Integrating quantitative and qualitative methodologies for the assessment of health care systems: emergency medicine in post-conflict Serbia

BACKGROUND: Due to the complexity of health system reform in the post-conflict, post-disaster, and development settings, attempts to restructure health services are fraught with pitfalls that are often unanticipated because of inadequate preliminary assessments. Our proposed Integrated Multimodal Assessment – combining quantitative and qualitative methodologies – may provide a more robust mechanism for identifying programmatic priorities and critical barriers for appropriate and sustainable health system interventions. The purpose of this study is to describe this novel multimodal assessment using emergency medicine in post-conflict Serbia as a model. METHODS: Integrated quantitative and qualitative methodologies – system characterization and observation, focus group discussions, free-response questionnaires, and by-person factor analysis – were used to identify needs, problems, and potential barriers to the development of emergency medicine in Serbia. Participants included emergency and pre-hospital personnel from all emergency medical institutions in Belgrade. RESULTS: Demographic data indicate a loosely ordered network of part-time emergency departments supported by 24-hour pre-hospital services and an academic emergency center. Focus groups and questionnaires reveal significant impediments to delivery of care and suggest development priorities. By-person factor analysis subsequently divides respondents into distinctive attitudinal types, compares participant opinions, and identifies programmatic priorities. CONCLUSIONS: By combining quantitative and qualitative methodologies, our Integrated Multimodal Assessment identified critical needs and barriers to emergency medicine development in Serbia and may serve as a model for future health system assessments in post-conflict, post-disaster, and development settings

Spatial Segregation of Roma Settlements Within Serbian Cities. Examples from Belgrade, Novi Sad, and Kruševac

This chapter focuses on the spatial segregation of Roma settlements within Serbian cities, shaped by the long-standing ethnic distance and social exclusion. In order to understand the broader context, the historical background against which Roma settlements emerged in Serbia, as well as their current demographic, legislative, and urban characteristics, are briefly presented. Several forms of segregation of Roma settlements are analysed, including segregation as a consequence of racist hostility, institutional discrimination by city administration, and development-based conflicts. Examples of setting up a wall enclosing a Roma settlement in Kruševac, racist pressures that prevent the construction of housing for Roma in Belgrade and the reluctance to improve and legalise Roma settlements in Novi Sad, illustrate the various manifestations of segregation and division of urban space in Serbia.The Urban Book Serie

Cross-linguistic adaptations of The Comprehensive Aphasia Test: Challenges and solutions

Comparative research on aphasia and aphasia rehabilitation is challenged by the lack of comparable assessment tools across different languages. In English, a large array of tools is available, while in most other languages, the selection is more limited. Importantly, assessment tools are often simple translations and do not take into consideration specific linguistic and psycholinguistic parameters of the target languages. As a first step in meeting the needs for comparable assessment tools, the Comprehensive Aphasia Test is currently being adapted into a number of languages spoken in Europe. In this article, some key challenges encountered in the adaptation process and the solutions to ensure that the resulting assessment tools are linguistically and culturally equivalent, are proposed. Specifically, we focus on challenges and solutions related to the use of imageability, frequency, word length, spelling-to-sound regularity and sentence length and complexity as underlying properties in the selection of the testing material

Noun and verb knowledge in monolingual preschool children across 17 languages: Data from cross-linguistic lexical tasks (LITMUS-CLT)

This article investigates the cross-linguistic comparability of the newly developed lexical assessment tool Cross-linguistic Lexical Tasks (LITMUS-CLT). LITMUS-CLT is a part the Language Impairment Testing in Multilingual Settings (LITMUS) battery (Armon-Lotem, de Jong & Meir, 2015). Here we analyse results on receptive and expressive word knowledge tasks for nouns and verbs across 17 languages from eight different language families: Baltic (Lithuanian), Bantu (isiXhosa), Finnic (Finnish), Germanic (Afrikaans, British English, South African English, German, Luxembourgish, Norwegian, Swedish), Romance (Catalan, Italian), Semitic (Hebrew), Slavic (Polish, Serbian, Slovak) and Turkic (Turkish). The participants were 639 monolingual children aged 3;0-6;11 living in 15 different countries. Differences in vocabulary size were small between 16 of the languages; but isiXhosa-speaking children knew significantly fewer words than speakers of the other languages. There was a robust effect of word class: accuracy was higher for nouns than verbs. Furthermore, comprehension was more advanced than production. Results are discussed in the context of cross-linguistic comparisons of lexical development in monolingual and bilingual populations

Imageability ratings across languages

Imageability is a psycholinguistic variable that indicates how well a word gives rise to a mental image or sensory experience. Imageability ratings are used extensively in psycholinguistic, neuropsychological, and aphasiological studies. However, little formal knowledge exists about whether and how these ratings are associated between and within languages. Fifteen imageability databases were cross-correlated using nonparametric statistics. Some of these corresponded to unpublished data collected within a European research network-the Collaboration of Aphasia Trialists (COST IS1208). All but four of the correlations were significant. The average strength of the correlations (rho = .68) and the variance explained (R (2) = 46%) were moderate. This implies that factors other than imageability may explain 54% of the results. Imageability ratings often correlate across languages. Different possibly interacting factors may explain the moderate strength and variance explained in the correlations: (1) linguistic and cultural factors; (2) intrinsic differences between the databases; (3) range effects; (4) small numbers of words in each database, equivalent words, and participants; and (5) mean age of the participants. The results suggest that imageability ratings may be used cross-linguistically. However, further understanding of the factors explaining the variance in the correlations will be needed before research and practical recommendations can be made

Purification of the anti-IgE monoclonal antibody E1 from ascitic fluid

Contemporary biochemical methods for protein purification were applied for the isolation of anti-IgE monoclonal antibody E1 from mouse ascitic fluid. The yield of monoclonal antibody E1 in each of the isolated fractions was estimated by determining the total protein concentration and the specific concentration of IgG1. The homogeneity and purity of the isolated protein was determined by SDS PAG electrophoresis. Precipitation methods (ammonium sulphate, polyethylene glycol, caprylic acid, rivanol) were used, alternatively or successively, as the first step in the isolation of MoAb E1. Higher levels of purity of monoclonal antibody E1 were obtained using chromatographic methods (ion exchange chromatography, gel filtration and affinity chromatography). The best result (97% purity and 77% yield) was obtained by affinity chromatography on Staphylococcal protein A

Purification of the anti-IgE monoclonal antibody E1 from ascitic fluid

Contemporary biochemical methods for protein purification were applied for the isolation of anti-IgE monoclonal antibody E1 from mouse ascitic fluid. The yield of monoclonal antibody E1 in each of the isolated fractions was estimated by determining the total protein concentration and the specific concentration of IgG1. The homogeneity and purity of the isolated protein was determined by SDS PAG electrophoresis. Precipitation methods (ammonium sulphate, polyethylene glycol, caprylic acid, rivanol) were used, alternatively or successively, as the first step in the isolation of MoAb E1. Higher levels of purity of monoclonal antibody E1 were obtained using chromatographic methods (ion exchange chromatography, gel filtration and affinity chromatography). The best result (97% purity and 77% yield) was obtained by affinity chromatography on Staphylococcal protein A