Tourism Development and Regional Integration in Central America

What is the relationship between tourism and regional integration in Central America? Since the signing of the Peace Accords, tourism has emerged as a primary development strategy for Central American countries. At the same time, tourism has become a driving force for the regional political-economic integration project, facilitating consensus between governments over the regional developmental model. This ARI outlines the contours of the dual processes of regional integration and tourism development in contemporary Central America. It argues that a convergence of development priorities across the region around export-oriented growth and commitments to poverty reduction has placed tourism as a driver of the regional integration project

Culture, language, and the doctor-patient relationship

BACKGROUND: This review\u27s goal was to determine how differences between physicians and patients in race, ethnicity and language influence the quality of the physician-patient relationship. METHODS: We performed a literature review to assess existing evidence for ethnic and racial disparities in the quality of doctor-patient communication and the doctor-patient relationship. RESULTS: We found consistent evidence that race, ethnicity; and language have substantial influence on the quality of the doctor-patient relationship. Minority patients, especially those not proficient in English, are less likely to engender empathic response from physicians, establish rapport with physicians, receive sufficient information, and be encouraged to participate in medical decision making. CONCLUSIONS: The literature calls for a more diverse physician work force since minority patients are more likely to choose minority physicians, to be more satisfied by language-concordant relationships, and to feel more connected and involved in decision making with racially concordant physicians. The literature upholds the recommendation for professional interpreters to bridge the gaps in access experienced by non-English speaking physicians. Further evidence supports the admonition that majority physicians need to be more effective in developing relationships and in their communication with ethnic and racial minority patients

Reducing Plasmodium falciparum malaria transmission in Africa: a model-based evaluation of intervention strategies.

BACKGROUND: Over the past decade malaria intervention coverage has been scaled up across Africa. However, it remains unclear what overall reduction in transmission is achievable using currently available tools. METHODS AND FINDINGS: We developed an individual-based simulation model for Plasmodium falciparum transmission in an African context incorporating the three major vector species (Anopheles gambiae s.s., An. arabiensis, and An. funestus) with parameters obtained by fitting to parasite prevalence data from 34 transmission settings across Africa. We incorporated the effect of the switch to artemisinin-combination therapy (ACT) and increasing coverage of long-lasting insecticide treated nets (LLINs) from the year 2000 onwards. We then explored the impact on transmission of continued roll-out of LLINs, additional rounds of indoor residual spraying (IRS), mass screening and treatment (MSAT), and a future RTS,S/AS01 vaccine in six representative settings with varying transmission intensity (as summarized by the annual entomological inoculation rate, EIR: 1 setting with low, 3 with moderate, and 2 with high EIRs), vector-species combinations, and patterns of seasonality. In all settings we considered a realistic target of 80% coverage of interventions. In the low-transmission setting (EIR approximately 3 ibppy [infectious bites per person per year]), LLINs have the potential to reduce malaria transmission to low levels (90%) or novel tools and/or substantial social improvements will be required, although considerable reductions in prevalence can be achieved with existing tools and realistic coverage levels. CONCLUSIONS: Interventions using current tools can result in major reductions in P. falciparum malaria transmission and the associated disease burden in Africa. Reduction to the 1% parasite prevalence threshold is possible in low- to moderate-transmission settings when vectors are primarily endophilic (indoor-resting), provided a comprehensive and sustained intervention program is achieved through roll-out of interventions. In high-transmission settings and those in which vectors are mainly exophilic (outdoor-resting), additional new tools that target exophagic (outdoor-biting), exophilic, and partly zoophagic mosquitoes will be required

A Disk-Wind Model for the Near-Infrared Excess Emission in Protostars

Protostellar systems, ranging from low-luminosity T Tauri and Herbig Ae stars to high-luminosity Herbig Be stars, exhibit a near-infrared (NIR) excess in their spectra that is dominated by a bump in the monochromatic luminosity with a peak near 3 microns. The bump can be approximated by a thermal emission component of temperature 1500 K that is of the order of the sublimation temperature of interstellar dust grains. In the currently popular "puffed up rim" scenario, the bump represents stellar radiation that propagates through the optically thin inner region of the surrounding accretion disk and is absorbed and reemitted by the dust that resides just beyond the dust sublimation radius, Rsub. However, this model cannot account for the strongest bumps measured in these sources, and it predicts a large secondary bounce in the interferometric visibility curve that is not observed. In this paper we present an alternative interpretation, which attributes the bump to reemission of stellar radiation by dust that is uplifted from the disk by a centrifugally driven wind. Winds of this type are a leading candidate for the origin of the strong outflows associated with protostars, and there is observational evidence for disk winds originating on scales ~Rsub. Using a newly constructed Monte Carlo radiative transfer code, we show that this model can account for the NIR excess emission even in bright Herbig Ae stars such as AB Auriga and MWC 275, and that it successfully reproduces the basic features of the visibilities measured in these protostars. We argue that a robust dusty outflow in these sources could be self-limiting to a relatively narrow launching region between Rsub and 2Rsub. Finally, we suggest that our model could also naturally account for the NIR and scattered-light variability exhibited by a source like MWC 275, which may be triggered by the uplifting of dust clouds from the disk.Comment: 19 pages, 8 figures. Updated submitted version to refereed and accepted one (accepted 8/29/2012 for publication in The Astrophysical Journal

Propositional Idea Density: Computerized analysis to determine effects of presence and severity of aphasia

This paper presents research that aimed to extend the available analyses of informativeness of aphasic discourse. A ‘proposition’ can be defined as a linguistic relation and its associated arguments (Kintsch & Keenan, 1973; Turner & Greene, 1977), and has been used as an index of informativeness in research on language and aging. The proportion of propositions in a text (Propositional Idea Density – PD) has been found to be a sensitive index of age-associated cognitive impairment and dementia (Riley, Snowdon, Desrosiers, & Markesbery, 2005). The research on PD has primarily used manual analysis methods, noting high training needs for raters to ensure adequate inter-coder and intra-coder reliability, as has also been found in analyses of informativeness in the field of aphasia (Nicholas & Brookshire, 1993; Oelschlaeger & Thorne, 1999; Yorkston & Beukelman, 1980). The development of a computer program, Computerized Propositional Idea Density Rater known as CPIDR (Brown, Snodgrass, & Covington, 2007; Brown, Snodgrass, Kemper, Herman, & Covington, 2008) has made the process of calculating PD accessible to untrained individuals. The benefits of a computer-based program are further seen in reliability, with 100% consistency when re-counting a single sample, and inter-rater reliability of 97% when compared to manual calculations which is more reliable than most human coders (Brown, et al., 2008). The present research made use of this computerised analysis of PD to investigate the effects of aphasia on informativeness. It was hypothesised that information content, as measured by PD, would be significantly reduced in the oral discourse of people with aphasia when compared to non-aphasic controls, and that PD would decrease with increasing aphasia severity as determined by Western Aphasia Battery - Aphasia Quotient (Kertesz, 2006)