Rural Kansas Family Physician Satisfaction with Caring for Spanish-Speaking Only Patients

Introduction. Patient satisfaction with the care they receive can beinfluenced negatively by a language barrier between the physician andpatient. However, there is a paucity of information regarding the consequencesof a language barrier on physician satisfaction, althoughthis barrier has the potential to decrease physician wellness. Thisstudy sought to determine if a language barrier is a source of professionaldissatisfaction in family medicine physicians in rural Kansas. Methods. In a cross-sectional study, members of the Kansas Academyof Family Physicians who practiced in the rural Kansas countieswith the highest percentage of Hispanic residents were surveyed. Aquestionnaire was developed to determine the demographics of thephysician, details regarding his or her practice, and percentage of Hispanicand Spanish-speaking only (SSO) patients in their practice.Physicians also were queried as to their level of Spanish-speakingability, availability of certified interpreters, and their satisfaction withcaring for their SSO patients. Results. Fifty-two physicians were identified and sent questionnairesby mail. Eighteen questionnaires were completed and returned, resultingin a 34% response rate. Respondents remained anonymous. In thepractices surveyed, 61% of practice settings had a Hispanic-patientpopulation greater than 25%. Only one of the eighteen respondentshad greater than 25% of SSO patients in his or her practice. A certifiedinterpreter was used less than 25% of the time in over 75% ofthe clinical encounters with SSO patients. Seventy-five percent ofphysicians reported no difficulty establishing trust and rapport withtheir SSO patients. Eighty-nine percent of respondents rated theirrelationship with SSO patients as good to excellent, and 83% weresatisfied with the care they were able to provide this group. Seventyeightpercent of respondents reported that their ability to care forSSO patients decreased or had no effect on their professional satisfaction.Seventy-eight percent of physicians also rated their overallprofessional satisfaction in regards to their physician/patient relationshipas good to excellent. However, language barriers affectedphysician-patient relationships, physician satisfaction with care, andprofessional satisfaction. Conclusion. Language barrier affected physician’s relationships withSSO patients, led to decreased physician satisfaction with the carethey provided and to decreased professional satisfaction.KS J Med 2017;10(4):79-83

Do Humans Optimally Exploit Redundancy to Control Step Variability in Walking?

It is widely accepted that humans and animals minimize energetic cost while walking. While such principles predict average behavior, they do not explain the variability observed in walking. For robust performance, walking movements must adapt at each step, not just on average. Here, we propose an analytical framework that reconciles issues of optimality, redundancy, and stochasticity. For human treadmill walking, we defined a goal function to formulate a precise mathematical definition of one possible control strategy: maintain constant speed at each stride. We recorded stride times and stride lengths from healthy subjects walking at five speeds. The specified goal function yielded a decomposition of stride-to-stride variations into new gait variables explicitly related to achieving the hypothesized strategy. Subjects exhibited greatly decreased variability for goal-relevant gait fluctuations directly related to achieving this strategy, but far greater variability for goal-irrelevant fluctuations. More importantly, humans immediately corrected goal-relevant deviations at each successive stride, while allowing goal-irrelevant deviations to persist across multiple strides. To demonstrate that this was not the only strategy people could have used to successfully accomplish the task, we created three surrogate data sets. Each tested a specific alternative hypothesis that subjects used a different strategy that made no reference to the hypothesized goal function. Humans did not adopt any of these viable alternative strategies. Finally, we developed a sequence of stochastic control models of stride-to-stride variability for walking, based on the Minimum Intervention Principle. We demonstrate that healthy humans are not precisely “optimal,” but instead consistently slightly over-correct small deviations in walking speed at each stride. Our results reveal a new governing principle for regulating stride-to-stride fluctuations in human walking that acts independently of, but in parallel with, minimizing energetic cost. Thus, humans exploit task redundancies to achieve robust control while minimizing effort and allowing potentially beneficial motor variability

Replacement of daily load attenuates but does not prevent changes to the musculoskeletal system during bed rest

The dose-response effects of exercise in reduced gravity on musculoskeletal health have not been well documented. It is not known whether or not individualized exercise prescriptions can be effective in preventing the substantial loss in bone mineral density and muscle function that have been observed in space flight and in bed rest. In this study, typical daily loads to the lower extremities were quantified in free-living subjects who were then randomly assigned to control or exercise groups. Subjects were confined to 6-degree head-down bed rest for 84 days. The exercise group performed individually prescribed 1 g loaded locomotor exercise to replace their free-living daily load. Eleven subjects (5 exercise, 6 control) completed the protocol. Volumetric bone mineral density results from quantitative computed tomography demonstrated that control subjects lost significant amounts of bone in the intertrochanteric and total hip regions (p  0.0125). Pre-and post-bed rest muscle volumes were calculated from analysis of magnetic resonance imaging data. The exercise group retained a larger percentage of their total quadriceps and gastrocnemius muscle volume (−7.2% ± 5.9, −13.8% ± 6.1, respectively) than their control counterparts (−23.3% ± 5.9, −33.0 ± 8.2, respectively; p  0.05). The decline in VO2max was 17% ± 18 in exercising subjects (p  0.05). In summary, the decline in a number of important measures of musculoskeletal and cardiovascular health was attenuated but not eliminated by a subject-specific program of locomotor exercise designed to replace daily load accumulated during free living. We conclude that single daily bouts of exposure to locomotor exercise can play a role in a countermeasures program during bed rest, and perhaps space flight, but are not sufficient in their own right to ensure musculoskeletal or cardiovascular health. Keywords: Space flight, Bed rest, Exercise, Biomechanics, Simulation, Gravit

On Quantitative Comparative Research in Communication and Language Evolution

Quantitative comparison of human language and natural animal communication requires improved conceptualizations. We argue that an infrastructural approach to development and evolution incorporating an extended interpretation of the distinctions among illocution, perlocution, and meaning (Austin 1962; Oller and Griebel 2008) can help place the issues relevant to quantitative comparison in perspective. The approach can illuminate the controversy revolving around the notion of functional referentiality as applied to alarm calls, for example in the vervet monkey. We argue that referentiality offers a poor point of quantitative comparison across language and animal communication in the wild. Evidence shows that even newborn human cry could be deemed to show functional referentiality according to the criteria typically invoked by advocates of referentiality in animal communication. Exploring the essence of the idea of illocution, we illustrate an important realm of commonality among animal communication systems and human language, a commonality that opens the door to more productive, quantifiable comparisons. Finally, we delineate two examples of infrastructural communicative capabilities that should be particularly amenable to direct quantitative comparison across humans and our closest relatives