Australia and New Zealand both have large populations of people with limited English proficiency (LEP). Australia's free telephone interpreter service, which is also used by New Zealand through Language Line (LL) but at a cost to the practices, is underused in both countries. Interpreter guidelines warn against the use of family members, yet the lack of uptake of interpreter services must mean that they are still often used. This paper reviews the literature on medical interpreter use and reports the results of a week-long audit of interpreted consultations in an urban New Zealand primary health centre with a high proportion of refugee and migrant patients. The centre's (annualised) tally of professionally interpreted consultations was three times more than that of LL consultations by all other NZ practices put together. Despite this relatively high usage, 49% of all interpreted consultations used untrained interpreters (mostly family), with more used in 'on-the-day' (OTD) clinics. Clinicians rated such interpreters as working well 88% of the time in the OTD consultations, and 36% of the time in booked consultations. An in-house interpreter (28% of consultations) was rated as working well 100% of the time. Telephone interpreters (21% of consultations) received mixed ratings. The use of trained interpreters is woefully inadequate and needs to be vigorously promoted. In primary care settings where on-going relationships, continuity and trust are important - the ideal option (often not possible) is an in-house trained interpreter. The complexity of interpreted consultations needs to be appreciated in making good judgements when choosing the best option to optimise communication and in assessing when there may be a place for family interpreting. This paper examines the elements of making such a judgement.
RationalePrimary graft dysfunction in lung transplant recipients derives from the initial, largely leukocyte-dependent, ischaemia-reperfusion injury. Intravascular lung-marginated monocytes have been shown to play key roles in experimental acute lung injury, but their contribution to lung ischaemia-reperfusion injury post transplantation is unknown.ObjectiveTo define the role of donor intravascular monocytes in lung transplant-related acute lung injury and primary graft dysfunction.MethodsIsolated perfused C57BL/6 murine lungs were subjected to warm ischaemia (2 hours) and reperfusion (2 hours) under normoxic conditions. Monocyte retention, activation phenotype and the effects of their depletion by intravenous clodronate-liposome treatment on lung inflammation and injury were determined. In human donor lung transplant samples, the presence and activation phenotype of monocytic cells (low side scatter, 27E10+, CD14+, HLA-DR+, CCR2+) were evaluated by flow cytometry and compared with post-implantation lung function.ResultsIn mouse lungs following ischaemia-reperfusion, substantial numbers of lung-marginated monocytes remained within the pulmonary microvasculature, with reduced L-selectin and increased CD86 expression indicating their activation. Monocyte depletion resulted in reductions in lung wet:dry ratios, bronchoalveolar lavage fluid protein, and perfusate levels of RAGE, MIP-2 and KC, while monocyte repletion resulted in a partial restoration of the injury. In human lungs, correlations were observed between pre-implantation donor monocyte numbers/their CD86 and TREM-1 expression and post-implantation lung dysfunction at 48 and 72 hours.ConclusionsThese results indicate that lung-marginated intravascular monocytes are retained as a ‘passenger’ leukocyte population during lung transplantation, and play a key role in the development of transplant-associated ischaemia-reperfusion injury.
This was a retrospective study to determine the validity of institutional reference intervals for interpreting biochemistry and hematology results in healthy adults in the context of clinical trials of preventive vaccines. An example population of 974 healthy adults participating in clinical trials at the Jenner Institute, Oxford, UK, between 1999 and 2009 was studied. Methods for calculating the central 95% ranges and determining the coefficients of within person variation were demonstrated. Recommendations have been made as to how these data can be usefully applied to the interpretation of blood results in healthy adult subjects for the purposes of clinical trial inclusion decisions and post-vaccination safety monitoring.
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