevertheless, where DIF items were identified it would be advisable to analyse data taking account of DIF items, especially when age effects are the focus of interest

Interferometric Techniques Using Embedded Optical Fibers for the Quantitative NDE of Composites

Optical interferometric techniques using single mode optical fiber waveguide embedded in composites and other layered materials have been used to measure one- and two-dimensional stress distributions and acoustic emission caused by applied point source loads. By interferometrically comparing the phases of coherent optical signals propagated through an embedded sample fiber and a bypass reference fiber, a signal proportional to the instantaneous strain integrated along the embedded length of the sample fiber has been detected. System calibration has been obtained by applying a one-dimensional dc strain field to a cantilever beam containing the fiber. Using this calibrated system, an array of fibers attached to a 15cm × 15cm x 0.3cm plate simply supported at the corners and subjected to point loading on the surface has been used to quantitatively determine the two-dimensional dc stress field in the plate. Finally, the calibrated ac response of the interferometer to acoustic emission events in a composite panel has been demonstrated. Potential applications are discussed

The moral muteness of managers: an Anglo-American phenomenon? German and British managers and their moral reasoning about environmental sustainability in business

Several studies in the Anglo-American context have indicated that managers present themselves as morally neutral employees who act only in the best interest of the company by employing objective skills. The reluctance of managers to use moral arguments in business is further accentuated in the now common argument presented as a neutral fact that the company must always prioritise shareholder value. These and other commercial aims are seen as an objective reality in business, whilst questions about sustainability, environmental problems or fair trade are seen as emotional or moral ones; a phenomenon described as ‘moral muteness’. This research explores whether this ‘moral muteness’ is an Anglo-American phenomenon and/or whether managers in other countries - in this case Germany - might express themselves in a different way. The focus is on moral arguments around environmental sustainability and the implications of this study for cross-cultural management. This article is based on a qualitative, comparative cross-cultural study of British and German managers in the Food Retail and Energy Sectors. In line with the studies mentioned above, British managers placed a strong emphasis on their moral neutrality. In contrast, German managers tended to use moral arguments when discussing corporate greening, often giving such arguments more weight than financial arguments. Overall, the study suggests that the ‘moral muteness’ of managers is a British phenomenon and quite distinct from the German approach. The article ends in a short exploration of how this understanding can help managers better manage people, organisations and change across cultures

Dual variables and a connection picture for the Euclidean Barrett-Crane model

The partition function of the SO(4)- or Spin(4)-symmetric Euclidean Barrett-Crane model can be understood as a sum over all quantized geometries of a given triangulation of a four-manifold. In the original formulation, the variables of the model are balanced representations of SO(4) which describe the quantized areas of the triangles. We present an exact duality transformation for the full quantum theory and reformulate the model in terms of new variables which can be understood as variables conjugate to the quantized areas. The new variables are pairs of S^3-values associated to the tetrahedra. These S^3-variables parameterize the hyperplanes spanned by the tetrahedra (locally embedded in R^4), and the fact that there is a pair of variables for each tetrahedron can be viewed as a consequence of an SO(4)-valued parallel transport along the edges dual to the tetrahedra. We reconstruct the parallel transport of which only the action of SO(4) on S^3 is physically relevant and rewrite the Barrett-Crane model as an SO(4) lattice BF-theory living on the 2-complex dual to the triangulation subject to suitable constraints whose form we derive at the quantum level. Our reformulation of the Barrett-Crane model in terms of continuous variables is suitable for the application of various analytical and numerical techniques familiar from Statistical Mechanics.Comment: 33 pages, LaTeX, combined PiCTeX/postscript figures, v2: note added, TeX error correcte

A Lorentzian Signature Model for Quantum General Relativity

We give a relativistic spin network model for quantum gravity based on the Lorentz group and its q-deformation, the Quantum Lorentz Algebra. We propose a combinatorial model for the path integral given by an integral over suitable representations of this algebra. This generalises the state sum models for the case of the four-dimensional rotation group previously studied in gr-qc/9709028. As a technical tool, formulae for the evaluation of relativistic spin networks for the Lorentz group are developed, with some simple examples which show that the evaluation is finite in interesting cases. We conjecture that the `10J' symbol needed in our model has a finite value.Comment: 22 pages, latex, amsfonts, Xypic. Version 3: improved presentation. Version 2 is a major revision with explicit formulae included for the evaluation of relativistic spin networks and the computation of examples which have finite value

Exploring differential item functioning in the Western Ontario and McMaster Universities osteoarthritis index (WOMAC)

Background: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a widely used patient reported outcome in osteoarthritis. An important, but frequently overlooked, aspect of validating health outcome measures is to establish if items exhibit differential item functioning (DIF). That is, if respondents have the same underlying level of an attribute, does the item give the same score in different subgroups or is it biased towards one subgroup or another. The aim of the study was to explore DIF in the Likert format WOMAC for the first time in a UK osteoarthritis population with respect to demographic, social, clinical and psychological factors. Methods: The sample comprised a community sample of 763 people with osteoarthritis who participated in the Somerset and Avon Survey of Health. The WOMAC was explored for DIF by gender, age, social deprivation, social class, employment status, distress, body mass index and clinical factors. Ordinal regression models were used to identify DIF items. Results: After adjusting for age, two items were identified for the physical functioning subscale as having DIF with age identified as the DIF factor for 2 items, gender for 1 item and body mass index for 1 item. For the WOMAC pain subscale, for people with hip osteoarthritis one item was identified with age-related DIF. The impact of the DIF items rarely had a significant effect on the conclusions of group comparisons. Conclusions: Overall, the WOMAC performed well with only a small number of DIF items identified. However, as DIF items were identified in for the WOMAC physical functioning subscale it would be advisable to analyse data taking into account the possible impact of the DIF items when weight, gender or especially age effects, are the focus of interest in UK-based osteoarthritis studies. Similarly for the WOMAC pain subscale in people with hip osteoarthritis it would be worthwhile to analyse data taking into account the possible impact of the DIF item when age comparisons are of primary interest

Emotional persistence in online chatting communities

How do users behave in online chatrooms, where they instantaneously read and write posts? We analyzed about 2.5 million posts covering various topics in Internet relay channels, and found that user activity patterns follow known power-law and stretched exponential distributions, indicating that online chat activity is not different from other forms of communication. Analysing the emotional expressions (positive, negative, neutral) of users, we revealed a remarkable persistence both for individual users and channels. I.e. despite their anonymity, users tend to follow social norms in repeated interactions in online chats, which results in a specific emotional "tone" of the channels. We provide an agent-based model of emotional interaction, which recovers qualitatively both the activity patterns in chatrooms and the emotional persistence of users and channels. While our assumptions about agent's emotional expressions are rooted in psychology, the model allows to test different hypothesis regarding their emotional impact in online communication.Comment: 34 pages, 4 main and 12 supplementary figure

Imaging spontaneous currents in superconducting arrays of pi-junctions

Superconductors separated by a thin tunneling barrier exhibit the Josephson effect that allows charge transport at zero voltage, typically with no phase shift between the superconductors in the lowest energy state. Recently, Josephson junctions with ground state phase shifts of pi proposed by theory three decades ago have been demonstrated. In superconducting loops, pi-junctions cause spontaneous circulation of persistent currents in zero magnetic field, analogous to spin-1/2 systems. Here we image the spontaneous zero-field currents in superconducting networks of temperature-controlled pi-junctions with weakly ferromagnetic barriers using a scanning SQUID microscope. We find an onset of spontaneous supercurrents at the 0-pi transition temperature of the junctions Tpi = 3 K. We image the currents in non-uniformly frustrated arrays consisting of cells with even and odd numbers of pi-junctions. Such arrays are attractive model systems for studying the exotic phases of the 2D XY-model and achieving scalable adiabatic quantum computers.Comment: Pre-referee version. Accepted to Nature Physic

Responsible Innovation in Business

This chapter introduces responsible innovation in a business context. The first part explains the basic terms that constitute responsible innovation from a busi-ness perspective. The second part presents tangible business practices that opera-tionalise responsible innovation and introduces two good practice examples that hint at the variety of ways in which responsible innovation can be implemented in companies