Language disparities in patients transported by emergency medical services.

BACKGROUND: The population of the United States continues to diversify with an increasing percentage of residents with limited English proficiency (LEP). A major concern facing emergency medical services (EMS) providers is increasing scene and transport times. We hypothesized that there would be a significant difference in EMS scene and transport times when comparing LEP and English-speaking (ES) patients and there would be a difference in care, both in and out of hospital. METHODS: This is a retrospective case-control study with patient data extracted from hospital records and EMS run reports from a 911 emergency ambulance service. Patients were only included if they were transported to our level I trauma center. Inclusion in the LEP group was based on a field in EMS run reports that claimed language barrier as the sole reason for no patient signature. All LEP patients from July 1, 2012, to November 1, 2012, were reviewed. A random comparison sampling of ES patients from the same period was evaluated. The patients' demographic data, pain scores, interventions, medications, transport times, and scene times were analyzed. Patients were followed up from emergency department (ED) management through to disposition. Percentages were compared using 95% confidence intervals (CIs). Bivariate analysis used the Student t test and χ(2) test. A multivariable logistic regression model was created to determine predictive variables. A 5% random sampling was compared by 2 investigators for interrater agreement. RESULTS: Data were collected from a total of 101 ES and 100 LEP patients. Interrater agreement was 94% between extractors. Limited English proficiency patients were significantly older (56 ± 20 years old) than ES patients (41 ± 21 years old) and more likely to be female (odds ratio [OR], 2; 95% CI, 1.1-3.3). Limited English proficiency patients had a greater mean EMS transport time of 2.2 minutes (95% CI, 0.04-4.0). The odds of LEP patients receiving electrocardiograms were greater both in the ambulance (OR, 3.7; 95% CI, 1.7-8.1) and in the ED (OR, 2.0; 95% CI, 1.1-3.3) compared to ES patients. There were no differences in additional interventions, medications administered, or pain scores obtained between the 2 groups. In a multivariable logistic regression model corrected for age, type of call, smoking history, and sex, there was no difference in transport times in LEP patients. CONCLUSION: Compared to ES patients, LEP patients are older and more likely to be female. When corrected for differences in age, type of call, smoking history, and sex, we found no difference in scene or transport time for LEP patients. Results of this study indicate that EMS providers should be prepared for a different patient encounter when responding to 911 calls involving LEP patients rather than language variations alone.

Feline ocular epithelial response to growth factors in vitro.

OBJECTIVE: To examine the proliferative abilities of growth factors known to participate in wound healing on feline lens, iris pigment, ciliary, and retinal pigment epithelium cultured in vitro. ANIMALS: 8 clinically normal cats. PROCEDURE: Iris pigment, lens, ciliary, and retinal pigment epithelia of normal eyes of cats were isolated and cultured. Morphologic characteristics of primary cell cultures were studied by light and electron microscopy. Subcultures of epithelial cells were exposed to media supplemented with 0.5% fetal bovine serum plus various combinations of insulin and/or growth factors, including transforming growth factor-alpha, epidermal growth factor, acidic fibroblast growth factor, and basic fibroblast growth factor. Growth promoting effects were evaluated by counting with an electronic cell counter. RESULTS: Cells retained many of the morphologic characteristics of in vivo cells. Cell proliferation assays indicated that transforming growth factor-alpha stimulated lens and ciliary epithelial cell growth, and epidermal growth factor enhanced lens and iris pigment epithelial cell growth. Acidic fibroblast growth factor had proliferative effects on lens, iris pigment, and ciliary epithelium. Basic fibroblast growth factor was the most potent stimulator of all mitogens used, and caused substantial proliferation in all cell types. Insulin alone stimulated lens and ciliary epithelial proliferation but, combined with other growth factors, had a synergistic effect with those causing cell proliferation, except acidic fibroblast growth factor with iris pigment epithelium. CONCLUSION: Morphologic studies support the argument that pigment-producing cells are involved in feline ocular sarcoma. Growth factor studies indicated that ciliary epithelium has the most profound proliferative effect of all growth factors used. These data may help guide future studies in determining the cell of origin for feline ocular sarcoma.

Evaluation of methods for concentrating hepatitis A virus from drinking water.

By using recently developed cultivation and assay systems, currently available methods for concentrating enteric viruses from drinking water by adsorption to and subsequent elution from microporous filters followed by organic flocculation were evaluated for their ability to recover hepatitis A virus (HAV). Cell culture-adapted HAV (strain HM-175) in seeded tapwater was efficiently adsorbed by both electronegative (Filterite) and electropositive (Virosorb 1MDS) filters at pH and ionic conditions previously used for other enteric viruses. Adsorbed HAV was efficiently eluted from these filters by beef extract eluents at pH 9.5. Eluted HAV was further concentrated efficiently by acid precipitation (organic flocculation) of eluents containing beef extract made from powdered, but not paste, sources. By using optimum adsorption conditions for each type of filter, HAV was concentrated greater than 100-fold from samples of seeded tapwater, with about 50% recovery of the initial infectious virus added to the samples. The ability to recover and quantify HAV in contaminated drinking water with currently available methods should prove useful in further studies to determine the role of drinking water in HAV transmission.