Exploring the Impact of Language Services on Utilization and Clinical Outcomes for Diabetics

Background: Significant health disparities exist between limited English proficient and English-proficient patients. Little is known about the impact of language services on chronic disease outcomes such as for diabetes. Methods/Principal Findings: To determine whether the amount and type of language services received during primary care visits had an impact on diabetes-related outcomes (hospitalization, emergency room utilization, glycemic control) in limited English proficient patients, a retrospective cohort design was utilized. Hospital and medical record data was examined for 1425 limited English proficient patients in the Cambridge Health Alliance diabetes registry. We categorized patients receiving usual care into 7 groups based on the amount and combination of language services (language concordant providers, formal interpretation and nothing) received at primary care visits during a 9 month period. Bivariate analyses and multiple logistic regression were used to determine relationships between language service categories and outcomes in the subsequent 6 months. Thirty-one percent of patients (445) had no documentation of interpreter use or seeing a language concordant provider in any visits. Patients who received 100% of their primary care visits with language concordant providers were least likely to have diabetes-related emergency department visits compared to other groups (p<0001) in the following 6 months. Patients with higher numbers of co-morbidities were more likely to receive formal interpretation. Conclusions/Significance: Language concordant providers may help reduce health care utilization for limited English proficient patients with diabetes. However, given the lack of such providers in sufficient numbers to meet patients' communication needs, strategies are needed to both increase their numbers and ensure that the highest risk patients receive the most appropriate language services. In addition, systems serving diverse populations must clarify why some limited English proficient patients do not receive language services at some or all of their visits and whether this has an impact on quality of care

Trials

Background Optimising hearing and vision function may be important in improving a range of outcomes for people living with dementia (PwD) and their companions. The SENSE-Cog cross-national randomised controlled trial (RCT) is evaluating the effectiveness of a sensory intervention (SI) to improve quality of life for PwD with concurrent hearing and/or vision impairment, in five European countries. To ascertain how or why the intervention will, or will not, achieve its outcomes, we have designed a process evaluation to explore potential discrepancies between expected and observed outcomes. This will also help us to understand how context may influence the outcomes. Here we describe the protocol for this process evaluation, which is embedded within the RCT. Methods/design We will use a mixed methods approach with a theoretical framework derived from the UK Medical Research Council’s’ guidance on process evaluations. It will include the following: (1) evaluating how key aspects of the intervention will be delivered, which will be important to scale the intervention in real world populations; (2) characterising the contextual issues, which may shape the delivery and the impact of the intervention in different countries; and (3) investigating possible causal mechanisms through analyses of potential moderators and mediators. To avoid bias, we will analyse the process data before the analysis of the main effectiveness outcomes. Discussion This evaluation will provide insight into how the complex SENSE-Cog SI will be tailored, enacted and received across the different European contexts, all of which have unique health and social care economies. The findings will provide insight into the causal mechanisms effecting change, and will determine whether we should implement the intervention, if effective, on a wider scale for PwD and concurrent sensory impairment

Abstracts from the NIHR INVOLVE Conference 2017

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Persistent Place-Making in Prehistory: the Creation, Maintenance, and Transformation of an Epipalaeolithic Landscape

Most archaeological projects today integrate, at least to some degree, how past people engaged with their surroundings, including both how they strategized resource use, organized technological production, or scheduled movements within a physical environment, as well as how they constructed cosmologies around or created symbolic connections to places in the landscape. However, there are a multitude of ways in which archaeologists approach the creation, maintenance, and transformation of human-landscape interrelationships. This paper explores some of these approaches for reconstructing the Epipalaeolithic (ca. 23,000–11,500&nbsp;years BP) landscape of Southwest Asia, using macro- and microscale geoarchaeological approaches to examine how everyday practices leave traces of human-landscape interactions in northern and eastern Jordan. The case studies presented here demonstrate that these Epipalaeolithic groups engaged in complex and far-reaching social landscapes. Examination of the Early and Middle Epipalaeolithic (EP) highlights that the notion of “Neolithization” is somewhat misleading as many of the features we use to define this transition were already well-established patterns of behavior by the Neolithic. Instead, these features and practices were enacted within a hunter-gatherer world and worldview

IRM de quantification : vers des cartographies T₁, T₂, DP rapides et fiables à très hauts champs magnétiques chez l’homme

Quantitative MRI refers to methods able to measure different physical parameters accessible in Nuclear Magnetic Resonance. It offers benefits compared to weighting imaging commonly used, for the detection, the pathophysiological characterization but also for the therapeutic follow-up of pathologies for example. Despite this long-established potential, these methods remain little used in clinical routine. The main reason is the long acquisition time compared to the classical approach. The physical parameters that we will study more particularly are the longitudinal (T₁), transverse (T₂) relaxation time, the apparent diffusion coefficient (ADC), and the proton density (DP). Despite the possibility to achieve a better image quality, these in vivo mappings are virtually non-existent in the literature beyond 3T because their implementation requires overcom-ing a number of specific ultra-high-field (UHF) MRI limits. Through this thesis project, a Quantitative Imaging method using Configuration States (QuICS) was implemented under strong UHF constraints, to determine these parameters simultaneously. The technique has been optimized to obtain fast and reliable maps. The potential of the method was first demon-strated in vitro on a nucleus such as sodium, exhibiting complex properties. As a second step, acquisitions were performed in proton, in vivo, in an clinically-relevant acquisition time, compatible with a routine use at 7T for population imaging. The application of such a method of quantitative MRI to UHF will open new research possibilities for the future.L’IRM quantitative recouvre l’ensemble des méthodes permettant de mesurer des paramètres physiques accessibles en Résonance Magnétique Nucléaire. Elle offre un bénéfice par rapport à l’imagerie en pondération classiquement utilisée, notamment pour la détection, la caractérisation physiopathologique mais aussi pour le suivi thérapeutique des pathologies. Malgré ce potentiel avéré connu de longue date, ces méthodes restent peu utilisées dans la routine clinique. La raison principale est la longueur des acquisitions par rapport à l’approche classique. Les paramètres physiques que nous souhaitons étudier plus particulièrement sont le temps de relaxation longitudinal (T₁), transversal (T₂), le coefficient de diffusion apparent (ADC), et la densité de protons (DP). Malgré la possibilité d’atteindre une meilleure qualité d’images, ces cartographies in vivo sont quasiment inexistantes dans la littérature au-delà de 3T car leur implémentation nécessite de surmonter un certain nombre de limites spécifiques aux IRM ultra-haut champs (UHF). Au travers de ce projet de thèse, une méthode d’imagerie quantitative basée sur les états de configurations (QuICS) a été implémentée, pour déterminer ces paramètres quantitatifs de façon simultanée sous fortes contraintes propres aux UHF. L’approche a été optimisée dans le but d’obtenir des cartographies fiables et rapides. Le potentiel de la méthode a été démontré dans un premier temps in vitro sur un noyau tel que le sodium démontrant des propriétés complexes à cartographier. Puis dans un second temps, des acquisitions ont été réalisées sur proton, in vivo, en un temps d’acquisition compatible avec une utilisation en routine clinique à 7T. L’application d’une telle méthode d’IRM quantitative à UHF sur des populations permettra d’ouvrir de nouvelles voies d’études pour le futur

Enhancement of transmit and receive efficiencies with hybridized meta-atom in 7T head coil array

International audienceB1 + heterogeneity remains an important challenge for ultra-high field MRI scanners (B0≥7T). There are two methods to mitigate this problem: parallel transmission pTx [1], and passive shimming using high-dielectric pads [2], in this paper we will focus on passive shimming. High-dielectric constant pads have been proposed and optimized for passive shimming purposes [2-4]. Common formulations of dielectric pads for 7T applications are based on BaTiO3 mixed with water present some drawbacks such as performance decay over time. While previous studies tackled directly the formulation problem introducing new dielectric materials and solvent [5], we adopted a new approach based on metamaterial [6]. We demonstrated that the hybridization of four parallel metallic wires arranged on a square unit cell provides the ability to control radiofrequency field inside a 7T head birdcage. In the first part of this work, we show that these hybridized meta-atom (HMA) can be used like a dielectric pad placed on the side of the patient's head. In this configuration, we observe a strong enhancement of B1 amplitude near the metamaterial as well as a significant reduction of the inhomogeneities on the metamaterial side. Moreover, a significant gain in terms of signal to noise ratio is also observed as the reception of the MR signal is enhanced in a 1T/1R birdcage coil. In a second part, we address the HMA performances when used with a single channel transmit birdcage equipped with 32 channels receive array. In this configuration the HMA is deported between the emission coil and the receive array in order to maintain the patient's comfort. We demonstrated analytically using the impedance matrix [6], numerically and with measurement that the HMA structure is perfectly compatible with a birdcage emitter and does not perturb the receive array. Moreover, it has the ability to enhance both transmit and receive signal with the possibility to fill gaps usually observed in the brain temporal lobes. This metamaterial based passive shimming strategy would provide a cost effective and long-lasting solution without impacting the patient's comforts during the examination, especially in the presence of a head receive array routinely used for in vivo MRI protocol

A simple approach towards a multi-frequency MRI head phantom

International audienc

Mimicking the Electromagnetic Distribution in the Human Brain: A Multi-frequency MRI Head Phantom

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