Miracle-dz/UniFAR-FTUs huggingface dataset:
Efforts to Improve Patient Safety in Large, Capitated Medical Groups: Description and Conceptual Model

Medical care should be safer. Inpatient problems and solutions have received the most attention; this outpatient qualitative case study addresses a gap in knowledge. We describe safety improvements among large physician groups, model the key influences on their behavior, and identify beneficial public and private policies. All groups were trying to reduce medical injury, which was part of the sample design. The most commonly targeted problems are those that are similar across groups: shortcomings in diagnosis, abnormal tests follow-up, scope of practice and referral patterns, and continuity of care. Medical group innovators vary greatly, however, in implementation of improvements, that is, in the extent to which they implement process changes that identify events/problems, analyze and track incidents, decide how to change clinical and administrative practices, and monitor impacts of the changes. Our conceptual model identifies key determinants: (1) demand for safety comes from external factors: legal, market, and professional; (2) organizational responses depend on internal factors: group size, scope, and integration; leadership and governance; professional culture; information-system assets; and financial and intellectual capital. Further, safety is an aspect of quality (the same tools, decision making, interventions, and monitoring apply), and safety management benefits from prior efficiency management (similar skills and culture of innovation). Observed variation in even simple safeguards shows that existing safety incentives are too weak. Our model suggests that the biggest improvement would come from boosting the demand for quality and safety from both private and public larger group purchasers. Current policy relies too much on litigation and discipline, which have sometimes helped, but not solved, problems because they are inefficient, tend to drive needed information underground, and complicate needed cultural change. Patients' safety demand is also weak for want of information and market power. Big purchasers' demands, however, quickly influence the internal environment of medical groups, helping managers advance quality safety toward the top of groups' congested decision-making "queues. "
An 18–23 GHz 57.4-fs RMS Jitter −253.5-dB FoM Sub-Harmonically Injection-Locked All-Digital PLL With Single-Ended Injection Technique and ILFD Aided Adaptive Injection Timing Alignment Technique

This paper proposes a sub-harmonically injection-locked all-digital PLL (SIL-ADPLL). The SIL-ADPLL includes five main circuit blocks: injection-locked digitally controlled oscillator with single-ended injection technique (SILDCO), injection-locked frequency divider (ILFD), timing-adjusted phase detector (TPD), multiplexed time-to-digital converter (MTDC), and the pulse generator (PG). The single-ended injection technique relaxes the pulse width constraint of the injection pulse and thus reduces the design complexity of PG. The proposed ILFD aided injection timing alignment technique can align the injection timing adaptively at output frequency higher than 20 GHz. The ILFD block is inserted between the SILDCO and the TPD without much penalty of power consumption. The proposed MTDC can quantize the output of TPD with only one TDC core to further save power consumption. The proposed PG can relax the trade-off between the phase noise suppression and the power consumption. Implemented in 65 nm CMOS process with a core area of 0.462 mm2, the SIL-ADPLL achieves 18- to 23-GHz frequency range, 57.4-fs rms jitter at 20 GHz, 13.7-mW power consumption, and −253.5-dB FoM. The measurement results also show robustness over environment variation.
The preexposure prophylaxis revolution; from clinical trials to programmatic implementation

Purpose of reviewAn investment in preexposure prophylaxis (PrEP) delivery must have public health impact in reducing HIV infections. Sustainable delivery of PrEP requires policy, integration of services, and synergy with other existing HIV prevention programs. This review discusses key policy and programmatic considerations for implementation and scale up of PrEP in Africa. Recent findingsPrEP delivery has been delayed by concerns about adherence and delivery in ‘real world’ settings. Demonstration projects and clinical service delivery models are providing evidence of PrEP effectiveness with an impact much higher than that found in randomized clinical trials. Data confirm that PrEP uptake, adherence, and retention has been high, more so by persons who perceive themselves at high risk for HIV infection, and PrEP is well tolerated. PrEP delivery is more than dispensation of a pill and programs should address other risk drivers, which differ by population. In Africa, barriers to PrEP uptake and adherence include stigma among MSM and low HIV risk perception among young women. Additional data have provided insight into optimal points of service delivery, provider training requirements and quality assurance needs. Of the 2 million new HIV infections in 2014, 70% were in Africa. PrEP use is not lifelong, and use limited to periods of risk may be both effective and cost-effective for the continent. SummaryHIV prevention programs should determine strategies to identify those at substantial risk for HIV infection, formulate and deliver PrEP in combination with interventions that target social drivers of HIV vulnerability specific to each population. Policy guidance for optimal combination of interventions and service delivery avenues, clinical protocols, health infrastructure requirements are required. Cost-effectiveness and efficiency data are essential for policy guidance to navigate ethical questions over use of antiretroviral therapy for HIV-negative individuals when treatment coverage has not been attained in many parts of Africa. Countries need to invest in purposeful advocacy at both local and global forums. Failure to implement PrEP will be a failure to protect future generations.
Prevalence of Nonanatomical Graft Placement in a Series of Failed Anterior Cruciate Ligament Reconstructions

Background Anterior cruciate ligament reconstruction employing transtibial tunnel techniques may result in less than ideal femoral and tibial vertical graft placement, with a residual pivot shift and instability symptoms. Hypothesis Nonanatomical graft placement is highly prevalent among knees with failed primary and revision anterior cruciate ligament grafts. Study Design Case series; Level of evidence, 4. Methods A total of 122 consecutive patients presented to the authors’ center with a failed anterior cruciate ligament reconstruction. Radiographs, magnetic resonance imaging, and operative reports were used to define graft placement. Arthroscopic confirmation of graft placement was obtained in 92 knees during subsequent revision surgery. A nonanatomical graft placement was assigned when ≥50% of the graft was outside of the native tibial and femoral insertions. All patients prospectively completed Cincinnati Knee Rating System questionnaires. Results A nonanatomical graft placement occurred in 107 of 122 (88%) knees; 61% of the grafts were entirely on the intercondylar femoral roof, and 35% extended posterior to the anterior cruciate ligament tibial attachment. A transtibial technique had been used in 83%. The mean values for the coronal and sagittal graft placement showed a significantly increased vertical orientation in comparison with a control group (P < .01). Forty-two of the 107 nonanatomical grafts had undergone 1 or more revisions without correction of the misplaced graft tunnels, and these subsequently failed. Conclusion The occurrence of nonanatomical graft placement in primary and revision knees may represent an inadequacy of transtibial tunnel drilling techniques to obtain graft placement within the native femoral and tibial footprints. In revision cases, the prior graft location requires close scrutiny so the new graft tunnels are placed at the native anterior cruciate ligament attachments. Independent drilling of tibial and femoral tunnels is recommended using either 2-incision or anteromedial portal techniques.
Agent-based Approaches to Dynamic Team Simulation

Abstract : The Office of Naval Research (ONR) has recently funded the Personnel Integration of Selection, Classification, Evaluations, and Surveys (PISCES) effort. One of the products of the PISCES effort involves creating a virtual environment to enable team simulations. This report defines the capabilities required to develop Test Simulator (TESTOR), an experimental agent-based virtual simulation for a distributed team. These capabilities are organized around the technologies of agent-based approaches, simulation, and optimization relevant to team selection and performance. The report identifies supporting capabilities necessary for specifying and capturing team performance metrics in an experimental virtual simulation environment. Four applications of the model consistent with PISCES objectives are considered for the simulation: prediction of team performance, team selection, individual diagnostic assessment of teamwork, and assessment of teamwork. The report is organized into six sections. Section 1 characterizes current knowledge of teamwork and the factors that would need to be incorporated in a comprehensive simulation of team behavior. Section 2 reviews agent-based models of teamwork describing work involving both teamwork approaches to the design of multiagent systems and agent-based representation of human behavior. Section 3 examines the advantages and disadvantages of agent-based modeling in the context of the complexity and richness of human teams and explores possible methods for overcoming the difficulties. Section 4 discusses issues related to predicting team performance from simulation. Section 5 discusses advantages and disadvantages of conventional optimization and agent-based approaches to the team selection problem. Section 6 explores the problems and possibilities of using virtual team simulation for diagnostic assessment of an individual Sailor's teamwork behaviors and the extension of automatic assessment to human teams.
Family Socioeconomic Status and Self-Reported Sexually Transmitted Diseases Among Black and White American Adolescents

Objective: The objective of this study was to assess associations between socioeconomic status (SES) and adolescent sexually transmitted diseases (STDs) stratified by race and gender. Study: In cross-sectional analyses of the National Longitudinal Study of Adolescent Health Wave One (1995), unadjusted and adjusted associations between 4 family SES indicators and STD reports for black and white 7th through 12th graders were examined. Results: Lower maternal education and nonprofessional maternal occupations were associated with higher STD reports in all groups except white females. Generally, STD reports were higher for adolescents not living in 2-parent homes, and lower income was only associated for black males. Conclusion: Overall, SES is only a weak to moderate marker for adolescent STD risks. The relationship of SES and STDs varies by the SES measure used and differs across race-gender groups. Other individual factors such as risk behaviors or community factors such as income inequality could play a more critical role for adolescent STDs than family SES.
A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery.

Controversy exists regarding the routine use of aids to lung expansion in the prevention of pulmonary complications after abdominal surgery. We prospectively randomized 172 patients into 1 of 4 groups: the control group (44 patients) received no respiratory treatment, the IPPB group (45 patients) received intermittent positive pressure breathing therapy for 15 min 4 times daily, the IS group (42 patients) was treated with incentive spirometry 4 times daily, and the DBE group (41 patients) carried out deep breathing exercises under supervision for 15 min 4 times daily. Roentgenographic changes, observed 24 h after surgery, were comparable in the 4 groups (20.5 to 36.6%). Pulmonary complications were defined as the development of 3 or more of 6 new findings: cough, phlegm, dyspnea, chest pain, temperature greater than 38 degrees C, pulse rate more than 100 beats/min. The frequency of development of pulmonary complications was 48% in the control group, 22% in the IPPB group (p less than 0.05), 21% in the IS group (p less than 0.05), and 22% in the DBE group (p less than 0.05). Side effects of respiratory treatment were observed only in the IPPB group (18%; p less than 0.05). Hospital stay in patients undergoing upper abdominal surgery was significantly shorter in the IS group (mean +/- SD, 8.6 +/- 3 days) than in the control group (13 +/- 5 days). This difference was not observed for the other 2 treatment groups. (ABSTRACT TRUNCATED AT 250 WORDS)
PERBANDINGAN ANALISA DAYA DUKUNG TIANG PANCANG MENGGUNAKAN METODE PERHITUNGAN L. DECOURT DAN TES PDA

Dermaga IV pelabuhan Tanjung Intan Cilacap dibangun menggunakan struktur deck on pile dengan pondasi berupa tiang pancang pipa baja. Fungsi dari pondasi ini adalah untuk menyalurkan beban yang diterima oleh struktur, lalu diteruskan ke dalam tanah. Pondasi yang menopang struktur, harus memliliki daya dukung tiang yang lebih besar dari beban rencana yang diterima oleh pondasi tersebut. Pada artikel ini akan dibahas mengenai perbandingan daya dukung tiang pancang dengan analisa data lapangan dan pengujian daya dukung pondasi tiang. Metodologi pengumpulan data dilakukan dengan cara pengambilan data dari pihak proyek dan studi pustaka. Perhitungan daya dukung tiang pancang dilakukan menggunakan metode perhitungan L. Decourt (1982) dengan menggunakan data SPT yang didapatkan dari hasil pengujian tanah di area dermaga IV pelabuhan Tanjung Intan Cilacap. Perhitungan daya dukung pondasi tiang pancang dilakukan dengan memperhitungkan data-data seperti data SPT, Faktor keamanan, dan titik tanah yang ditinjau. Perhitungan daya dukung pondasi tiang dengan metode perhitungan L. Decourt (1982) sebaiknya tidak dianggap sebagai daya dukung pondasi ultimit yang sebenarnya. Untuk memastikan keakuratan hasil analisa struktur dengan metode L. Decourt (1982) diperlukan perbandingan dengan data daya dukung pondasi tiang dengan menggunakan pengujian PDA ( Pile Driving Analysis) .
Inhibition of the mammalian target of rapamycin blocks epilepsy progression in NS‐Pten conditional knockout mice

Purpose: Increased activity of mTOR Complex 1 (mTORC1) has been demonstrated in cortical dysplasia and tuberous sclerosis complex, as well as in animal models of epilepsy. Recent studies in such models revealed that inhibiting mTORC1 with rapamycin effectively suppressed seizure activity. However, seizures can recur after treatment cessation, and continuous rapamycin exposure can adversely affect animal growth and health. Here, we evaluated the efficacy of an intermittent rapamycin treatment protocol on epilepsy progression using neuron subset‐specific‐Pten (NS‐Pten) conditional knockout mice.
'Pitch accent' and prosodic structure in Scottish Gaelic: reassessing the role of contact

Several varieties of Scottish Gaelic have attracted interest in both descriptive and theoretical literature due to an interesting feature of their prosody, which involves contrasting laryngeal activity (pitch and glottalization) in segmentally identical forms. As an example, consider the difference between [ˈtuan] ‘hook’ (written dubhan) and [ˈtuan] ‘song’ (duan). As documented by Ladefoged et al.1 the first of these is realized in the dialect of Bernera (off the coast of Lewis in the Outer Hebrides) with a rising-falling contour, while the second one has a rising contour: an alternative way of describing the difference is analysing [ˈtuan] ‘hook’ as having an early pitch peak and [ˈtuan] ‘song’ as having a late one. An essentially identical contrast is found between words with and without a certain type of epenthetic vowel, traditionally called the svarabhakti vowel (underlined for clarity in the remainder for this paper). For instance, in the dialect of Bernera, the word [ˈpalɣak] ‘skull’ (ballag) has a high tone on the first vowel, comparable to the early peak of [ˈtuan] ‘hook’, while [ˈpalɣak] ‘belly’ (balg) has a rising pattern throughout both vowels, similar to the late peak in [ˈtuan] ‘song’. Descriptively, this contrast is extremely similar to “pitch accent” contrasts found in the North Germanic varieties of Sweden and Norway2 and in the West Germanic varieties of Limburg and
The Brain Recovery Core: Building a System of Organized Stroke Rehabilitation and Outcomes Assessment Across the Continuum of Care

This Special Interest article describes a multidisciplinary, interinstitutional effort to build an organized system of stroke rehabilitation and outcomes measurement across the continuum of care. This system is focused on a cohort of patients who are admitted with the diagnosis of stroke to our acute facility, are discharged to inpatient and/or outpatient rehabilitation at our free-standing facility, and are then discharged to the community. This article first briefly explains the justification, goals, and purpose of the Brain Recovery Core system. The next sections describe its development and implementation, with details on the aspects related to physical therapy. The article concludes with an assessment of how the Brain Recovery Core system has changed and improved delivery of rehabilitation services. It is hoped that the contents of this article will be useful in initiating discussions and potentially facilitating similar efforts among other centers.
MicroRNA regulation in mammalian adipogenesis

Adipogenesis, the complex development from preadipocytes or mesenchymal stem cells to mature adipocytes, is essential for fat formation and metabolism of adipose tissues in mammals. It has been reported to be regulated by hormones and various adipogenic transcription factors which are expressed as a transcriptional cascade promoting adipocyte differentiation, leading to the mature adipocyte phenotype. Recent findings indicate that microRNAs (miRNAs), a family of small RNA molecules of approximately 22 nucleotides in length, are involved in the regulatory network of many biological processes, including cell differentiation, through post-transcriptional regulation of transcription factors and/or other genes. In this review, we focus on the recent understanding of the roles of miRNAs in adipogenesis, including the most recent and relevant findings that support the role of several miRNAs as pro- or antiadipogenic factors regulating adipogenesis in mice, human and cattle to propose the future role of miRNA in adipogenesis of farm animal models.
Presence of Borrelia burgdorferi (Spirochaetales: Spirochaetaceae) in Southern Kettle Moraine State Forest, Wisconsin, and Characterization of Strain W97F51

Abstract Lyme disease, caused by Borrelia burgdorferi Johnson, Schmidt, Hyde, Steigerwalt & Brenner; babesiosis, caused by Babesia microti Franca; and human granulocytic ehrlichiosis, caused by Anaplasma phagocytophilum Bakken & Dumler have been reported in Wisconsin, mainly in the endemic areas of the northwestern part of the state. People exposed to blacklegged ticks, Ixodes scapularis Say, from this region can potentially contract one or all of these diseases concurrently. Within the past several years, there have been cases of Lyme disease reported from southeastern Wisconsin, an area that contains deer, mice, and similar vegetation found at regions with high endemicity. However, past white-tailed deer surveys suggested no existence of I. scapularis in southeastern Wisconsin. However, in 1996, we identified questing adult I. scapularis in the southernmost part of the Southern Kettle Moraine State Forest, Walworth County. To determine whether an established population of I. scapularis exists in this region, we performed a detailed survey of the abundance of host-seeking I. scapularis adults and the presence and abundance of subadults feeding on white-footed mice, Peromyscus leucopus Rafinesque. We also tested for possible infections of B. burgdorferi, Ba. microti, and A. phagocytophilum in ticks and B. burgdorferi harbored by mice. In 1997 and 1998, a total of 249 P. leucopus mice and 118 questing adult I. scapularis ticks, in addition to 157 larvae and seven nymphs feeding on mice, were collected and their locations were recorded from the Nordic trails of the Southern Kettle Moraine State Forest. Only one P. leucopus and its attached engorged I. scapularis nymph were infected with B. burgdorferi, whereas none of the engorged larvae attached to mice were infected. However, 4.2% of questing adult I. scapularis were infected with B. burgdorferi. The abundance of questing adult I. scapularis was 1.6 ticks per hour. The prevalence of subadult ticks on mice was 27%, with a mean intensity on infested mice of 2.0. I. scapularis adults were not infected with either Ba. microti or A. phagocytophilum. A unique strain of B. burgdorferi s.l. (W97F51) was discovered, showing 33 nucleotide substitutions and one codon insertion in a 567-bp fragment of the OspB gene, compared with Borrelia bissettii (strain Ca389). The sequences of ospA, ospB, ospC, fla, and rrs genes and the rrf-rrl intergenic spacer region were compared between W97F51 and other B. burgdorferi s.l. species. Although W97F51 was most genetically related to B. bissettii, the genetic identity of W97F51 was less than that of B. bissettii conspecifics. This study documents the existence of an established population of I. scapularis and the presence of B. burgdorferi with a novel strain in southeastern Wisconsin.
The impact of oral vitamin A derivatives on lipid metabolism – What recommendations can be derived for dealing with this issue in the daily dermatological practice?

Retinoids and vitamin A derivatives have been widely used topically and systemically in the treatment of hyper‐ and parakeratotic skin diseases, genodermatoses, severe acne, autoimmune diseases (i. e. lupus erythematosus) or cutaneous T‐cell lymphoma for more than 30 years. In addition to the desired proliferation‐inhibiting, differentiation‐inducing and antiinflammatory or sebo‐suppressive effects, vitamin A derivatives also affect lipid metabolism. This is shown primarily by an increase of transaminases, triglycerides or cholesterol levels which vary in intensity from patient to patient. The degree of impact on the different parameters of lipid metabolism depends on the nature of the vitamin A derivative on the one hand due to different receptor specific binding interactions (RAR/RXR), while on the other hand posttranslational processes also play a major role.