78 research outputs found
Predictors of Language Service Availability in U.S. Hospitals
Background: Hispanics comprise 17% of the total U.S. population, surpassing African-Americans as the largest
minority group. Linguistically, almost 60 million people speak a language other than English. This language diversity
can create barriers and additional burden and risk when seeking health services. Patients with Limited English
Proficiency (LEP) for example, have been shown to experience a disproportionate risk of poor health outcomes,
making the provision of Language Services (LS) in healthcare facilities critical. Research on the determinants of
LS adoption has focused more on overall cultural competence and internal managerial decision-making than on
measuring LS adoption as a process outcome influenced by contextual or external factors. The current investigation
examines the relationship between state policy, service area factors, and hospital characteristics on hospital
LS adoption.
Methods:We employ a cross-sectional analysis of survey data from a national sample of hospitals in the American
Hospital Association (AHA) database for 2011 (N= 4876) to analyze hospital characteristics and outcomes,
augmented with additional population data from the American Community Survey (ACS) to estimate language
diversity in the hospital service area. Additional data from the National Health Law Program (NHeLP) facilitated
the state level Medicaid reimbursement factor.
Results:Only 64%of hospitals offered LS. Hospitals that adopted LS were more likely to be not-for-profit, in areas
with higher than average language diversity, larger, and urban. Hospitals in above average language diverse counties
had more than 2-fold greater odds of adopting LS than less language diverse areas [Adjusted Odds Ratio (AOR):
2.26, P< 0.01]. Further, hospitals with a strategic orientation toward diversity had nearly 2-fold greater odds of
adopting LS (AOR: 1.90, P< 0.001).
Conclusion:Our findings support the importance of structural and contextual factors as they relate to healthcare
delivery. Healthcare organizations must address the needs of the population they serve and align their efforts
internally. Current financial incentives do not appear to influence adoption of LS, nor do Medicaid reimbursement
funds, thus suggesting that further alignment of incentives. Organizational and system level factors have a place in
disparities research and warrant further analysis; additional spatial methods could enhance our understanding of
population factors critical to system-level health services research
Predictors of language service availability in U.S. hospitals
Background:
Hispanics comprise 17% of the total U.S. population, surpassing African-Americans as the largest
minority group. Linguistically, almost 60 million people speak a language other than English. This language diversity
can create barriers and additional burden and risk when seeking health services. Patients with Limited English
Proficiency (LEP) for example, have been shown to experience a disproportionate risk of poor health outcomes,
making the provision of Language Services (LS) in healthcare facilities critical. Research on the determinants of
LS adoption has focused more on overall cultural competence and internal managerial decision-making than on
measuring LS adoption as a process outcome influenced by contextual or external factors. The current investigation
examines the relationship between state policy, service area factors, and hospital characteristics on hospital
LS adoption.
Methods:
We employ a cross-sectional analysis of survey data from a national sample of hospitals in the American
Hospital Association (AHA) database for 2011 (N=
4876) to analyze hospital characteristics and outcomes,
augmented with additional population data from the American Community Survey (ACS) to estimate language
diversity in the hospital service area. Additional data from the National Health Law Program (NHeLP) facilitated
the state level Medicaid reimbursement factor.
Results:
Only 64%
of hospitals offered LS. Hospitals that adopted LS were more likely to be not-for-profit, in areas
with higher than average language diversity, larger, and urban. Hospitals in above average language diverse counties
had more than 2-fold greater odds of adopting LS than less language diverse areas [Adjusted Odds Ratio (AOR):
2.26,
P
< 0.01]. Further, hospitals with a strategic orientation toward diversity had nearly 2-fold greater odds of
adopting LS (AOR: 1.90,
P
< 0.001).
Conclusion:
Our findings support the importance of structural and contextual factors as they relate to healthcare
delivery. Healthcare organizations must address the needs of the population they serve and align their efforts
internally. Current financial incentives do not appear to influence adoption of LS, nor do Medicaid reimbursement
funds, thus suggesting that further alignment of incentives. Organizational and system level factors have a place in
disparities research and warrant further analysis; additional spatial methods could enhance our understanding of
population factors critical to system-level health services researc
Forecasting global and multi-level thermospheric neutral density and ionospheric electron content by tuning models against satellite-based accelerometer measurements
Global estimation of thermospheric neutral density (TND) on various altitudes is important for geodetic and space weather applications. This is typically provided by models, however, the quality of these models is limited due to their imperfect structure and the sensitivity of their parameters to the calibration period. Here, we present an ensemble Kalman filter (EnKF)-based calibration and data assimilation (C/DA) technique that updates the model’s states and simultaneously calibrates its key parameters. Its application is demonstrated using the TND estimates from on-board accelerometer measurements, e.g., those of the Gravity Recovery and Climate Experiment (GRACE) mission (at ∼410 km altitude), as observation, and the frequently used empirical model NRLMSISE-00. The C/DA is applied here to re-calibrate the model parameters including those controlling the influence of solar radiation and geomagnetic activity as well as those related to the calculation of exospheric temperature. The resulting model, called here ‘C/DA-NRLMSISE-00’, is then used to now-cast TNDs and individual neutral mass compositions for 3 h, where the model with calibrated parameters is run again during the assimilation period. C/DA-NRLMSISE-00 is also used to forecast the next 21 h, where no new observations are introduced. These forecasts are unique because they are available globally and on various altitudes (300–600 km). To introduce the impact of the thermosphere on estimating ionospheric parameters, the coupled physics-based model TIE-GCM is run by replacing the O2, O1, He and neutral temperature estimates of the C/DA-NRLMSISE-00. Then, the non-assimilated outputs of electron density (Ne) and total electron content (TEC) are validated against independent measurements. Assessing the forecasts of TNDs with those along the Swarm-A (∼467 km), -B (∼521 km), and -C (∼467 km) orbits shows that the root-mean-square error (RMSE) is considerably reduced by 51, 57 and 54%, respectively. We find improvement of 30.92% for forecasting Ne and 26.48% for TEC compared to the radio occulation and global ionosphere maps (GIM), respectively. The presented C/DA approach is recommended for the short-term global multi-level thermosphere and enhanced ionosphere forecasting applications
Measurement of the cosmic ray spectrum above eV using inclined events detected with the Pierre Auger Observatory
A measurement of the cosmic-ray spectrum for energies exceeding
eV is presented, which is based on the analysis of showers
with zenith angles greater than detected with the Pierre Auger
Observatory between 1 January 2004 and 31 December 2013. The measured spectrum
confirms a flux suppression at the highest energies. Above
eV, the "ankle", the flux can be described by a power law with
index followed by
a smooth suppression region. For the energy () at which the
spectral flux has fallen to one-half of its extrapolated value in the absence
of suppression, we find
eV.Comment: Replaced with published version. Added journal reference and DO
Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory
The Auger Engineering Radio Array (AERA) is part of the Pierre Auger
Observatory and is used to detect the radio emission of cosmic-ray air showers.
These observations are compared to the data of the surface detector stations of
the Observatory, which provide well-calibrated information on the cosmic-ray
energies and arrival directions. The response of the radio stations in the 30
to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of
the incoming electric field. For the latter, the energy deposit per area is
determined from the radio pulses at each observer position and is interpolated
using a two-dimensional function that takes into account signal asymmetries due
to interference between the geomagnetic and charge-excess emission components.
The spatial integral over the signal distribution gives a direct measurement of
the energy transferred from the primary cosmic ray into radio emission in the
AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air
shower arriving perpendicularly to the geomagnetic field. This radiation energy
-- corrected for geometrical effects -- is used as a cosmic-ray energy
estimator. Performing an absolute energy calibration against the
surface-detector information, we observe that this radio-energy estimator
scales quadratically with the cosmic-ray energy as expected for coherent
emission. We find an energy resolution of the radio reconstruction of 22% for
the data set and 17% for a high-quality subset containing only events with at
least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO
Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy
We measure the energy emitted by extensive air showers in the form of radio
emission in the frequency range from 30 to 80 MHz. Exploiting the accurate
energy scale of the Pierre Auger Observatory, we obtain a radiation energy of
15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV
arriving perpendicularly to a geomagnetic field of 0.24 G, scaling
quadratically with the cosmic-ray energy. A comparison with predictions from
state-of-the-art first-principle calculations shows agreement with our
measurement. The radiation energy provides direct access to the calorimetric
energy in the electromagnetic cascade of extensive air showers. Comparison with
our result thus allows the direct calibration of any cosmic-ray radio detector
against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI.
Supplemental material in the ancillary file
Serine residue 115 of MAPK-activated protein kinase MK5 is crucial for its PKA-regulated nuclear export and biological function
The mitogen-activated protein kinase-activated protein kinase-5 (MK5) resides predominantly in the nucleus of resting cells, but p38MAPK, extracellular signal-regulated kinases-3 and -4 (ERK3 and ERK4), and protein kinase A (PKA) induce nucleocytoplasmic redistribution of MK5. The mechanism by which PKA causes nuclear export remains unsolved. In the study reported here we demonstrated that Ser-115 is an in vitro PKA phosphoacceptor site, and that PKA, but not p38MAPK, ERK3 or ERK4, is unable to redistribute MK5 S115A to the cytoplasm. However, the phosphomimicking MK5 S115D mutant resides in the cytoplasm in untreated cells. While p38MAPK, ERK3 and ERK4 fail to trigger nuclear export of the kinase dead T182A and K51E MK5 mutants, S115D/T182A and K51E/S115D mutants were able to enter the cytoplasm of resting cells. Finally, we demonstrated that mutations in Ser-115 affect the biological properties of MK5. Taken together, our results suggest that Ser-115 plays an essential role in PKA-regulated nuclear export of MK5, and that it also may regulate the biological functions of MK5
Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016
Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations
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