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

Modeling functional connectivity on empirical and randomized structural brain networks

This study combines modeling of neuronal activity and networks derived from neuroimaging data in order to investigate how the structural organization of the human brain affects the temporal dynamics of interacting brain areas. The dynamics of the neuronal activity is modeled with FitzHugh–Nagumo oscillators and the blood-oxygen-level-dependent (BOLD) time series is inferred via the Balloon–Windkessel hemodynamic model. The simulations are based on anatomical probability maps between considered brain regions of interest. These maps were derived from diffusion-weighted magnetic resonance imaging measurements. In addition, the length of the fiber tracks allows for inference of coupling delays due to finite signal propagation velocities. We aim to investigate (i) graph-theoretical properties of the network topology derived from neuroimaging data and (ii) how randomization of structural connections influences the dynamics of neuronal activity. The network characteristics of the structural connectivity data are compared to density-matched Erdős–Rényi random graphs. Furthermore, the neuronal and BOLD activity are modeled on both empirical and random (Erdős–Rényi type) graphs. The simulated temporal dynamics on both graphs are compared statistically to capture whether the spatial organization of these network affects the modeled time series. Results support previous findings that key topological network properties such as small-worldness of our neuroimaging data are distinguishable from random networks. We also show that simulated BOLD activity is affected by the underlying network topology and the strength of connections between the network nodes. The difference of the modeled temporal dynamics of brain networks from the dynamics on randomized graphs suggests that anatomical connections in the human brain together with dynamical self-organization are crucial for the temporal evolution of the resting-state activity

Liquid chromatographic-mass spectrometric method for the determination of fluoxetine and norfluoxetine in human plasma: Application to clinical study

A selective, sensitive, simple, and rapid method for the simultaneous determination of fluoxetine (FL) and norfluoxetine (nor-FL) was developed and validated, and further applied to analyze plasma samples obtained from FL-treated patients with Parkinson disease (n:=:18). After one step liquid-liquid extraction with ethyl acetate, plasma samples were chromatographed on a C8 column. The mobile phase was acetate buffer and acetonitrile (40:60 v/v). Determination of FL and nor-FL was performed with MS detection in selective ion monitoring (SIM) mode, so the other components did not interfere with this assay. FL, nor-FL and flumazenil as internal standard were eluted in 6:min. Recoveries ranged from 89.7 to 96.6% and from 80.2 to 85.3% for FL and nor-FL, respectively. The limit of quantitation under described conditions was 2,5 μg/l for FL and 10 μg/l for nor-FL. The method was found to be reproducible with coefficient of variation less than 9%. The parameters of the method were found to be acceptable to enable its routine use for clinical studies. The method was employed to analyze the Parkinsonian patients' plasma samples. A great deviation in plasma concentrations of FL and nor-FL found among 18 studied patients indicates high pharmacokinetic variability of the drug. Obtained results also indicate absence of the influence of Parkinson disease on the drug disposition