Miracle-dz/UniFAR-FTUs huggingface dataset:
Reforming primary healthcare: from public policy to organizational change.

PURPOSE Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. DESIGN/METHODOLOGY/APPROACH An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. FINDINGS The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of "intermediate change" and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. RESEARCH LIMITATIONS/IMPLICATIONS This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. PRACTICAL IMPLICATIONS The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. ORIGINALITY/VALUE This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design.
Mouse astrocytes respond to the chemokines MCP‐1 and KC, but reverse transcriptase‐polymerase chain reaction does not detect mRNA for the KC or new MCP‐1 receptor

Previous studies demonstrated the involvement of astrocytes in the development of astrogliosis, a condition in which these cells undergo proliferation and hypertrophy. To examine whether astrocytes could migrate into lesions, we tested the influence of the murine chemokines MCP‐1, KC, TCA3, and MIP‐1β on migration of cultured neonatal mouse astrocytes. Subnanomolar concentrations on MCP‐1 and KC were active chemoattractants indicating that these molecules were effective at physiologic concentrations. Specificity of MCP‐1 was demonstrated by antibody inhibition and by the finding that the chemokine MIP‐1β failed to induce astrocyte migration. The migratory responses were sensitive to pertussis toxin; this finding is consistent with involvement of G protein‐coupled receptors.
Forecast Bias and Fiscal Slack Accumulation in School Districts

The years during and after the Great Recession constrained revenue across all levels of government. Revenue shortfalls in states decreased intergovernmental transfers, which compounded the plight of local governments already facing large declines in own-source property taxes. Among the many casualties of this economic downturn were school districts, which responded by implementing a variety of financial management strategies to continue providing educational service provision to more than 50 million students across the United States. One strategy school districts continue to utilize is countercyclical stabilization of expenditures with fiscal slack, which raises an important—and, to date, largely unanswered—question of how school districts manage to accumulate fiscal slack, given both volatility and decreases in revenues in the years following the Great Recession. One approach is to use implicit slack from biased forecasts to generate explicit fiscal slack in the unassigned fund balance. This article provides evidence for this strategy by empirically testing it with data from Kentucky school districts from school years 2001-2002 to 2013-2014. The findings indicate that school districts are engaged in strategic planning with implicit fiscal slack, which allows them to accumulate explicit fiscal slack, a cornerstone of prudent financial management that can provide budgetary flexibility during financial uncertainty. The relationship between implicit and explicit fiscal slack is heterogeneous over the business cycle, providing further evidence of strategic planning. Practitioners can also use the findings of this article to support the strategic use of forecasts to help accumulate unassigned fund balance, particularly in the years after the Great Recession.
Carbonic anhydrase isozymes IX and XII in gastric tumors.

AIM To systematically study the expression of carbonic anhydrase (CA) isozymes IX and XII in gastric tumors. METHODS We analyzed a representative series of specimens from non-neoplastic gastric mucosa and from various dysplastic and neoplastic gastric lesions for the expression of CA IX and XII. Immunohistochemical staining was performed using isozyme-specific antibodies and biotin-streptavidin complex method. RESULTS CA IX was highly expressed in the normal gastric mucosa and remained positive in many gastric tumors. In adenomas, CA IX expression significantly decreased towards the high grade dysplasia. However, the expression resumed back to the normal level in well differentiated adenocarcinomas, while it again declined in carcinomas with less differentiation. In comparison, CA XII showed no or weak immunoreaction in the normal gastric mucosa and was slightly increased in tumors. CONCLUSION These results demonstrate that CA IX expression is sustained in several types of gastric tumors. The variations observed in the CA IX levels support the concept that gastric adenomas and carcinomas are distinct entities and do not represent progressive steps of a single pathway.
NeuroAIDS in the Asia Pacific Region

Over 8.3 million people living in the Asia Pacific region are human immunodeficiency virus (HIV) positive and up to 40% of these individuals have had prior acquired immunodeficiency syndrome (AIDS) illnesses. Recently endeavors have been made to better characterize the burden of HIV-related neurological disease within the Asia Pacific region and, with this in mind, the NeuroAIDS in Asia and the Pacific Rim workshop was held in Sydney, Australia, as an affiliated event of the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention. The workshop was supported by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute of Mental Health (NIMH) of the United States National Institutes of Health and the Australian Government overseas AID program, AusAID. HIV neurologists, infectious disease physicians, pediatricians, psychiatrists, immunologists, virologists, and researchers from 12 countries of the Asia Pacific region (including Australia), the United States, and the United Kingdom attended the meeting. A broad range of topics were addressed, including common HIV neurological disorders, the lack of diagnostic, management, and research infrastructure, central nervous system (CNS) immune restoration disease, pediatric neuroAIDS, and current clinical and laboratory research projects being undertaken within the Asia Pacific region.
Integration of optical and radar classifications for mapping pasture type in Western Australia

In this study, independent classifications of Landsat Thematic Mapper imagery and Jet Propulsion Laboratory AirSAR were combined to create an integrated classification of pasture and other vegetation types for a study area in the agricultural zone of Western Australia. The resulting classification combines greenness and brightness information from optical data with structure and water content information from synthetic aperture radar (SAR). Field observations of vegetation type, botanical composition, ground cover percentage, wet and dry biomass, canopy height, and soil water content were collected at 34 sites representing a range of pastures, browse shrubs, and crops. An unsupervised version of the Complex Wishart classification procedure, based on preserving scattering characteristics from the Freeman and Durden backscatter decomposition, was applied to the C-, L-, and P-band polarimetric SAR data. The optical classification was carried out using a principle component analysis on the green, red, and near-infrared bands and clustering on the basis of a class centroid distance measure and knowledge of ground targets. These two classification results were then fused together. Assessment of a confusion matrix using the individual sites showed that identification of more uniform, dense, and structurally distinct canopies was better than that of more diverse, sparse, and structurally ambiguous canopies, as the former were better represented by the canopy height attribute used in the SAR classification component. The optical classification enabled correction of SAR misclassification of vegetation due to surface roughness and soil moisture effects, or similar backscatter responses from herbaceous or arboreal canopies. The results show that simplification of vegetation into groups based upon properties with sensitive responses in both the optical and SAR domains, and combination of separate SAR and optical classifications, has potential for improving classification of diverse and heterogeneous herbaceous and browse cover in grazing lands. However, collection of ground calibration data must be at an appropriate spatial scale and include canopy and surface measurements directly related to backscatter mechanisms and spectral sensitivity.
Characterization of a glycerol/H+ symport in the halotolerant yeast Pichia sorbitophila

Pichia sorbitophila is a halotolerant yeast capable of surviving to extracellular NaCl concentrations up to 4 M in mineral medium when glucose or glycerol are the only carbon and energy sources. Evidence is presented here that glycerol, the main compatible solute this yeast accumulates so as to maintain osmotic balance, is actively co‐transported with protons. This transport system was shown to be constitutive, not needing induction by either glycerol or salt, and was not repressible by glucose. In glucose‐ or glycerol‐grown cells, a simple diffusion was detectable, and iterative calculations were performed to calculate kinetic parameters, in the presence and in the absence of NaCl. At 25°C, pH 5·0, in glucose‐grown cells these were: Km = 0·81 ± 0·11 mM and Vmax = 634·2 ± 164·8 μmol h−1 per g (glycerol); Km = 1·28 ± 0·60 mM and Vmax = 558·6 · 100·6 μmol h−1 per g (protons). Correspondent stoichiometry was approximately 1, either for these conditions or in the presence of 1 M‐NaCl. An increase in acumulation capacity was evident when different concentrations of NaCl were present. This capacity was shown to be dependent on ΔpH and membrane potential, consistently with an electrogenic character. We suggest that the main role of this system is in osmoregulation, by keeping glycerol accumulated inside the cells, compensating for leakage, due to its liposoluble character.
Data Utilization for Medical Decision Making at the Time of Patient Admission to ICU*

Objectives:Information overload in electronic medical records can impede providers’ ability to identify important clinical data and may contribute to medical error. An understanding of the information requirements of ICU providers will facilitate the development of information systems that prioritize the presentation of high-value data and reduce information overload. Our objective was to determine the clinical information needs of ICU physicians, compared to the data available within an electronic medical record. Design:Prospective observational study and retrospective chart review. Setting:Three ICUs (surgical, medical, and mixed) at an academic referral center. Subjects:Newly admitted ICU patients and physicians (residents, fellows, and attending staff). Measurements and Main Results:The clinical information used by physicians during the initial diagnosis and treatment of admitted patients was captured using a questionnaire. Clinical information concepts were ranked according to the frequency of reported use (primary outcome) and were compared to information availability in the electronic medical record (secondary outcome). Nine hundred twenty-five of 1,277 study questionnaires (408 patients) were completed. Fifty-one clinical information concepts were identified as being useful during ICU admission. A median (interquartile range) of 11 concepts (6–16) was used by physicians per patient admission encounter with four used greater than 50% of the time. Over 25% of the clinical data available in the electronic medical record was never used, and only 33% was used greater than 50% of the time by admitting physicians. Conclusions:Physicians use a limited number of clinical information concepts at the time of patient admission to the ICU. The electronic medical record contains an abundance of unused data. Better electronic data management strategies are needed, including the priority display of frequently used clinical concepts within the electronic medical record, to improve the efficiency of ICU care.
An Interpretation of Langmuir Probe Floating Voltage Signals in a Cutting Arc

An experimental study of the electrostatic probe floating voltage signals in a cutting arc and its physical interpretation in terms of the arc plasma structure is reported. Sweeping electrostatic probes have been used to register the local floating potential and ion current at 3.5 mm from the nozzle exit in a 30-A arc generated by a high energy density cutting torch with a nozzle bore radius of 0.5 mm and an oxygen mass flow rate of 0.71 g ldr s-1. It is found that the floating potential signal presented a central hump with duration almost similar to that corresponding to the ion current signal but having also lateral wings with much larger duration. Capacitive coupling between the probe and the conducting body of the nozzle and arc as a source for the floating potential signal was discarded. It is assumed that the hump in these probe voltage signals results from the presence of an electrostatic field directed in the radial direction outward the arc axis that is caused by thermoelectric effects. The probe floating voltage signal is inverted using the generalized Ohm's law together with the Saha equation, thus obtaining the radial profiles of the temperature, particle densities, radial electric field, and potential of the plasma at the studied section of the arc. The resulting temperature and density profiles derived from our interpretation are in good agreement with the data published elsewhere in this kind of high-pressure arcs. There is not a straightforward connection between the measured hump amplitude in the floating signal (ap4 V) and the derived increase in the plasma potential between the arc edge and the arc center ( ap10 V), due to the global zero current balance condition established by the finite size of the probe. It is shown, however, that the probe takes a floating potential value close to that corresponding to the plasma temperature at the probe center.
Barriers to ego identity status formation: a contextual qualification of Marcia's identity status paradigm.

While many psychological, sociological and educational researchers acknowledge that ego identity formation is a socially embedded process, others have found that identity research often focuses, almost exclusively, on internal psychological development. The concept of "barriers" provides a means by which to describe external influences associated with adolescent and young adult ego identity exploration and commitment processes which affect and possibly limit individual developmental options. Based on Erikson's assumption that ego identity formation involves both personal growth and communal change, the barriers qualification expands upon Marica's identity status paradigm to more accurately reflect socio-cultural variables which may have impact upon individual internal psychological function.
Biomechanical properties of the keratoconic cornea: a review

There has been a recent surge of interest in assessing corneal biomechanical properties due to potential clinical applications, particularly in the early detection of keratoconus (KC). This review discusses the effects of keratoconus on the biomechanical properties of the cornea and the current techniques used to detect these changes both in the laboratory and clinical setting. Specific structural changes occurring in the corneal stroma as part of the disease process can be linked to alterations in the viscous and elastic properties of the cornea in keratoconus. Although there are extensive ex vivo studies using techniques such as extensometry and inflation testing to analyse the biomechanical properties of the normal cornea, few have investigated the keratoconic cornea using the same methods. There are a number of ex vivo studies that confirm the effectiveness of collagen cross‐linking in increasing Young's modulus in healthy corneas. Recently, research has focussed on measuring corneal biomechanical parameters in vivo using two commercially available instruments: the Ocular Response Analyser (ORA) and the CorVis ST (CST). Both instruments analyse the dynamic behaviour of the cornea, when temporarily deformed by an air puff; however, the outputs of these instruments are not directly comparable due to differences in the characteristics of the air puff and output parameters. Studies using these instruments have reported significant differences between keratoconic and healthy corneas; however, neither instrument can currently be used in isolation to reliably diagnose keratoconus. Further research analysing the outputs of these instruments may enhance their diagnostic capabilities.
A 10-year study of esophageal cancer in Guilan province, Iran: the Guilan Cancer Registry Study (GCRS).

BACKGROUND Northern Iran counts as one of the highest prevalence regions for esophageal cancer (EC) worldwide. This study was designed to assess the epidemiologic aspects of EC in north central and northwest Iran over a 10 year period. MATERIALS AND METHODS The Guilan cancer registry study (GCRS) is a population- based cancer registry study featuring retrospective (1996-2003) and prospective (2004-2005) phases. A detailed questionnaire based on WHO standards for cancer registratration was applied to gather the required information. Two trained physicians coded information using ICD-O-3 in close coordination with an expert pathologist. RESULTS A total of 19,936 cases of malignancy (mean age 55.4±18.0 years, range: 1-98 years) were registered, including 1,147 cases (670 males, 447 female; mean age: 64.0±11.5 years) of EC. In 1996 the male/female ratio among patients with EC was 1.25 which increased to 1.53 in 2005. The lower third of the esophagus still remained the most common site of tumors. The average age-standardized rate (ASR) was 6.9 and 4.1 per 105 men and women, respectively. In 1996, the ASRs were 7.2 and 5.2 per 105 men and women which decreased to 6.9 and 4.1 per 105 in 2004-2005. Squamous cell carcinoma (SCC) was the most prevalent histological subtype of EC accounting over 80% of cases. CONCLUSIONS However the prevalence of adenocarcinoma (ADC) showed an increase to 18.4%. Guilan province may be considered a relatively low incidence region for EC.
Essays on New Economic Geography and International Trade

The current thesis is a collection of two essays contributing on the field of New Economic Geography and International Trade. The title of the first essay is "Globalization, Regional Productivity, Taste Bias and Internal Spatial Distribution". The title of the second essay is "Foreign Productivity Improvements and Domestic Welfare Effects". I believe that the current Ph.D. thesis illustrates and sheds light on the role of some fundamental insights for the class of New Economic Geography and International Trade models, in general.
The role of vancomycin in the persistence or recurrence of Staphylococcus aureus bacteraemia

Persistence and recurrence of Staphylococcus aureus bacteraemia (SAB) have been linked primarily with difficult-to-eradicate foci of infection such as endocarditis, osteomyelitis or abscess formation. Although vancomycin therapy has been suggested as a predictor of relapse of SAB, it has never been shown to be associated with persistent SAB. The purpose of this study was to examine the possible association of vancomycin therapy and persistence of SAB. Two groups of patients were retrospectively studied. One group consisted of 124 patients who completed ≥10 d of appropriate anti-staphylococcal therapy (from among a total of 284 patients with SAB during 2 y, 1997–8). In this group, persistence of SAB (methicillin resistant and susceptible combined) for >3 d while on therapy, occurred in 11 (22%) of 55 vancomycin recipients and in none of 52 cloxacillin recipients (p = 0.002). When calculated for methicillin susceptible SAB alone, the numbers were 3 of 13 vs 0 of 52, respectively (p = 0.007). The second study group included all patients with persistence and/or relapse of SAB while on appropriate anti-staphylococcal therapy during 4 y (1997–2000). In this group, the persistence occurred while on vancomycin therapy, in 32 (94%) of 34 patients with >3 d of persistence of SAB. In the majority of these patients a secondary focus of infection serving as the site of persistence was identified in addition to the primary focus (or portal of entry). It was concluded that vancomycin is inferior to cloxacillin therapy in terminating SAB and therefore may predispose to prolonged bacteraemia and secondary seeding of infection during therapy.
Synergistic Effects of Traumatic Head Injury and Apolipoprotein-epsilon4 in Patients With Alzheimer's Disease

Article abstract-The apolipoprotein-epsilon4 allele increases the risk of Alzheimer's disease (AD), but cerebral deposition of beta-amyloid with age, a genetic mutation, or head injury may contribute to the pathogenesis of this disease. We examined the risks of AD associated with traumatic head injury and apolipoprotein-epsilon4 in 236 community-dwelling elderly persons. A 10-fold increase in the risk of AD was associated with both apolipoprotein-epsilon4 and a history of traumatic head injury, compared with a two-fold increase in risk with apolipoprotein-epsilon4 alone. Head injury in the absence of an apolipoprotein-epsilon4 allele did not increase risk. These data imply that the biological effects of head injury may increase the risk of AD, but only through a synergistic relationship with apolipoprotein-epsilon4. NEUROLOGY 1995;45: 555-557