Miracle-dz/UniFAR-FTUs huggingface dataset:
What do we know about patients' perceptions of continuity of care? A meta-synthesis of qualitative studies.

OBJECTIVE The increasing complexity in healthcare delivery might impede the achievement of continuity of care, being defined as 'one patient experiencing care over time as coherent and linked'. This article aims to improve the knowledge on patients' perceptions of relational (RC), informational (IC) and management continuity (MC) across care levels. DESIGN A descriptive, qualitative meta-synthesis was conducted based on a literature search in various electronic databases using the subject heading 'continuity of care' and linked key terms. We scanned retrieved articles for adherence to inclusion criteria: (i) relevance to research topic, (ii) original study adopting a qualitative design and (iii) investigating the patient's perspective. Content analysis was conducted by identification of themes and aggregation of findings. RESULTS The selected 25 studies most frequently investigated RC. Being attended to regularly and over time by one physician (RC) was valued by chronic ill patients, but balanced with convenient access by young patients (MC). Communication and information transfer across care settings as well as the gathering of holistic information about the patient were perceived to foster IC. Critical features for achieving MC were accessibility between care levels, individualized care and a smooth discharge process including the receipt of support. Patients further considered that their personal involvement was one facilitating element of continuity of care. CONCLUSIONS Patients identified elements that enhance or distract from continuity of care across boundaries. Variations in perceived importance seem to depend on both individual and contextual factors which should be taken into account during healthcare provision.
Genetically informed ecological niche models improve climate change predictions

We examined the hypothesis that ecological niche models (ENMs) more accurately predict species distributions when they incorporate information on population genetic structure, and concomitantly, local adaptation. Local adaptation is common in species that span a range of environmental gradients (e.g., soils and climate). Moreover, common garden studies have demonstrated a covariance between neutral markers and functional traits associated with a species’ ability to adapt to environmental change. We therefore predicted that genetically distinct populations would respond differently to climate change, resulting in predicted distributions with little overlap. To test whether genetic information improves our ability to predict a species’ niche space, we created genetically informed ecological niche models (gENMs) using Populus fremontii (Salicaceae), a widespread tree species in which prior common garden experiments demonstrate strong evidence for local adaptation. Four major findings emerged: (i) gENMs predicted population occurrences with up to 12‐fold greater accuracy than models without genetic information; (ii) tests of niche similarity revealed that three ecotypes, identified on the basis of neutral genetic markers and locally adapted populations, are associated with differences in climate; (iii) our forecasts indicate that ongoing climate change will likely shift these ecotypes further apart in geographic space, resulting in greater niche divergence; (iv) ecotypes that currently exhibit the largest geographic distribution and niche breadth appear to be buffered the most from climate change. As diverse agents of selection shape genetic variability and structure within species, we argue that gENMs will lead to more accurate predictions of species distributions under climate change.
Thermal limits of leaf metabolism across biomes

High‐temperature tolerance in plants is important in a warming world, with extreme heat waves predicted to increase in frequency and duration, potentially leading to lethal heating of leaves. Global patterns of high‐temperature tolerance are documented in animals, but generally not in plants, limiting our ability to assess risks associated with climate warming. To assess whether there are global patterns in high‐temperature tolerance of leaf metabolism, we quantified Tcrit (high temperature where minimal chlorophyll a fluorescence rises rapidly and thus photosystem II is disrupted) and Tmax (temperature where leaf respiration in darkness is maximal, beyond which respiratory function rapidly declines) in upper canopy leaves of 218 plant species spanning seven biomes. Mean site‐based Tcrit values ranged from 41.5 °C in the Alaskan arctic to 50.8 °C in lowland tropical rainforests of Peruvian Amazon. For Tmax, the equivalent values were 51.0 and 60.6 °C in the Arctic and Amazon, respectively. Tcrit and Tmax followed similar biogeographic patterns, increasing linearly (˜8 °C) from polar to equatorial regions. Such increases in high‐temperature tolerance are much less than expected based on the 20 °C span in high‐temperature extremes across the globe. Moreover, with only modest high‐temperature tolerance despite high summer temperature extremes, species in mid‐latitude (~20–50°) regions have the narrowest thermal safety margins in upper canopy leaves; these regions are at the greatest risk of damage due to extreme heat‐wave events, especially under conditions when leaf temperatures are further elevated by a lack of transpirational cooling. Using predicted heat‐wave events for 2050 and accounting for possible thermal acclimation of Tcrit and Tmax, we also found that these safety margins could shrink in a warmer world, as rising temperatures are likely to exceed thermal tolerance limits. Thus, increasing numbers of species in many biomes may be at risk as heat‐wave events become more severe with climate change.
Sensitivity of soil carbon fractions and their specific stabilization mechanisms to extreme soil warming in a subarctic grassland

Terrestrial carbon cycle feedbacks to global warming are major uncertainties in climate models. For in‐depth understanding of changes in soil organic carbon (SOC) after soil warming, long‐term responses of SOC stabilization mechanisms such as aggregation, organo‐mineral interactions and chemical recalcitrance need to be addressed. This study investigated the effect of 6 years of geothermal soil warming on different SOC fractions in an unmanaged grassland in Iceland. Along an extreme warming gradient of +0 to ~+40 °C, we isolated five fractions of SOC that varied conceptually in turnover rate from active to passive in the following order: particulate organic matter (POM), dissolved organic carbon (DOC), SOC in sand and stable aggregates (SA), SOC in silt and clay (SC‐rSOC) and resistant SOC (rSOC). Soil warming of 0.6 °C increased bulk SOC by 22 ± 43% (0–10 cm soil layer) and 27 ± 54% (20–30 cm), while further warming led to exponential SOC depletion of up to 79 ± 14% (0–10 cm) and 74 ± 8% (20–30) in the most warmed plots (~+40 °C). Only the SA fraction was more sensitive than the bulk soil, with 93 ± 6% (0–10 cm) and 86 ± 13% (20–30 cm) SOC losses and the highest relative enrichment in 13C as an indicator for the degree of decomposition (+1.6 ± 1.5‰ in 0–10 cm and +1.3 ± 0.8‰ in 20–30 cm). The SA fraction mass also declined along the warming gradient, while the SC fraction mass increased. This was explained by deactivation of aggregate‐binding mechanisms. There was no difference between the responses of SC‐rSOC (slow‐cycling) and rSOC (passive) to warming, and 13C enrichment in rSOC was equal to that in bulk soil. We concluded that the sensitivity of SOC to warming was not a function of age or chemical recalcitrance, but triggered by changes in biophysical stabilization mechanisms, such as aggregation.
Nitrogen‐mediated effects of elevated CO2 on intra‐aggregate soil pore structure

Soil pore structure has a strong influence on water retention, and is itself influenced by plant and microbial dynamics such as root proliferation and microbial exudation. Although increased nitrogen (N) availability and elevated atmospheric CO2 concentrations (eCO2) often have interacting effects on root and microbial dynamics, it is unclear whether these biotic effects can translate into altered soil pore structure and water retention. This study was based on a long‐term experiment (7 yr at the time of sampling) in which a C4 pasture grass (Paspalum notatum) was grown on a sandy loam soil while provided factorial additions of N and CO2. Through an analysis of soil aggregate fractal properties supported by 3D microtomographic imagery, we found that N fertilization induced an increase in intra‐aggregate porosity and a simultaneous shift toward greater accumulation of pore space in larger aggregates. These effects were enhanced by eCO2 and yielded an increase in water retention at pressure potentials near the wilting point of plants. However, eCO2 alone induced changes in the opposite direction, with larger aggregates containing less pore space than under control conditions, and water retention decreasing accordingly. Results on biotic factors further suggested that organic matter gains or losses induced the observed structural changes. Based on our results, we postulate that the pore structure of many mineral soils could undergo N‐dependent changes as atmospheric CO2 concentrations rise, having global‐scale implications for water balance, carbon storage, and related rhizosphere functions.
Decreased photosynthesis and growth with reduced respiration in the model diatom Phaeodactylum tricornutum grown under elevated CO2 over 1800 generations

Studies on the long‐term responses of marine phytoplankton to ongoing ocean acidification (OA) are appearing rapidly in the literature. However, only a few of these have investigated diatoms, which is disproportionate to their contribution to global primary production. Here we show that a population of the model diatom Phaeodactylum tricornutum, after growing under elevated CO2 (1000 μatm, HCL, pHT: 7.70) for 1860 generations, showed significant differences in photosynthesis and growth from a population maintained in ambient CO2 and then transferred to elevated CO2 for 20 generations (HC). The HCL population had lower mitochondrial respiration, than did the control population maintained in ambient CO2 (400 μatm, LCL, pHT: 8.02) for 1860 generations. Although the cells had higher respiratory carbon loss within 20 generations under the elevated CO2, being consistent to previous findings, they downregulated their respiration to sustain their growth in longer duration under the OA condition. Responses of phytoplankton to OA may depend on the timescale for which they are exposed due to fluctuations in physiological traits over time. This study provides the first evidence that populations of the model species, P. tricornutum, differ phenotypically from each other after having been grown for differing spans of time under OA conditions, suggesting that long‐term changes should be measured to understand responses of primary producers to OA, especially in waters with diatom‐dominated phytoplankton assemblages.
Gravidez na adolescência: valores e reações dos membros da família

Objetivo: Descrever as experiencias dos membros da familia a respeito da gravidez na adolescencia. Metodos: Na pesquisa, desenvolvida com a abordagem qualitativa, utilizou-se a analise da narrativa para sistematizar os dados. Resultados: Das narrativas de 19 entrevistados emergiram tres categorias descritivas: Valores familiares e orientacoes fornecidas; O recebimento da noticia e as providencias tomadas e O suporte fornecido. Conclusoes: A gravidez ocorreu em um contexto de organizacao familiar solida e as trajetorias das mulheres adolescentes apos o nascimento da crianca foram marcadas por aliancas e suporte da rede social. A constituicao do novo nucleo familiar foi caracterizada pela existencia de apoio material e afetivo dos membros da familia.
Iceberg killing fields limit huge potential for benthic blue carbon in Antarctic shallows

Climate‐forced ice losses are increasing potential for iceberg‐seabed collisions, termed ice scour. At Ryder Bay, West Antarctic Peninsula (WAP) sea ice, oceanography, phytoplankton and encrusting zoobenthos have been monitored since 1998. In 2003, grids of seabed markers, covering 225 m2, were established, surveyed and replaced annually to measure ice scour frequency. Disturbance history has been recorded for each m2 of seabed monitored at 5–25 m for ~13 years. Encrusting fauna, collected from impacted and nonimpacted metres each year, show coincident benthos responses in growth, mortality and mass of benthic immobilized carbon. Encrusting benthic growth was mainly determined by microalgal bloom duration; each day, nanophytoplankton exceeded 200 μg L−1 produced ~0.05 mm radial growth of bryozoans, and sea temperature >0 °C added 0.002 mm day−1. Mortality and persistence of growth, as benthic carbon immobilization, were mainly influenced by ice scour. Nearly 30% of monitored seabed was hit each year, and just 7% of shallows were not hit. Hits in deeper water were more deadly, but less frequent, so mortality decreased with depth. Five‐year recovery time doubled benthic carbon stocks. Scour‐driven mortality varied annually, with two‐thirds of all monitored fauna killed in a single year (2009). Reduced fast ice after 2006 ramped iceberg scouring, killing half the encrusting benthos each year in following years. Ice scour coupled with low phytoplankton biomass drove a phase shift to high mortality and depressed zoobenthic immobilized carbon stocks, which has persevered for 10 years since. Stocks of immobilized benthic carbon averaged nearly 15 g m−2. WAP ice scouring may be recycling 80 000 tonnes of carbon yr−1. Without scouring, such carbon would remain immobilized and the 2.3% of shelf which are shallows could be as productive as all the remaining continental shelf. The region's future, when glaciers reach grounding lines and iceberg production diminishes, is as a major global sink of carbon storage.
Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe

Importance Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5. Objective To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact. Design, Setting, and Participants Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016. Main Outcomes and Measures The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking. Results Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7% (0.1%), 12-month prevalence of 1.8% (0.1%), and 30-day prevalence of 0.8% (0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6% [0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0% [0.9%]) and other anxiety (51.7% [0.9%]) disorders. Severe role impairment is common across life domains (50.6% [1.2%]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2% [1.2%]), especially those with severe role impairment (59.4% [1.8%]) or comorbid disorders (55.8% [1.4%]) and those living in high-income countries (59.0% [1.3%]). Conclusions and Relevance The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation.
The use of data from national and other large-scale user experience surveys in local quality work: a systematic review.

PURPOSE An important goal for national and large-scale surveys of user experiences is quality improvement. However, large-scale surveys are normally conducted by a professional external surveyor, creating an institutionalized division between the measurement of user experiences and the quality work that is performed locally. The aim of this study was to identify and describe scientific studies related to the use of national and large-scale surveys of user experiences in local quality work. DATA SOURCES Ovid EMBASE, Ovid MEDLINE, Ovid PsycINFO and the Cochrane Database of Systematic Reviews. STUDY SELECTION Scientific publications about user experiences and satisfaction about the extent to which data from national and other large-scale user experience surveys are used for local quality work in the health services. DATA EXTRACTION Themes of interest were identified and a narrative analysis was undertaken. RESULTS OF DATA SYNTHESIS Thirteen publications were included, all differed substantially in several characteristics. The results show that large-scale surveys of user experiences are used in local quality work. The types of follow-up activity varied considerably from conducting a follow-up analysis of user experience survey data to information sharing and more-systematic efforts to use the data as a basis for improving the quality of care. CONCLUSION This review shows that large-scale surveys of user experiences are used in local quality work. However, there is a need for more, better and standardized research in this field. The considerable variation in follow-up activities points to the need for systematic guidance on how to use data in local quality work.
Interventions to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA: a systematic review.

PURPOSE This article describes the characteristics and reviews the methodological quality of interventions designed to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA. DATA SOURCES A total of 17 electronic databases and 13 websites for the period of 2002-13. STUDY SELECTION Studies were included if they evaluated an intervention strategy designed to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, the USA or Canada. DATA EXTRACTION Information on the characteristics and methodological quality of included studies was extracted using standardized assessment tools. RESULTS OF DATA SYNTHESIS Sixteen published evaluations of interventions to improve cultural competency in health care for Indigenous peoples were identified: 11 for Indigenous peoples of the USA and 5 for Indigenous Australians. The main types of intervention strategies were education and training of the health workforce, culturally specific health programs and recruitment of an Indigenous health workforce. Main positive outcomes reported were improvements in health professionals' confidence, and patients' satisfaction with and access to health care. The methodological quality of evaluations and the reporting of key methodological criteria were variable. Particular problems included weak study designs, low or no reporting of consent rates, confounding and non-validated measurement instruments. CONCLUSION There is a lack of evidence from rigorous evaluations on the effectiveness of interventions for improving cultural competency in health care for Indigenous peoples. Future evaluations should employ more rigorous study designs and extend their measurement of outcomes beyond those relating to health professionals, to those relating to the health of Indigenous peoples.
Evaluation of hydronephrotic kidney parenchymal density by non-contrast multislice computed tomography

It is well known that a prolonged ureteral obstruction leads to function loss of the congested kidney. Determining whether kidney stones cause any obstruction by non-contrast multislice CT is crucial for deciding about the timing of treatment. In our study we evaluated by Non-Contrast Multislice Computed Tomography (NCMSCT) detectable reliable changes of the density of the renal parenchyma in rats with artificial hydronephrosis. We made total or partial obstruction to left ureters of Spraque-Dawley rats, and applied sham operation to control groups. Using NCMSCT we measured the renal average parenchyma densities in the first, third and thirteenth days of operation. There was no significant difference between the parenchyma density of partial obstructed group and control group. However the parenchyma density in totally obsructed kidneys has significantly decreased compared to the contralateral kidneys and control group. In this group the duration of the obstruction correlated with significantly decreased parenchyma density. The average density values of the upper, middle and lower renal segments were similar. We assume that our results can be useful in the evaluation of the consequences of the ureteral obstruction. The decrease of the parenchyma density evaluated in NCMSCT could be an important indicator of the renal parenchymal damages. ﻿Hidronefrotik bobrek parankim dansitesinin kontrastsiz cok kesitli bilgisayarli tomografi kullanilarak degerlendirilmesi ﻿Uzun suren ureteral obstruksiyonun bobrek fonksiyon kaybina neden oldugu iyi bilinmektedir. Uriner sistem tasina bagli herhangi bir obstruksiyonun kontrastsiz cok kesitli bilgisayarli tomografi (KCKBT) ile belirlenmesi tedavi zamanlamasi hakkinda karar vermek acisindan cok onemlidir. Calismamizda deneysel hidronefroz olusturulan ratlarda renal parankim dansitesinde meydana gelen degisiklikler KCKBT ile degerlendirildi. Bu calismada sol ureterlerinde total veya parsiyel obstruksiyon olusturulmus Spraque-Dawley ratlarin bobrek parankim dansiteleri deneyin 1. ,3. ve 30. gunlerinde KCKBT ile degerlendirilerek, sham ve kontrol grubu ratlarin bobrek parankim dansiteleri ile karsilastirildi. Parsiyel ureteral obstruksiyon olusturulmus ratlarin bobrek parankim dansiteleri ile kontrol grubunun bobrek parankim dansiteleri arasinda anlamli bir fark olmadigi saptandi. Bununla birlikte total ureteral obstruksiyon olusturulmus ratlarin bobrek parankim dansitelerinin karsi taraf bobrekleri ve kontrol grubu ile karsilastirildiginda anlamli olarak azaldigi saptandi. Elde edilen bu bulgularin insanlarda ureter obstruksiyonun sonuclarinin degerlendirilmesinde yararli olabilecegini dusunmekteyiz. KCKBT degerlendirilmesinde renal parankim dansitesinin azalmasi renal parankimal hasarin bir gostergesi olabilir. J. Exp. Clin. Med., 2012; 29:215-220