Language Barriers in Health Care Settings: An Annotated Bibliography of Research Literature

Provides an overview of resources related to the prevalence, role, and effects of language barriers and access in health care

Developments in modelling of backward erosion piping

One of the failure mechanisms that can affect the safety of a dyke or another water-retaining structure is backward erosion piping, a phenomenon that results in the formation of shallow pipes at the interface of a sandyor silty foundation and a cohesive cover layer. Themodels available for predicting the critical head at which the pipe progresses to the upstreamside have been validated and adapted on the basis of experiments with two-dimensional (2D) configurations. However, the experimental base for backward erosion in three-dimensional (3D) configurations in which the flow concentrates towards one point, a situation that is commonly encountered in the field, is limited. This paper presents additional 3D configuration experiments at two scales with a range of sand types. The critical gradients, the formed pipes and the erosion mechanism were analysed for the available experiments, indicating that the erosion mechanism is more complex than previously assumed, as both erosion at the tip of the pipe (primary erosion) and in the pipe (secondary erosion) are relevant. In addition, a 3D configuration was found to result in significantly lower critical gradients than those predicted by an accepted calculation model calibrated on the basis of 2D experiments, a finding that is essential for the application of the model in the field

Optimisation of the Schizosaccharomyces pombe urg1 expression system

The ability to study protein function in vivo often relies on systems that regulate the presence and absence of the protein of interest. Two limitations for previously described transcriptional control systems that are used to regulate protein expression in fission yeast are: the time taken for inducing conditions to initiate transcription and the ability to achieve very low basal transcription in the "OFF-state". In previous work, we described a Cre recombination-mediated system that allows the rapid and efficient regulation of any gene of interest by the urg1 promoter, which has a dynamic range of approximately 75-fold and which is induced within 30-60 minutes of uracil addition. In this report we describe easy-to-use and versatile modules that can be exploited to significantly tune down P urg1 "OFF-levels" while maintaining an equivalent dynamic range. We also provide plasmids and tools for combining P urg1 transcriptional control with the auxin degron tag to help maintain a null-like phenotype. We demonstrate the utility of this system by improved regulation of HO-dependent site-specific DSB formation, by the regulation Rtf1-dependent replication fork arrest and by controlling Rhp18(Rad18)-dependent post replication repair

Design principles for riboswitch function

Scientific and technological advances that enable the tuning of integrated regulatory components to match network and system requirements are critical to reliably control the function of biological systems. RNA provides a promising building block for the construction of tunable regulatory components based on its rich regulatory capacity and our current understanding of the sequence–function relationship. One prominent example of RNA-based regulatory components is riboswitches, genetic elements that mediate ligand control of gene expression through diverse regulatory mechanisms. While characterization of natural and synthetic riboswitches has revealed that riboswitch function can be modulated through sequence alteration, no quantitative frameworks exist to investigate or guide riboswitch tuning. Here, we combined mathematical modeling and experimental approaches to investigate the relationship between riboswitch function and performance. Model results demonstrated that the competition between reversible and irreversible rate constants dictates performance for different regulatory mechanisms. We also found that practical system restrictions, such as an upper limit on ligand concentration, can significantly alter the requirements for riboswitch performance, necessitating alternative tuning strategies. Previous experimental data for natural and synthetic riboswitches as well as experiments conducted in this work support model predictions. From our results, we developed a set of general design principles for synthetic riboswitches. Our results also provide a foundation from which to investigate how natural riboswitches are tuned to meet systems-level regulatory demands

The science of clinical practice: disease diagnosis or patient prognosis? Evidence about "what is likely to happen" should shape clinical practice.

BACKGROUND: Diagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful. DISCUSSION: Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous 'yes' or 'no' is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient's future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome. SUMMARY: Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care

Interactions between climate change and land use change on biodiversity: attribution problems, risks, and opportunities

Global change drivers are known to interact in their effects on biodiversity, but much research to date ignores this complexity. As a consequence, there are problems in the attribution of biodiversity change to different drivers and, therefore, our ability to manage habitats and landscapes appropriately. Few studies explicitly acknowledge and account for interactive (i.e., nonadditive) effects of land use and climate change on biodiversity. One reason is that the mechanisms by which drivers interact are poorly understood. We evaluate such mechanisms, including interactions between demographic parameters, evolutionary trade-offs and synergies and threshold effects of population size and patch occupancy on population persistence. Other reasons for the lack of appropriate research are limited data availability and analytical issues in addressing interaction effects. We highlight the influence that attribution errors can have on biodiversity projections and discuss experimental designs and analytical tools suited to this challenge. Finally, we summarize the risks and opportunities provided by the existence of interaction effects. Risks include ineffective conservation management; but opportunities also arise, whereby the negative impacts of climate change on biodiversity can be reduced through appropriate land management as an adaptation measure. We hope that increasing the understanding of key mechanisms underlying interaction effects and discussing appropriate experimental and analytical designs for attribution will help researchers, policy makers, and conservation practitioners to better minimize risks and exploit opportunities provided by land use-climate change interactions

Boundary Crossing: Networked Policing and Emergent “Communities of Practice” in Safeguarding Children

Child safeguarding has come to the forefront of public debate in the UK in the aftermath of a series of highly publicised incidents of child sexual exploitation and abuse. These have exposed the inadequacies and failings of inter-organisational relations between police and key partners. While the discourse of policing partnerships is now accepted wisdom, progress has been distinctly hesitant. This paper contributes to understanding both the challenges and opportunities presented through working across organisational boundaries in the context of safeguarding children. It draws on a study of relations within one of the largest Safeguarding Children partnerships in England, developing insights from Etienne Wenger regarding the potential of ‘communities of practice’ that innovate on the basis of everyday learning through ‘boundary work’. We demonstrate how such networked approaches expose the differential power relations and sites of conflict between organisations but also provide possibilities to challenge introspective cultures and foster organisational learning. We argue that crucial in cultivating effective ‘communities of practice’ are: shared commitment and purpose; relations of trust; balanced exchange of information and resources; mutual respect for difference; and an open and mature dialogue over possible conflicts. Boundary crossing can open opportunities to foster increased reflexivity among policing professionals, prompting critical self-reflection on values, ongoing reassessment of assumptions and questioning of terminology. Yet, there is an inherent tension in that the learning and innovative potential afforded by emergent ‘communities of practice’ derives from the coexistence and interplay between both the depth of knowledge within practices and active boundaries across practices

Gestational weight gain and group prenatal care: A systematic review and meta-analysis

Abstract Background Group visits for chronic medical conditions in non-pregnant populations have demonstrated successful outcomes including greater weight loss compared to individual visits for weight management. It is plausible that group prenatal care can similarly assist women in meeting gestational weight gain goals. The purpose of this study was to evaluate the effect of group vs. traditional prenatal care on gestational weight gain. Methods A keyword search of Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and Google Scholar was performed up to April 2017. Studies were included if they compared gestational weight gain in a group prenatal care setting to traditional prenatal care in either randomized controlled trials, cohort, or case-control studies. The primary and secondary outcomes were excessive and adequate gestational weight gain according to the Institute of Medicine guidelines. Heterogeneity was assessed with the Q test and I2 statistic. Pooled relative risks (RRs) and confidence intervals (CI) were reported with random-effects models from the randomized controlled trials (RCT) and cohort studies. Results One RCT, one secondary analysis of an RCT, one study with “random assignment”, and twelve cohort studies met the inclusion criteria for a total of 13,779 subjects. Thirteen studies used the CenteringPregnancy model, defined by 10 sessions that emphasize goal setting and self-monitoring. Studies targeted specific populations such as adolescents, African-Americans, Hispanics, active-duty military or their spouses, and women with obesity or gestational diabetes. There were no significant differences in excessive [7 studies: pooled rates 47% (1806/3582) vs. 43% (3839/8521), RR 1.09, 95% CI 0.97–1.23] or adequate gestational weight gain [6 studies: pooled rates 31% (798/2875) vs. 30% (1410/5187), RR 0.92, 95% CI 0.79–1.08] in group and traditional prenatal care among the nine studies that reported categorical gestational weight gain outcomes in the meta-analysis. Conclusions Group prenatal care was not associated with excessive or adequate gestational weight gain in the meta-analysis. Since outcomes were overall inconsistent, we propose that prenatal care models (e.g., group vs. traditional) should be evaluated in a more rigorous fashion with respect to gestational weight gain

Measurements of neutrino oscillation in appearance and disappearance channels by the T2K experiment with 6.6 x 10(20) protons on target

111 pages, 45 figures, submitted to Physical Review D. Minor revisions to text following referee comments111 pages, 45 figures, submitted to Physical Review D. Minor revisions to text following referee comments111 pages, 45 figures, submitted to Physical Review D. Minor revisions to text following referee commentsWe thank the J-PARC staff for superb accelerator performance and the CERN NA61/SHINE Collaboration for providing valuable particle production data. We acknowledge the support of MEXT, Japan; NSERC, NRC, and CFI, Canada; CEA and CNRS/IN2P3, France; DFG, Germany; INFN, Italy; National Science Centre (NCN), Poland; RSF, RFBR and MES, Russia; MINECO and ERDF funds, Spain; SNSF and SER, Switzerland; STFC, UK; and the U. S. Deparment of Energy, USA. We also thank CERN for the UA1/NOMAD magnet, DESY for the HERA-B magnet mover system, NII for SINET4, the WestGrid and SciNet consortia in Compute Canada, GridPP, UK, and the Emerald High Performance Computing facility in the Centre for Innovation, UK. In addition, participation of individual researchers and institutions has been further supported by funds from ERC (FP7), EU; JSPS, Japan; Royal Society, UK; and DOE Early Career program, USA