Talking With Patients: How Hospitals Use Bilingual Clinicians and Staff to Care for Patients With Language Needs

Presents survey findings on bilingual clinicians, staff, interpreters, and volunteers providing language services; training and assessment; hospital policies; and their impact. Recommends explicit policies, robust assessments, and proactive approaches

AN EVALUATION OF CENTRIFUGED vs ELECTRONICALLY DETERMINED HEMATOCRITS IN ASSESSING THE DEGREE OF POLYCYTHEMIA IN CYANOTIC CONGENITAL HEART DISEASE

Secondary polycythemia is defined as an absolute erythrocytosis caused by an enhanced stimulation of red blood cell production. One of the most common methods of monitoring the degree of polycythemia is the measurement of the hematocrit. The hematocrit is the measurement of the volume of red blood cells.expressed as a percentage of the volume of whole blood in a sample. This measurement is usually done using one of two methods: (1) the Coulter Model S® or (2) the centrifuged micro-hematocrit method. However, we have noted a significant difference in the hematocrit values determined by these two methods when the hematocrits exceed 54 percent. As many as 10 hematocrit units of difference have been reported (1 hematocrit unit = ml of packed erythrocytes/100 ml of whole blood). Several questions arise: (1) does this variation in hematocrit (hct) values increase in proportion to the increase in hematocrit; (2) is there a relationship between the fibrinogen level and the amount of trapped plasma in the centrifuged micro-hct; (3) is there a relationship between the red blood cell count (RBC), mean corpuscular volume (MCV), and whole blood viscosity; (4) which measurement is a better indicator of the degree of polycythemia and the increase in viscosity. To answer these questions data from the Coulter Model S®: centrifuged micro-hct, whole blood viscosity and fibrinogen determination were evaluated. With these data it was planned to determine if it would be possible (1) to construct a nomogram establishing the relationship between the micro-hat and Coulter S® hct greater than 50 percent for the conversion of one value to the other, and (2) to assess the degree of polycythemia and the need for phlebotomy by the use of each measurement

An Assessment of the Safety Net in Queens, New York

This report examines key issues that shape the healthcare network available to uninsured and underserved residents in Queens. It provides background on the Queens health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them

Amino acid losses during hemodialysis with infusion of amino acids and glucose

Amino acid losses during hemodialysis with infusion of amino acids and glucose. This study evaluated the effects during hemodialysis of intravenous infusion of amino acids and glucose on plasma amino acid and glucose concentrations and amino acid losses. Eight men undergoing maintenance hemodialysis were each studied during two dialyses using glucose-free dialysate. During one hemodialysis, they were infused with 800ml of normal saline. During the other hemodialysis, they were infused with an equal volume of water which contained 39.5g of essential and non-essential free L-amino acids and 200g of d-glucose. The solutions were infused throughout the dialysis procedure into the drip chamber of the venous outflow from the dialyzer. Subjects were fasted from the night before until the end of hemodialysis, and the order of administration of the two solutions was determined randomly. Plasma essential, non-essential, and total amino acids fell significantly during the infusion of normal saline and rose during the administration of amino acids and glucose. Dialysate total-free amino acid losses averaged 8.2 ± 3.1SDg during the infusion of normal saline and 12.6 ± 3.6g with the administration of amino acids and glucose. These findings indicate that the intravenous infusion of amino acids and glucose during hemodialysis prevents a fall in plasma amino acid and glucose concentrations and leads to only a slight increase in the losses of free amino acids into dialysate. Because most of the infused amino acids are retained, this technique may be used during hemodialysis to avoid a net outflow of amino acids, minimize disruption of amino acid and glucose pools, and provide a nutritional supplement.Pertes en amino-acides au cours de l'hémodialyse avec perfusion d'acides aminés et de glucose. Cette étude a permis d'évaluer les effets de la perfusion intraveineuse d'acides aminés et de glucose pendant l'hémodialyse sur les concentrations plasmatiques d'acides aminés et de glucose, et les pertes d'acides aminés. Huit hommes en hémodialyse chronique ont chacun été étudiés pendant deux dialyses avec un dialysat sans glucose. Pendant une des dialyses ils étaient perfusés avec 800ml de soluté physiologique. Pendant l'hemodialyse autre ils ont infusé avec un égal volume d'eau contenant 39,5g de L-acides aminés libres essentiels ou non, et 200g de d-glucose. Les solutions étaient perfusées pendant la dialyse dans la tubulure veineuse venant du dialyseur. Les malades étaient à jeûn la nuit précédante et jusqu'à la fin de la dialyse, et l'ordre d'administration des deux solutions était déterminé au hasard. Les acides aminés plasmatiques totaux, essentiels et non essentiels ont significativement diminué pendant la perfusion de soluté physiologique, et se sont élevés pendant l'administration d'acides aminés et de glucose. Dans le dialysat, les pertes totales d'acides aminés libres étaient en moyenne de 8,2 ± 3,1g (ds) pendant la perfusion de soluté physiologique, et de 12,6 ± 3,6g lors de l'administration d'acides aminés et de glucose. Ces résultats indiquent que la perfusion intraveineuse d'acides aminés et de glucose au cours de la dialyse empêche la chute des acides aminés et du glucose plasmatiques et n'occasionne qu'une diminution minime des pertes en acides aminés libres dans le dialysat. Puisque la plupart des acides aminés perfusés est retenue, cette technique pourrait être utilisée pendant l'hémodialyse pour éviter une fuite nette d'acides aminés, pour minimiser la dissipation des réserves d'acides aminés et de glucose et pour apporter un supplément nutritif

Characterization of the Amebae Isolated From the First Confirmed Case of Primary Amebic Meningoencephalitis in Oklahoma

Naegleria fowleri causes a fatal brain disease, primary amebic meningoencephalitis (PAM). This research characterizes the infectious agent, designated HBT1-1998, of a victim of PAM as N. fowleri. Tests performed included concanavalin A (Con A) agglutination, enflagellation, growth studies, ameba and cyst measurement, drug studies with azithromycin and amphotericin B, and indirect immunofluorescence (IIF). In vivo studies included examination of brain tissue from infected mice, calculated LD50, percent mortality, and mean time to death. HBT1-1998 morphology, including positive enflagellation, and growth conditions were typical of N. fowleri. Con A did not cause agglutination. Drug study results for HBT1-1998 and control N. fowleri were compatible. IIF confirmed the amebae as N. fowleri. In vivo studies showed an LD50 of 132 amebae/mouse, percent mortality of 100% with a dose of 1 x 10 5 amebae/mouse, and a mean time to death of 6 days. These data support the identification of HBT1-1998 as Naegleria fowleri.Department of Biochemistry and Molecular Biolog

Social and Psychological Factors Associated with Health Care Transition for Young Adults Living with Sickle Cell Disease

Introduction: Due to advances in disease management, mortality rates in children with sickle cell disease (SCD) have decreased. However, mortality rates for young adults (YA) increased, and understanding of social and psychological factors is critical. The aim of this study was to explore factors associated with health care transition experiences for YA with SCD. Method: This was a qualitative descriptive study. A 45-minute semistructured interview was conducted with 13 YA (M = 21.5 years, SD = 1.73). Results: Results suggest that social and psychological factors and self-management experiences influence health care transition. Eight themes emerged: “need for accessible support”; “early assistance with goal setting”; “incongruence among expectations, experiences, and preparation”; “spiritual distress”; “stigma”; “need for collaboration”; “appreciation for caring providers”; and “feeling isolated.” Discussion: Consideration of cultural contexts will guide nurses in supporting health care transition. Designing culturally relevant interventions that address unique needs for YA living with SCD is warranted

Safety and physiological effects of two different doses of elosulfase alfa in patients with morquio a syndrome: A randomized, double-blind, pilot study.

The primary treatment outcomes of a phase 2, randomized, double-blind, pilot study evaluating safety, physiological, and pharmacological effects of elosulfase alfa in patients with Morquio A syndrome are herewith presented. Patients aged ≥7 years and able to walk ≥200 m in the 6-min walk test (6MWT) were randomized to elosulfase alfa 2.0 or 4.0 mg/kg/week for 27 weeks. The primary objective was to evaluate the safety of both doses. Secondary objectives were to evaluate effects on endurance (6MWT and 3-min stair climb test [3MSCT]), exercise capacity (cardio-pulmonary exercise test [CPET]), respiratory function, muscle strength, cardiac function, pain, and urine keratan sulfate (uKS) levels, and to determine pharmacokinetic parameters. Twenty-five patients were enrolled (15 randomized to 2.0 mg/kg/week and 10 to 4.0 mg/kg/week). No new or unexpected safety signals were observed. After 24 weeks, there were no improvements versus baseline in the 6MWT, yet numerical improvements were seen in the 3MSCT with 4.0 mg/kg/week. uKS and pharmacokinetic data suggested no linear relationship over the 2.0-4.0 mg/kg dose range. Overall, an abnormal exercise capacity (evaluated in 10 and 5 patients in the 2.0 and 4.0 mg/kg/week groups, respectively), impaired muscle strength, and considerable pain were observed at baseline, and there were trends towards improvements in all domains after treatment. In conclusion, preliminary data of this small study in a Morquio A population with relatively good endurance confirmed the acceptable safety profile of elosulfase alfa and showed a trend of increased exercise capacity and muscle strength and decreased pain

Diploma Privilege and the Constitution

The COVID-19 pandemic and resulting shutdowns are affecting every aspect of society. The legal profession and the justice system have been profoundly disrupted at precisely the time when there is an unprecedented need for legal services to deal with a host of legal issues generated by the pandemic, including disaster relief, health law, insurance, labor law, criminal justice, domestic violence, and civil rights. The need for lawyers to address these issues is great but the prospect of licensing new lawyers is challenging due to the serious health consequences of administering the bar examination during the pandemic. State Supreme Courts are actively considering alternative paths to licensure. One such alternative is the diploma privilege, a path to licensure currently used only in Wisconsin. Wisconsin\u27s privilege, limited to graduates of its two in-state schools, has triggered constitutional challenges never fully resolved by the lower courts. As states consider emergency diploma privileges to address the pandemic, they will face these unresolved constitutional issues. This Article explores those constitutional challenges and concludes that a diploma privilege limited to graduates of in-state schools raises serious Dormant Commerce Clause questions that will require the state to tie the privilege to the particular competencies in-state students develop and avenues they have to demonstrate those competencies to the state\u27s practicing bar over three years. Meeting that standard will be particularly difficult if a state adopts an in-state privilege on an emergency basis. States should consider other options, including privileges that do not prefer in-state schools. The analysis is important both for states considering emergency measures and for those that might restructure their licensing after the pandemic

A Field-Based Testing Protocol for Assessing Gross Motor Skills in Preschool Children: The Children\u27s Activity and Movement in Preschool Study Motor Skills Protocol

The purpose of this study was to develop a valid and reliable tool for use in assessing motor skills in preschool children in field-based settings. The development of the Children’s Activity and Movement in Preschool Study Motor Skills Protocol included evidence of its reliability and validity for use in field-based environments as part of large epidemiological studies. Following pilot work, 297 children (3–5 years old) from 22 preschools were tested using the final version of the Children’s Activity and Movement in Preschool Study Motor Skills Protocol and the Test of Gross Motor Development (2nd Edition). Reliability of the Children’s Activity and Movement in Preschool Study Motor Skills Protocol and interobserver reliability were determined using intraclass correlation procedures (intraclass correlation coefficients; ANOVA). Concurrent validity was assessed using Pearson correlation coefficients to compare the Children’s Activity and Movement in Preschool Study Motor Skills Protocol to the original Test of Gross Motor Development (2nd Edition). Results indicated that test reliability, interobserver reliability, and validity coefficients were all high, generally above R/r = .90. Significant age differences were found. Outcomes indicate that the Children’s Activity and Movement in Preschool Study Motor Skills Protocol is an appropriate tool for assessing motor development of 3-, 4-, and 5-year-old children in field-based settings that are consistent with large-scale trials