Confronting Cultural Challenges for Migrant Healthcare in Switzerland

Switzerland is home to many migrants, and migration exacerbates health risks. In addition to physical health problems, migrants are more likely than Swiss nationals to face mental health challenges and cultural barriers, which complicate their experiences seeking healthcare. Similarly, clinicians encounter numerous challenges related to the special circumstances of migrant patients. As a response to the specific health needs of migrants, hospital networks and migrant support organizations promote the migrant health situation. However, these services are not ubiquitous in Switzerland, partly due to the partial freedoms of each canton to create its own health policy. This paper explores the barriers to access to quality healthcare services for migrants in Switzerland and assesses the Swiss health system’s responses to confront these barriers. Some ways that the Swiss health system confronts the health problems faced by migrants are facilitation of communication by community interpreters, cross-cultural competency education for clinicians, and promotion of health literacy. Transcultural psychiatry and group therapy methods are employed to address the additional mental health challenges for migrants. A specific focus on vulnerable migrant populations including asylum seekers and undocumented immigrants in the canton of Vaud highlights the challenges faced at by migrant groups a local level

The Impact of Block Scheduling and Release Time on Operating Room Efficiency

Planning for sufficient surgical capacity at a hospital requires that many tactical and operational decisions be made before the day of surgery. Typically, blocks of time in operating rooms (ORs) are assigned and specific surgical cases are placed in rooms. The hospital monitors utilization to determine the schedule\u27s effectiveness in balancing the risk of overtime with idle time. In this thesis, we will examine how adjusting schedule risk ratios and penalty values, and providing shared, open posting time affected the hospital\u27s ability to identify an efficient but high quality and low cost block schedule. The proposed schedules were tested by assigning surgical cases to ORs and simulating the schedule\u27s performance using recent data from a local hospital. We also show how scheduling accuracy can impact the performance level of the schedules proposed. Once the schedule has been set, the use of block release time is investigated in order to provide insight on how to better fill these ORs and increase utilization levels. Release policies are simulated based on various surgery arrival distributions, capacity levels, and case durations. We will show how different policies involving assigned and open posting rooms impact utilization levels, number of cases not fit into the schedule, and number of cases posted after the block release time

Proposed application of the Bayesian Truth Serum for policy analysis

Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2009.Includes bibliographical references (p. 59-63).Uncertainty and risk are obstacles that nearly all policy-makers encounter during their careers. However, evaluating uncertainty and risk can be difficult since these concepts may be broadly defined. This may result in inaccurate estimates of risk and uncertainty. Expert elicitation is a formal, structured method of obtaining subjective expert judgment in scenarios where objective data is unobtainable. It is designed to reduce the influence of ambiguity on expert judgment, meaning that analysts may use such subjective data as if it were objectively generated. Expert elicitation methods tend to aggregate expert judgment in order to create a unified response, but determining how to combine expert opinions remains a difficult problem. In this thesis, a review of the literature and background behind defining expertise and expert elicitation will be provided. Additionally, this thesis introduces the Bayesian Truth Serum as a potential weighting algorithm for combining expert judgments. As opposed to other weighting algorithms, the Bayesian Truth Serum uses the metaknowledge of experts to create weights for aggregation. Using such information may prove superior to assuming a normal distribution of expertise or relying upon experts to provide estimates of their own expertise.by Rebecca Weiss.S.M.in Technology and Polic

Practices and Attitudes Towards Infant Hearing Protection at Orthodox Jewish Weddings

Previous research has shown that prolonged exposure to noise can cause permanent hearing loss no matter what age, including infants. The impact of noise at orthodox Jewish weddings, where infants are frequently in attendance, can reach extremely high and damaging levels of sound intensity. Because the hearing conservation behaviors and attitudes towards child hearing protection in this population are unknown, the objective of this study is to identify the attitudes and behaviors of orthodox Jewish wedding attendees toward child hearing conservation. A survey was developed and administered electronically to congregants of orthodox Jewish synagogues in the New York City area. Participants were asked to respond to a series of items addressing hearing conservation attitudes and behaviors. Analysis of the attitudes and behaviors of this population can help guide future child hearing conservation education efforts for the orthodox Jewish Community. Current results revealed that the majority of participants have a healthy, positive attitude towards the concept of child hearing protection, however the actual use of child hearing protection at orthodox Jewish weddings is somewhat limited

Virtual Design of an Assistive Stair Ascent Device for Individuals with Knee Osteoarthritis

Osteoarthritis (OA) is a disease that is becoming increasingly more prevalent due to heavier and aging populations. Effects of OA in the knee range from weakness and instability to loss of range of motion, resulting in difficulty performing everyday tasks such as walking, stair negotiation, and chair rise. With few options to mitigate these effects, individuals with knee OA may turn to noninvasive devices in an attempt to decrease pain and increase function while taking on these everyday activities. There are currently few devices available to such individuals to assist in stair negotiation, most of which are expensive or ineffective. Additionally, studies show that individuals with knee OA biomechanically climb stairs differently, due to the compromised joint. However, no devices on the market are currently designed for individuals with knee OA. The goal of this project is to simulate an assistive device that aids individuals with knee OA in stair ascent. The Neuromuscular Biomechanics Research Laboratory previously collected motion data of individuals with knee OA during stair ascent. In this study, I used a program called OpenSim Moco to create a model and run dynamic simulations. I simulated an assistive device by placing torsional springs of varying stiffnesses at the hip, knee and ankle to observe how stair climbing was affected. The goal was to simulate lower limb kinematics of those of a healthy individual, without increasing metabolic cost. Results from this study showed that no spring placement or stiffness had a positive impact on both metabolic cost and maximum muscle force. The results of the simulations from this study and future work can provide insight for design parameters for an assistive stair climbing devices for individuals with knee OA, and possibly improve their performance in daily activities.No embargoAcademic Major: Mechanical Engineerin

Interobserver Reliability in Describing Radiographic Lung Changes After Stereotactic Body Radiation Therapy

Purpose Radiographic lung changes after stereotactic body radiation therapy (SBRT) vary widely between patients. Standardized descriptions of acute (≤6 months after treatment) and late (\u3e6 months after treatment) benign lung changes have been proposed but the reliable application of these classification systems has not been demonstrated. Herein, we examine the interobserver reliability of classifying acute and late lung changes after SBRT. Methods and materials A total of 280 follow-up computed tomography scans at 3, 6, and 12 months post-treatment were analyzed in 100 patients undergoing thoracic SBRT. Standardized descriptions of acute lung changes (3- and 6-month scans) include diffuse consolidation, patchy consolidation and ground glass opacity (GGO), diffuse GGO, patchy GGO, and no change. Late lung change classifications (12-month scans) include modified conventional pattern, mass-like pattern, scar-like pattern, and no change. Five physicians scored the images independently in a blinded fashion. Fleiss\u27 kappa scores quantified the interobserver agreement. Results The Kappa scores were 0.30 at 3 months, 0.20 at 6 months, and 0.25 at 12 months. The proportion of patients in each category at 3 and 6 months was as follows: Diffuse consolidation 11% and 21%; patchy consolidation and GGO 15% and 28%; diffuse GGO 10% and 11%; patchy GGO 15% and 15%; and no change 49% and 25%, respectively. The percentage of patients in each category at 12 months was as follows: Modified conventional 46%; mass-like 16%; scar-like 26%; and no change 12%. Uniform scoring between the observers occurred in 26, 8, and 14 cases at 3, 6, and 12 months, respectively. Conclusions Interobserver reliability scores indicate a fair agreement to classify radiographic lung changes after SBRT. Qualitative descriptions are insufficient to categorize these findings because most patient scans do not fit clearly into a single classification. Categorization at 6 months may be the most difficult because late and acute lung changes can arise at that time

Substituted Anthraquinones Represent a Potential Scaffold for DNA Methyltransferase 1-Specific Inhibitors

In humans, the most common epigenetic DNA modification is methylation of the 5-carbon of cytosines, predominantly in CpG dinucleotides. DNA methylation is an important epigenetic mark associated with gene repression. Disruption of the normal DNA methylation pattern is known to play a role in the initiation and progression of many cancers. DNA methyltransferase 1 (DNMT1), the most abundant DNA methyltransferase in humans, is primarily responsible for maintenance of the DNA methylation pattern and is considered an important cancer drug target. Recently, laccaic acid A (LCA), a highly substituted anthraquinone natural product, was identified as a direct, DNA-competitive inhibitor of DNMT1. Here, we have successfully screened a small library of simplified anthraquinone compounds for DNMT1 inhibition. Using an endonuclease-coupled DNA methylation assay, we identified two anthraquinone compounds, each containing an aromatic substituent, that act as direct DNMT1 inhibitors. These simplified anthraquinone compounds retain the DNA-competitive mechanism of action of LCA and exhibit some selectivity for DNMT1 over DNMT3a. The newly identified compounds are at least 40-fold less potent than LCA, but have significantly less complex structures. Collectively, this data indicates that substituted anthraquinone compounds could serve as a novel scaffold for developing DNMT1-specific inhibitors

Serial subtraction by sevens significantly alters limb knee adduction during lateral step-down when compared to the Stroop color-word test

"Dual tasking pairs movement and cognitive tasks to simulate real-world movement conditions. Dual tasking can lead to increased injury risk while performing dynamic lower limb movements. Bilateral asymmetry in neuromuscular control is suggested to play a role in the risk for lower limb injuries. Lower limb dominance influences motor control."--Introduction

Auswirkungen und Wirkung der Schienenversorgung unter der Lupe : wie Handgelenksschienen bei Betroffenen mit rheumatoider Arthritis Einfluss auf deren Alltagsbewältigung nehmen

Hintergrund: Die rheumatoide Arthritis ist die häufigste entzündliche Gelenkserkrankung. Verbesserte medikamentöse Behandlungsmöglichkeiten wirken sich positiv auf die Alltagsbewältigung der Betroffenen und deren Symptome aus. Diese Veränderungen erfordern eine Überprüfung der ergotherapeutischen Schienenversorgung bei Betroffenen mit rheumatoider Arthritis. Ziel: Der evidenzbasierte Wissensstand zum Einfluss der ergotherapeutischen Schienenversorgung mittels Handgelenksschiene auf die Alltagsbewältigung von Betroffenen mit rheumatoider Arthritis wird aufgearbeitet und in das zeitgenössische Paradigma eingebettet. Methode: Mittels systematischer Literaturrecherche wurde in gesundheitsspezifischen und ergotherapeutischen Datenbanken mit vordefinierten Kriterien nach passenden Studien gesucht. Die vier eingeschlossenen Hauptstudien wurden zusammengefasst und gewürdigt. Die gewonnenen Erkenntnisse zu den Körperfunktionen wurden auf die Alltagsbewältigung und in das zeitgenössische Berufsparadigma übertragen. Ergebnisse: Die Ergebnisse zeigen, dass Körperfunktionen wie Schmerz, Kraft, Geschicklichkeit und Muskelkraft durch eine Schienenversorgung beeinflusst werden können und sich dies bei gegebener Adherence positiv auf die Alltagsbewältigung auswirken kann. Eine Eingliederung der Schienenversorgung ins zeitgenössische Para-digma ist unter Berücksichtigung gewisser Aspekte umsetzbar. Schlussfolgerung: Die Schienenversorgung bietet nach genauer individueller Abklärung eine Möglichkeit zur Symptombehandlung und zeigt sich unterstützend für die Alltagsbewältigung bei Betroffenen mit rheumatoider Arthritis. Deshalb ist es sinnvoll, wenn die Ergotherapie weiterhin eine Schienenversorgung mittels Handgelenksschiene bei entsprechender Indikation vornimmt