Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions

A predictive model for fluid-saturated, brittle granular materials during high-velocity impact events

Granular materials -- aggregates of many discrete, disconnected solid particles -- are ubiquitous in natural and industrial settings. Predictive models for their behavior have wide ranging applications, e.g. in defense, mining, construction, pharmaceuticals, and the exploration of planetary surfaces. In many of these applications, granular materials mix and interact with liquids and gases, changing their effective behavior in non-intuitive ways. Although such materials have been studied for more than a century, a unified description of their behaviors remains elusive. In this work, we develop a model for granular materials and mixtures that is usable under particularly challenging conditions: high-velocity impact events. This model combines descriptions for the many deformation mechanisms that are activated during impact -- particle fracture and breakage; pore collapse and dilation; shock loading; and pore fluid coupling -- within a thermo-mechanical framework based on poromechanics and mixture theory. This approach allows for simultaneous modeling of the granular material and the pore fluid, and includes both their independent motions and their complex interactions. A general form of the model is presented alongside its specific application to two types of sands that have been studied in the literature. The model predictions are shown to closely match experimental observation of these materials through several GPa stresses, and simulations are shown to capture the different dynamic responses of dry and fully-saturated sand to projectile impacts at 1.3 km/s

A new charge-transfer complex in UHV co-deposited tetramethoxypyrene and tetracyanoquinodimethane

UHV-deposited films of the mixed phase of tetramethoxypyrene and tetracyanoquinodimethane (TMP1-TCNQ1) on gold have been studied using ultraviolet photoelectron spectroscopy (UPS), X-ray-diffraction (XRD), infrared (IR) spectroscopy and scanning tunnelling spectroscopy (STS). The formation of an intermolecular charge-transfer (CT) compound is evident from the appearance of new reflexes in XRD (d1= 0.894 nm, d2= 0.677 nm). A softening of the CN stretching vibration (red-shift by 7 cm-1) of TCNQ is visible in the IR spectra, being indicative of a CT of the order of 0.3e from TMP to TCNQ in the complex. Characteristic shifts of the electronic level positions occur in UPS and STS that are in reasonable agreement with the prediction of from DFT calculations (Gaussian03 with hybrid functional B3LYP). STS reveals a HOMO-LUMO gap of the CT complex of about 1.25 eV being much smaller than the gaps (>3.0 eV) of the pure moieties. The electron-injection and hole-injection barriers are 0.3 eV and 0.5 eV, respectively. Systematic differences in the positions of the HOMOs determined by UPS and STS are discussed in terms of the different information content of the two methods.Comment: 20 pages, 6 figure

Cerebral haemodynamics and carbon dioxide reactivity during sepsis syndrome

peer reviewed[en] BACKGROUND: Most patients with sepsis develop potentially irreversible cerebral dysfunctions. It is yet not clear whether cerebral haemodynamics are altered in these sepsis patients at all, and to what extent. We hypothesized that cerebral haemodynamics and carbon dioxide reactivity would be impaired in patients with sepsis syndrome and pathological electroencephalogram patterns. METHODS: After approval of the institutional ethics committee, 10 mechanically ventilated patients with sepsis syndrome and pathological electroencephalogram patterns underwent measurements of cerebral blood flow and jugular venous oxygen saturation before and after reduction of the arterial carbon dioxide partial pressure by 0.93 +/- 0.7 kPa iu by hyperventilation. The cerebral capillary closing pressure was determined from transcranial Doppler measurements of the arterial blood flow of the middle cerebral artery and the arterial pressure curve. A t test for matched pairs was used for statistical analysis (P < 0.05). RESULTS: During stable mean arterial pressure and cardiac index, reduction of the arterial carbon dioxide partial pressure led to a significant increase of the capillary closing pressure from 25 +/- 11 mmHg to 39 +/- 15 mmHg (P < 0.001), with a consecutive decrease of blood flow velocity in the middle cerebral artery of 21.8 +/- 4.8%/kPa (P < 0.001), of cerebral blood flow from 64 +/- 29 ml/100 g/min to 39 +/- 15 ml/100 g/min (P < 0.001) and of jugular venous oxygen saturation from 75 +/- 8% to 67 +/- 14% (P < 0.01). CONCLUSION: In contrast to other experimental and clinical data, we observed no pathological findings in the investigated parameters of cerebral perfusion and oxygenation