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Abstract The aim of our study was to analyze the use of interpreter services and improve communication during health encounters with families with limited language proficiency (LLP) at the pediatric emergency department (ED) of the University Hospital of Bern. This study is a pre- and post-intervention study analyzing the use of interpreter services for LLP families. All families originating from a country with a native language other than German, English or French presenting to the ED were eligible to participate in the study. If they agreed to participate, the language proficiency of the caregiver present during the health encounter was systematically assessed during a phone interview within a few days after the consultation, using a standardized screening tool. If screened positive (relevant LLP), a second phone interview with an interpreter was conducted. Further variables were extracted including nationality, age, gender and date of visit using administrative health records. To increase the use of interpreter services, a package of interventions was implemented at the department during 3 months. It consisted of: i) in person and online transcultural teaching ii) awareness raising through the regular information channels and iii) the introduction of a pathway to systematically identify and manage LLP families. The proportion of LLP families who received an interpreter was 11.0% (14/127) in the pre-intervention period compared to 14.8% (20/135) in the post-intervention period. The interpreter use was therefore increased by 3.8% (95% CI − 0.43 to 0.21; p = 0.36). The assessed level of language proficiency of caregivers differed from the self-reported level of language proficiency. Of the study participants in the interview whose language proficiency was screened as limited, 77.1% estimated their language proficiency level as intermediate. More than half of the LLP families who did not receive an interpreter and participated in the interview reported, that they would have liked an interpreter during the consultation. Conclusions: Interpreter services are largely underused during health encounters with LLP families. Relying on caregivers´ self-assessed language proficiency and their active request for an interpreter is not sufficient to ensure safe communication during health encounters. Systematic screening of language proficiency and standardized management of LLP families is feasible and needed at health care facilities to ensure equitable care. Further studies are needed to analyze personal and institutional barriers to interpreter use and find interventions to sustainably increase the use of interpreter services for LLP families.

AIMS OF THE STUDY: Health equity is a key component of quality of care and an objective for a growing number of quality improvement projects for deontological, ethical, public health and economic reasons. To monitor equity in the delivery of health services in Switzerland, there is a need to implement valid, measurable and actionable equity indicators, along with vulnerability stratifiers such as migrant status, which could lead to differences in quality of care. The aim of this study was to develop a set of healthcare equity indicators and stratifiers targeting inpatient and outpatient populations and to test their feasibility. METHODS: A scoping literature review and inputs from a national interprofessional expert taskforce provided a set of indicators and vulnerability stratifiers. The most valid and measurable indicators and stratifiers were retained using a Delphi process. They were then operationalised, and their implementation tested in three Swiss hospitals from the three language regions. RESULTS: A taskforce of 18 experts, including a patient representative, selected 11 indicators that evaluate structures, processes and outcomes, and five vulnerability stratifiers. Although most indicators and stratifiers could be implemented in all three hospitals, data availability was limited for some variables, including patient satisfaction and access to interpreters for foreign-language patients. CONCLUSIONS: The equity indicators and stratifiers identified by this two-stage process have content validity, wide patient coverage and are focused on inequities in the healthcare system that are actionable through improvement projects. Both the indicators and the project methodology could be replicated in institutions aiming for more equitable care.

During referential communication, speaker choices regarding the syntactic encoding of their expressions can modulate the linear ordering of the properties necessary to identify the referent. We investigated whether such syntactic choices are influenced by the informativity of these properties in a given visual context, as quantified by Referential Entropy Reduction (RER). In two experiments, a maze-based sentence completion task was used to examine whether informativity of a particular property (animal or action) influenced the decision to produce pre- versus post-nominal modifications when describing animal-performing-action referents in a visual scene. While many participants used a fixed strategy, informativity did significantly influence linearization for the remaining participants, consistent with a maximal informativity strategy in which the high RER property is be encoded first. This suggests that speakers who vary their encodings are indeed sensitive to the informativity of properties in a visual scene, preferring syntactic linearization in which informative properties appear early.

Abstract Background Streptococcus pyogenes (group A streptococcus, GAS) causes a variety of diseases ranging from mild superficial infections of the throat and skin to severe invasive infections, such as necrotizing soft tissue infections (NSTIs). Tissue passage of GAS often results in mutations within the genes encoding for control of virulence (Cov)R/S two component system leading to a hyper-virulent phenotype. Dendritic cells (DCs) are innate immune sentinels specialized in antigen uptake and subsequent T cell priming. This study aimed to analyze cytokine release by DCs and other cells of monocytic origin in response to wild-type and natural covR/S mutant infections. Methods Human primary monocyte-derived (mo)DCs were used. DC maturation and release of pro-inflammatory cytokines in response to infections with wild-type and covR/S mutants were assessed via flow cytometry. Global proteome changes were assessed via mass spectrometry. As a proof-of-principle, cytokine release by human primary monocytes and macrophages was determined. Results In vitro infections of moDCs and other monocytic cells with natural GAS covR/S mutants resulted in reduced secretion of IL-8 and IL-18 as compared to wild-type infections. In contrast, moDC maturation remained unaffected. Inhibition of caspase-8 restored secretion of both molecules. Knock-out of streptolysin O in GAS strain with unaffected CovR/S even further elevated the IL-18 secretion by moDCs. Of 67 fully sequenced NSTI GAS isolates, 28 harbored mutations resulting in dysfunctional CovR/S. However, analyses of plasma IL-8 and IL-18 levels did not correlate with presence or absence of such mutations. Conclusions Our data demonstrate that strains, which harbor covR/S mutations, interfere with IL-18 and IL-8 responses in monocytic cells by utilizing the caspase-8 axis. Future experiments aim to identify the underlying mechanism and consequences for NSTI patients.

Objectives Communication is a main challenge in migrant health and essential for patient safety. The aim of this study was to describe the satisfaction of caregivers with limited language proficiency (LLP) with care related to the use of interpreters and to explore underlying and interacting factors influencing satisfaction and self-advocacy.Design A mixed-methods study.Setting Paediatric emergency department (PED) at a tertiary care hospital in Bern, Switzerland.Participants and methods Caregivers visiting the PED were systematically screened for their language proficiency. Semistructured interviews were conducted with all LLP-caregivers agreeing to participate and their administrative data were extracted.Results The study included 181 caregivers, 14 of whom received professional language interpretation. Caregivers who were assisted by professional interpretation services were more satisfied than those without (5.5 (SD)±1.4 vs 4.8 (SD)±1.6). Satisfaction was influenced by five main factors (relationship with health workers, patient management, alignment of health concepts, personal expectations, health outcome of the patient) which were modulated by communication. Of all LLP-caregivers without professional interpretation, 44.9% were satisfied with communication due to low expectations regarding the quality of communication, unawareness of the availability of professional interpretation and overestimation of own language skills, resulting in low self-advocacy.Conclusion The use of professional interpreters had a positive impact on the overall satisfaction of LLP-caregivers with emergency care. LLP-caregivers were not well—positioned to advocate for language interpretation. Healthcare providers must be aware of their responsibility to guarantee good-quality communication to ensure equitable quality of care and patient safety.

ABSTRACT The obligate intracellular bacterium Chlamydia trachomatis inserts a family of inclusion membrane (Inc) proteins into the membrane of its vacuole (the inclusion). The Inc CpoS is a critical suppressor of host cellular immune surveillance, but the underlying mechanism remained elusive. By complementing a cpoS mutant with various natural orthologs and variants of CpoS, we linked distinct molecular interactions of CpoS to distinct functions. Unexpectedly, we found CpoS to be essential for the formation of inclusion membrane microdomains that control the spatial organization of multiple Incs involved in signaling and modulation of the host cellular cytoskeleton. While the function of CpoS in microdomains was uncoupled from its role in the suppression of host cellular defenses, we found the ability of CpoS to interact with Rab GTPases to be required not only for the manipulation of membrane trafficking, such as to mediate transport of ceramide-derived lipids (sphingolipids) to the inclusion, but also for the inhibition of Stimulator of interferon genes (STING)-dependent type I interferon responses. Indeed, depletion of Rab35 phenocopied the exacerbated interferon responses observed during infection with CpoS-deficient mutants. Overall, our findings highlight the role of Inc–Inc interactions in shaping the inclusion microenvironment and the modulation of membrane trafficking as a pathogenic immune evasion strategy. IMPORTANCE Chlamydia trachomatis is a prevalent bacterial pathogen that causes blinding ocular scarring and urogenital infections that can lead to infertility and pregnancy complications. Because Chlamydia can only grow within its host cell, boosting the intrinsic defenses of human cells may represent a novel strategy to fight pathogen replication and survival. Hence, CpoS, a Chlamydia protein known to block host cellular defenses, or processes regulated by CpoS, could provide new opportunities for therapeutic intervention. By revealing CpoS as a multifunctional virulence factor and by linking its ability to block host cellular immune signaling to the modulation of membrane trafficking, the present work may provide a foundation for such rationale targeting and advances our understanding of how intracellular bacteria can shape and protect their growth niche.

Questions under Discussion (QUDs) have been suggested to influence the integration of individual utterances into a discourse-level representation. Previous work has shown that processing ungrammatical ellipses is facilitated when the elided material addresses an implicit QUD raised through a nonactuality implicature (NAIs). It is not clear, however, if QUDs influence discourse coherence during comprehension of fully acceptable discourse. We present two ERP studies examining the effects of QUDs introduced by NAIs using two-sentence discourses. Experiment 1 showed that processing definite NPs with inaccessible antecedents is facilitated when their content is relevant to the QUD. Using acceptable discourses, Experiment 2 showed that definite NPs failing to address a QUD elicit increased processing cost. Overall, our results indicate that QUDs raise the expectation that the following discourse will address them, providing unambiguous evidence that their influence is not limited to the processing of ungrammatical input.

Influenza A Virus (IAV), Staphylococcus aureus (staphylococci), and Streptococcus pneumoniae (pneumococci) are leading viral and bacterial causes of pneumonia. Dendritic cells (DCs) are present in the lower respiratory tract. They are characterized by low expression of co-stimulatory molecules, including CD80 and CD86 and high capacity of antigen uptake. Subsequently, DCs upregulate co-stimulatory signals and cytokine secretion to effectively induce T-cell priming. Here, we investigated these processes in response to bacterial and viral single as well as coinfections using human monocyte-derived (mo)DCs. Irrespective of single or coinfections, moDCs matured in response to IAV and/or staphylococcal infections, secreted a wide range of cytokines, and activated CD4+, CD8+ as well as double-negative T cells. In contrast, pneumococcal single and coinfections impaired moDC maturation, which was characterized by low expression of CD80 and CD86, downregulated expression of CD40, and a mild cytokine release resulting in abrogated CD4+ T-cell activation. These actions were attributed to the cholesterol-dependent cytotoxin pneumolysin (Ply). Infections with a ply-deficient mutant resulted in restored moDC maturation and exclusive CD4+ T-cell activation. These findings show that Ply has important immunomodulatory functions, supporting further investigations in specific modalities of Ply-DC interplay.

Behavioral studies demonstrate the influence of speakergaze in visually-situated spoken language comprehension.We present an ERP experiment examining the influence ofspeaker’s gaze congruency on listeners’ comprehension of ref-erential expressions related to a shared visual scene. Wedemonstrate that listeners exploit speakers’ gaze toward ob-jects in order to form sentence continuation expectations:Compared to a congruent gaze condition, we observe an in-creased N400 when (a) the lack of gaze (neutral) does not al-low for upcoming noun prediction, and (b) when the noun vi-olates gaze-driven expectations (incongruent). The later alsoresults in a late (sustained) positivity, reflecting the need to up-date the assumed situation model. We take the combinationof the N400 and late positivity as evidence that speaker gazeinfluences both lexical retrieval and integration processes, re-spectively (Brouwer et al., in press). Moreover, speaker gazeis interpreted as reflecting referential intentions (Staudte &Crocker, 2011).

In a natural environment, bacteria are members of multispecies communities. To compete with rival species, bacteria produce antimicrobial peptides (AMPs), called bacteriocins. Bacteriocins are small, cationic, ribosomally synthesized peptides, which normally inhibit closely related species of the producing organism. Bacteriocin production is best studied in lactic bacteria (LAB). Streptococcus anginosus, belonging to LAB, produces the potent bacteriocin Angicin, which shows inhibitory activity against other streptococci, Listeria monocytogenes and vancomycin resistant Enterococcus faecium (VRE). Furthermore, Angicin shows a high resistance toward pH changes and heat, rendering it an interesting candidate for food preservation or clinical applications. The inhibitory activity of Angicin depends on the presence of a mannose phosphotransferase system (Man-PTS) in target cells, since L. monocytogenes harboring a deletion in an extracellular loop of this system is no longer sensitive to Angicin. Furthermore, we demonstrated by liposome leakage and pHluorin assays that Angicin destroys membrane integrity but shows only low cytotoxicity against human cell lines. In conclusion, we show that Angicin has a detrimental effect on the membrane of target organisms by using the Man-PTS as a receptor.

The project ‘Application of remote sensing for the early detection of drought stress at vulnerable forest sites (ForDroughtDet)’ is funded by the German Federal Agency of Agriculture and Food and aims to detect drought stress in an early phase using remote sensing techniques. In this project, three test sites in the south and middle part of Germany are selected. Three levels of observation and analyses are performed. In the first level, close-range stereo images and spectral information are captured with a research crane in Kranzberg forest. In the second level, three study sites are imaged twice in three years by airborne hyperspectral and stereo cameras. In the third level, the drought stress detection approach will be transferred to regional scale by satellite image. In this paper, we will briefly report our results from the first and second levels. In the first level, 3D models of the forest canopies are generated with the MC-CNN based dense matching approaches, with which the 3D shapes of the stressed and healthy trees are analysed. In addition, for the spectral analyses, different chlorophyll-sensitive indices are calculated and compared for the stressed and healthy trees. In order to further analyse the tree drought stress in the second level, a novel individual tree crown (ITC) segmentation approach is proposed and tested on the airborne stereo dataset.

Shared reading represents an established practice to foster preschool vocabulary development, particularly when coupled with explicit instruction in word meanings. However, a question remains as to whether explicit word definitions detract from story delivery and hence language learning. Accordingly, this study compared explicit versus story-focused, elaborative storytelling in a 2 × 2 pre-posttest randomized and counterbalanced mixed design with 63 preschoolers. Children were told two fairytales daily across three sessions in either explicit or elaborative conditions, whereby target words were accompanied with either an explicit (e.g., definition, question) or elaborative (e.g., gesture, metaphor, rhetorical question) word learning technique. Stories were either read aloud or freely told by experimenters. Both conditions resulted in similarly large gains in target vocabulary and performance on a story retelling. Some differential effects were found, with there being a larger difference between explained versus incidental words in the explicit condition. Furthermore, children in the elaborative condition were less restless during storytelling. The findings suggest that both elaborative as well as explicit approaches promote vocabulary growth and provide some evidence of differential effects for child behavior during storytelling.

High-resolution NMR spectra of samples with anisotropic broadening are simplified to their isotropic spectra by fast rotation of the sample at the magic angle 54.7 circ. This dissertation concerns the development of novel Nuclear Magnetic Resonance (NMR) methodologies based which would rotate the magnetic field instead of the sample, rotating field NMR. It provides an over of the NMR concepts, procedures, and experiments needed to understand the methodologies that will be used for rotating field NMR. A simple two-dimensional shimming method based on harmonic corrector rings which can provide arbitrary multiple order shimming corrections were developed for rotating field systems, but could be used in shimming other systems as well. Those results demonstrate, for example, that quadrupolar order shimming improves the linewidth by up to an order of magnitude. An additional order of magnitude reduction is in principle achievable by utilizing this shimming method for z-gradient correction and higher order xy gradients. A specialized pulse sequence for the rotating field NMR experiment is under development. The pulse sequence allows for spinning away from the magic angle and spinning slower than the anisotropic broadening. This pulse sequence is a combination of the projected magic angle spinning (p-MAS) and magic angle turning (MAT) pulse sequences. This will be useful to rotating field NMR because there are limits on how fast a field can be spun and spin at the magic angle is difficult. One of the goals of this project is for rotating field NMR to be used on biological systems. The p-MAS pulse sequence was successfully tested on bovine tissue samples which suggests that it will be a viable methodology to use in a rotating field set up. A side experiment on steering magnetic particle by MRI gradients was also carried out. Some movement was seen in these experiment, but for total control over steering further experiments would need to be done.

Shimming systems are required to provide sufficient field homogeneity for high resolution NMR. In certain specialized applications, such as rotating-field NMR and portable (ex-situ) NMR, permanent magnet-based shimming systems can provide considerable advantages. We present a simple two-dimensional shimming method based on harmonic corrector rings which can provide arbitrary multipole order shimming corrections. Results demonstrate, for example, that quadrupolar order shimming improves the linewidth by up to and order of magnitude. An additional order of magnitude reduction is in principle achievable by ultilizing this shimming method for z-gradient correction and higher order xy gradients.

High-resolution NMR spectra of materials subject to anisotropic broadening are usually obtained by rotating the sample about the magic angle, which is 54.7 degrees to the static magnetic field. In projected Magic Angle Spinning (p-MAS), the sample is spun about two angles, neither of which is the magic angle. This provides a method of obtaining isotropic spectra while spinning at shallow angles. The p-MAS experiment may be used in situations where spinning the sample at the magic angle is not possible due to geometric or other constraints, allowing the choice of spinning angle to be determined by factors such as the shape of the sample, rather than by the spin physics. The application of this technique to bovine tissue samples is demonstrated as a proof of principle for future biological or medical applications.