Physicians’ knowledge and communication about traditional, complementary and alternative medicine use among Latino patients at Kaiser Permanente, Oakland CA

Understanding Latinos’ health beliefs and traditional, complementary and alternative medicine (TCAM) practices, and improving cross-cultural communication skills may improve quality of care and reduce health disparities. Although studies have examined the health beliefs and practices of Latino patients, few have examined the knowledge, attitudes, and communication skills of health care providers in regards to Latino TCAM use. This paper discusses the results from 10 physician questionnaires, which form part of a larger mixed-methods study of patients and physicians at a bilingual clinic at Kaiser Permanente in Oakland, California. Physicians had a range of knowledge regarding health beliefs and practices common among Latinos, but all reported an open and non-judgmental attitude during patient interactions and were permissive of TCAM therapies they considered safe. Physicians believed that TCAM use decreased with acculturation and varied by ethnicity, education and income. Physicians were more concerned with the misuse of prescription drugs among Latino patients than the potential for herbal toxicity or herb-drug interactions. The results indicate a need to include questions about pharmaceuticals in future research on Latino health practices, and also point to the need for research on how education, income and acculturation affect health beliefs and TCAM practices within different Latino subgroups.La compréhension des croyances des Latinos en matière de santé et de leur recours aux médecines traditionnelle, complémentaire et alternative, et l'amélioration des compétences en matière de communication interculturelle peut faire progresser la qualité des soins et réduire les disparités dans le domaine de la santé. Plusieurs études se sont penchées sur les croyances et les pratiques des Latinos en matière de santé mais peu se sont intéressées aux connaissances, aux attitudes et aux aptitudes en communication des professionnels de santé à l'égard des médecines TCA utilisées par les Latinos. Cette étude discute des résultats de 10 questionnaires complétés par des médecins, qui font partie d'une étude à méthodologie mixte à grande échelle portant sur des patients et des médecins d’une clinique bilingue du Kaiser Permanente à Oakland en Californie. Les médecins ont montré qu’ils avaient un large éventail de connaissances concernant les croyances et les pratiques liées à la santé répandues dans la communauté latino, et tous ont rapporté une attitude ouverte et sans jugement pendant les entretiens avec les patients et se sont montrés tolérants vis-à-vis des traitements traditionnels, complémentaires et alternatifs qu'ils considéraient comme sans danger. Les résultats montrent que les médecins estiment que le recours aux médecines TCA diminue avec l'acculturation et varie en fonction de l'ethnicité, de l'éducation et du revenu. Les médecins sont davantage préoccupés par le mauvais usage que font les patients latinos des médicaments prescrits que par le risque de toxicité des plantes ou des interactions plantes-médicaments. Les résultats indiquent le besoin d'inclure des questions sur les produits pharmaceutiques dans les futurs travaux de recherche sur les pratiques de santé des Latinos, et pointent sur la nécessité d'étudier la manière dont l'éducation, le revenu et l'acculturation affectent les croyances en matière de santé et le recours aux médecines TCA dans les différents sous-groupes de Latinos.Entender las creencias respecto a la salud, y las prácticas de medicina tradicional, complementaria y alternativa entre los latinos, así como mejorar las habilidades de comunicación interculturales, podrían mejorar la calidad de la atención y reducir las desigualdades de salud. Aunque se han realizado estudios que han examinado las creencias y prácticas relacionadas a la salud de los pacientes latinos, pocos se han centrado en el conocimiento, las actitudes y las habilidades de los profesionales de la salud para comunicarse  respecto al uso de la medicina tradicional, complementaria y alternativa entre los latinos. Este trabajo analiza los resultados de 10 cuestionarios médicos que forman parte de un estudio más amplio (que utiliza distintos métodos) de pacientes y profesionales médicos en una clínica bilingüe de Kaiser Permanente en Oakland (California). Los médicos contaban con conocimientos sobre las creencias y prácticas de salud habituales entre los latinos, aunque todos ellos manifestaban mantener una actitud abierta sin prejuicios durante las interacciones con los pacientes y eran permisivos con las terapias de medicina tradicional, complementaria y alternativa que consideraban seguras. Los profesionales médicos consideraban que dichas prácticas disminuían con la asimilación cultural y variaban según la etnia, el nivel educativo y el nivel de ingresos. A los facultativos les preocupaba más la mala utilización de las recetas de medicamentos entre los pacientes latinos que la posible toxicidad de las hierbas o la interacción entre medicamentos y hierbas. Los resultados indican que es necesario incluir preguntas sobre productos farmacéuticos en futuros estudios sobre prácticas de salud entre los latinos, así como resaltar la necesidad de investigar cómo la educación, el nivel de ingresos y la asimilación cultural afectan a las creencias de salud y las prácticas de medicina tradicional, complementaria y alternativa en los distintos subgrupos latinos

Combining unit and specification-based testing for meta-model validation and verification

This is the author’s version of a work that was accepted for publication in Information Systems. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Information Systems, VOL 62, (2016)] DOI 10.1016/j.is.2016.06.008Meta-models play a cornerstone role in Model-Driven Engineering as they are used to define the abstract syntax of modelling languages, and so models and all sorts of model transformations depend on them. However, there are scarce tools and methods supporting their Validation and Verification (V&V), which are essential activities for the proper engineering of meta-models. In order to fill this gap, we propose two complementary meta-model V&V languages. The first one has similar philosophy to the xUnit framework, as it enables the definition of meta-model unit test suites comprising model fragments and assertions on their (in-)correctness. The second one is directed to express and verify expected properties of a meta-model, including domain and design properties, quality criteria and platform-specific requirements. As a proof of concept, we have developed tooling for both languages in the Eclipse platform, and illustrate its use within an example-driven approach for meta-model construction. The expressiveness of our languages is demonstrated by their application to build a library of meta-model quality issues, which has been evaluated over the ATL zoo of meta-models and some OMG specifications. The results show that integrated support for meta-model V&V (as the one we propose here) is urgently needed in meta-modelling environments.This work has been funded by the Spanish Ministry of Economy and Competitivity with project “Flexor” (TIN2014-52129-R), the region of Madrid with project “SICOMORO-CM” (S2013/ICE-3006), and the EU commission with project “MONDO” (FP7- ICT-2013-10, #611125)

Catálogo actualizado de los briófitos de la Región de Murcia (Sureste de España)

An updated checklist of the bryophytes of the Region of Murcia is provided. Bryophyte diversity in Murcia consists of 200 especies and 15 infraespecific taxa (77 genera) of mosses and 32 species (20 genera) of liverworts. Grimmia tergestina is confirmed in the territory. Aschisma cuynetii, Brachytheciastrum dieckii, Brachythecium albicans, Brachythecium rutabulum, Brachythecium salebrosum, Bryum alpinum, Bryum elegans, Campyliadelphus chrysophyllus, Campylopus pilifer and Didymodon eckeliae are new reported for Murcia. Bryum tenuisetum, Entosthodon attenuatus and Fissidens bryoides are excluded from the check-list.Se actualiza el catálogo de los briófitos de la Región de Murcia. Para este territorio se aceptan 200 especies y 15 taxones infraespecíficos (77 géneros) de musgos y 32 especies de hepáticas (20 géneros). Grimmia tergestina se confirma en el territorio. Aschisma cuynetii, Brachytheciastrum dieckii, Brachythecium albicans, Brachythecium rutabulum, Brachythecium salebrosum, Bryum alpinum, Bryum elegans, Campyliadelphus chrysophyllus, Campylopus pilifer y Didymodon eckeliae son nuevas citas para Murcia. Bryum tenuisetum, Entosthodon attenuatus y Fissidens bryoides se excluyen del catálogo

Contra los que atacan las imágenes sagradas. Discurso apologético

Polémicos son también sus discursos apologéticos «sobre las imágenes sagradas», en los que el Damasceno defiende la ortodoxia de la veneración de las imágenes en contra del criterio del emperador León III y de quienes entendían que la veneración de la imagen era, en realidad, una adoración idólatra que debía ser erradicada. El estilo sencillo que Juan de Damasco empleó en estos textos facilitó su difusión entre la población cristiana e incitó a la misma a tomar postura ante la nueva polémica promovida por el poder imperial

Multipurpose Monte Carlo simulator for photon transport in turbid media

Proceeding of: 2009 IEEE Nuclear Science Symposium Conference Record (NSS/MIC), Orlando, Florida, 25-31 October 2009Monte Carlo methods provide a flexible and rigorous solution to the problem of light transport in turbid media, which enable approaching complex geometries for a closed analytical solution is not feasible. The simulator implements local rules of propagation in the form of probability density functions that depend on the local optical properties of the tissue. This work presents a flexible simulator that can be applied in multiple applications related to optical tomography. In particular, unlike previous codes, the simulator explicitly supports fluorescent-tissues and variance reduction and code parallelization techniques are implemented in order to speed up the execution with fluorochrome-labelled agents. The simulator is validated with simple geometries for which an analytical solution exists, as well as with an experimental polyester resin based optical phantom.This work was supported in part by the Ministry of Science and Innovation under projects TEC2008-06715 and TEC2007-64731/TCM and by the EU’s 7th Frame Programme under contract HEALTH-F5-2008-20179

Dementia research in the Caribbean Hispanic islands: Present findings and future trends

During the last decade, the Caribbean Hispanic islands experienced accelerated demographic aging, representing the fastest aging region within Latin America. Age-related non-communicable diseases, including dementia, are now reported at high prevalence. The Caribbean islands share similar genetic ancestry, culture, migration patterns, and risk profiles, providing a unique setting to understand dementia in the Caribbean-Hispanics. This perspective article aimed to describe the impact of dementia in the Caribbean, at a local and regional level and reflect on research strategies to address dementia. We report on 10/66 project findings, described research projects and regional plans for the region. According to our results, the prevalence of dementia in the Caribbean is the highest in Latin America, with 11.7% in Dominican Republic, 11.6% in Puerto Rico, and 10.8% in Cuba. Preliminary data from new waves of the 10/66 study shows increasing numbers of dementia cases. Furthermore, dementia is expected to be one of the most serious medical and social issues confronted by Caribbean health systems. However, there is a scarcity of knowledge, awareness, and health services to deal with this public health crisis. In light of the new evidence, local and regional strategies are underway to better understand dementia trends for the region and develop policies aimed to decrease the impact of dementia. Implementation of our national plans is critical to deal with an aging population with high dementia rates. Current recommendations include emphasizing public health prevention campaigns to address modifiable risk factors and expand support to caregiver and family interventions

Simulation of 3d Ising spin glass model using three replicas: study of Binder cumulants

We have carried out numerical simulations of the three-dimensional Ising spin glass model with first neighbour Gaussian couplings using three replicas for each sample of couplings. We have paid special attention to the measure of two types of Binder cumulant that can be constructed from the three possible overlaps between the replicas. We obtain new information about the possible phase transition and perform an initial analysis of the ultrametricity issue.Comment: 14 pages and 7 figures, available at http://chimera.roma1.infn.it/index_papers_complex.htm

New embedded digital front-end for high resolution PET scanner

This work describes a new digital front-end for a high-resolution low-cost animal PET scanner which is currently under development. The advances in flexibility and size of modern FPGAs together with the release of new tools enable the integration of most of the front-end electronics in a single FPGA. The implemented system includes a small 32-bit RISC processor, several peripherals attached to the internal buses and a special DSP unit closely attached to the processor which is dedicated to the detection of the gamma events. On top of these, a small footprint real time operating system abstracts the underlying hardware, providing the mechanisms to combine on-chip slow control and data streamingThis work was supported in part by the FPU Research Grant from the Spanish Education and Science Ministry, by the Spanish Thematic Network IM3 (PI052204) and project TEC2004-07052-C02-02Publicad

Real-Time Digital Timing in Positron Emission Tomography

Positron emission tomography (PET) requires accurate timing of scintillation events to properly discriminate between coincident and noncoincident pairs. The traditional solution to timing is based on custom application specific integrated circuits (ASIC) designs, whose cost may not be justified in the design of experimental small animal PET scanners. The new generation of PET scanners introduces the idea of continuous sampling of the detected scintillation pulse, replacing event-triggered acquisition front-ends. This approach enables new options to the timing procedure based on digital processing of the sampled pulse signal. This work proposes a time stamping algorithm based on the optically matched filter and compares the potential performance benefits of this approach versus other FIR-based timing algorithms, some of which have been already implemented by different authors. Results show that the coincidence timing resolution may be as low as 1.5 ns without the need of expensive high-speed converters when the proper signal processing is appliedIEEE Nuclear and Plasma Sciences SocietyPublicad

Relativistic current densities for bound spin-orbit partners and the longitudinal-transverse response in (e,ép) processes

Scalar, baryon and vector-current densities in coordinate and momentum space are calculated within a relativistic mean-field model. The role of the low components of the bound nucleon wave function is investigated in detail for different spin-orbit partner shells. We show that the relative importance of the negative-energy projection components can be explained from the different quantum numbers involved in the relativistic wave function. This fact has proved to be important in the analysis of various electron scattering observables even for low-medium values of the bound nucleon momentum.DGICYT PB/95–0123 PB/95–0533–