Miracle-dz/UniFAR-FTUs huggingface dataset:
Innovatori, indecisi, bisognosi o autonomi. I medici di medicina generale tra integrazione e accountability

L’assistenza primaria in Italia sta subendo una radicale riforma con l’introduzione delle Aggregazioni Funzionali Territoriali (AFT), ovvero gruppi obbligatori di medici di medicina generale che si associano per rispondere insieme sia ai bisogni della popolazione assistita, sia per implementare le logiche del governo clinico. La Toscana gia a partire del 2014 e stata una delle prime Regioni a formalizzare le AFT negli Accordi Regionali e Aziendali e a nominare i coordinatori di AFT, ovvero medici di medicina generale che hanno il compito di guidare l’AFT nella programmazione e revisione di obiettivi di governo. A partire da un questionario rivolto ai coordinatori di AFT toscani, gli autori hanno analizzato la percezione dei coordinatori rispetto all’innovazione rappresentata dalla AFT, sia in termini di fiducia verso la logica di integrazione monoprofessionale (fiducia verso l’organizzazione), sia in termini di difficolta percepita rispetto all’assolvimento del proprio incarico (fiducia verso il ruolo). Sulla base di tali criteri, gli autori hanno delineato, per il contesto della Toscana, 4 differenti gruppi di coordinatori con percezioni simili verso l’innovazione manageriale e organizzativa della medicina generale.
"Yesterday I lectured and today I taught" A report on creative inquiry learning spaces: Actively connecting and engaging with students

The requirement for graduates from QUT to be curious, agile and resilient learners, coupled with new ways of working and a proliferation of mobile technologies, has triggered an urgent need for new approaches to learning and teaching. This development is aptly characterised by disruption and movement at all levels, with an emphasis on connecting with and engaging students (Nykvist, Mukherjee & McGraw, 2014). In order to maximise student learning, this inevitable disruption includes the physical and virtual spaces, technology provisions as well as the vital need for change of the role of the academic in these spaces. To this end, the Creative Inquiry Learning Space (CILS) prototyping project (KG S307/8) aims to explore how the Faculty of Education can actively address emerging learning and teaching practices that support QUT’s vision to produce graduate students who are ‘curious, agile and resilient learners’, who ‘will thrive in volatile environments’ (Real World Learning, 2020 Vision, QUT, 2016c, p.1). More importantly the project will investigate the extent to which learning environments that students prefer can be catered for at QUT and how academics can be adequately supported to reinvigorate their teaching practice to keep up with the current tide.
Investigation of RF Power Amplifiers for 802.11a Mobile Terminals

In this paper, the performances of various bias classes of Power Amplifiers (PA) working in 802.11a transmitters are presented. Computer simulations of a complete 802.11a transmitter have been made in order to investigate the PA efficiency and Adjacent Channel Power Ratio (ACPR) at the output of the non-linear PA. A high-level power amplifier model is used to model the different classes of amplifiers (class A, class B, class AB and class C) according to the conduction angle at the output signal of the PA. Other behaviors given in real amplifiers, such as the saturation level and compression near saturation are modeled as well. Results of PA efficiency, ACPR and output spectra are presented.
Improving the Diagnosis of SIBO Using an At-Home Handheld App Connected Breath Analysis Device (AIRE)

INTRODUCTION: Small Intestinal Bacterial Overgrowth (SIBO) is a common yet underdiagnosed condition. Lactulose hydrogen breath tests (LHBT) are typically used to detect SIBO; however, current breath testing methods require specialised, expensive equipment and technical support and are either done at a point-of-care facility and/or have to be mailed to a central laboratory. To address these issues a novel hand-held breath analyzer (AIRE, FoodMarble) was tested. The aims of this study were first, to perform a technical assessment of the AIRE device, second to compare the performance of the AIRE device against a commercially available mail-in LHBT kit using a zero-inflated negative binomial mixed effect model. METHODS: Three AIRE devices were tested with certified test gases covering a diagnostically meaningful range (hydrogen mixed with air at 3 ppm, 10 ppm and 50 ppm). For the clinical study, 36 patients suspected to have SIBO presenting to a tertiary level clinic were provided with an AIRE device and performed concurrent LHBTs at home with a mail-in LHBT kit. RESULTS: The overall average readings (mean +/- SD) for the AIRE devices tested at 3 ppm, 10 ppm and 50 ppm H2 were: 3.5 +/- 0.7 ppm; 10.7 +/- 1.1 ppm and 49.5 +/- 2.6 ppm respectively. The overall mean absolute error across the tested devices was 1.2 ppm. A significant positive correlation (r = 0.78, p < 0.001) was demonstrated between AIRE and mail-in kit H2 values. DISCUSSION: The AIRE device is a compelling alternative to mail-in LHBT kits for the diagnosis of SIBO. The AIRE device may also offer advantages over other traditional breath testing methods. KEYWORDS: Small intestinal bacterial overgrowth; lactulose hydrogen breath test; personal breath-test device; remote testing; digital health
Physiotherapists use different motivational strategies tailored to an individual's condition: a qualitative study

Question: How do physiotherapists use different motivational strategies for individuals in stroke rehabilitation? Design: A qualitative study using in-depth semi-structured online interviews. Participants: A criterion sample of 15 physiotherapists who have worked in rehabilitation for over 10 years and have an interest in an individual's motivation. Intervention: Not applicable. Outcome measures: Physiotherapists' perspectives and experiences regarding motivational strategies used depending on the individual's condition. Results: A total of nine themes emerged from the data upon thematic analysis and inductive coding. The participants used different strategies to encourage individuals' active participation in physiotherapy depending on their (1) mental health problems, (2) physical difficulties, (3) level of cognitive function, (4) personality, (5) activities and participation, (6) age, (7) human environment, and (8) type of rehabilitation service where the individual undergoes treatment. For example, in cases where an individual lost self-confidence, participants offered practice tasks that the individual could achieve with little effort to make them experience success. Conversely, for individuals with overconfidence, participants would provide them with a relatively difficult practice task to help them realize the necessity of practice through the experience of failure. The interviews also revealed (9) motivational strategies used regardless of the individual's condition. For instance, patient-centred communication was used to build a rapport with individuals, irrespective of their condition. Conclusion: This qualitative study is the first to demonstrate motivational strategies that physiotherapists use based on the individual's condition. Our findings provide a deeper understanding of the selection of motivational strategies in stroke rehabilitation.
Indoor Wind Speed Coefficients for Estimating Summer Comfort

Abstract There is a wide range of factors that influence natural ventilation. The uncertainties arising from the unpredictable nature of wind lead to the need to account for periods of time when winds are unable to provide indoor summer comfort. Some methods for estimating natural ventilation are outlined together with the effects of high site coverage, building porosity, insect screens, and local wind shelter from adjacent houses and vegetation. Indoor wind speed coefficients provide a direct method for comparing the natural ventilation potential of housing stock. Adaptive thermal comfort establishes the monthly temperature for operative comfort and comfort zone to accommodate 80% of people. Houses in the tropical city of Townsville in Australia are used to examine the potential for indoor summer thermal comfort. Ceiling fans can provide an energy-efficient back-up source of air movement for indoor comfort when winds are inadequate. The poor potential for natural ventilation of most contemporary housing stock with high site-coverage, raises concern for its long-term sustainability.
SCALE MODEL EXPERIMENT FOR THE VENTILATED AIR INTERFERENCE AT INTERMITTENT TUNNELS

New East Coast Freeway construction project is under planning on the route of east coast of Taiwan area. This freeway will be constructed in the very difficult terrain, such as severe land slide, typhoon and earth quake etc,, Due to this topographical conditions, 6 long tunnels ( over than 4km long) and other 4 short tunnels will be planned in this section (section length 80Km approx). Especially, two long tunnels will be located in each other with connecting short bridge structure (approx, 60m long). In addition, semi-shelter structure will be constructed on this bridge with following reasons. * For the prevention of big difference between two tunnels and short open section, such as, “visual environment by strong sun light on the short bridge section”, “natural wind force of lateral direction at open section”, and “wet, dry pavement conditions in the rain. ” * However, effects of air interference of ventilated air to down stream tunnel must be minimized for the reduction of all tunnel ventilation systems and power consumption. Based on these backgrounds and concepts, several types of semi -shelter structure were proposed and implemented by the scale model with vehicle running apparatus on the tunnel ventilation testing apparatus. As a results, two very important design factors to be obtained. * Rate of air interference between two tunnels and unit respiration air volume at opening part. * Aerodynamic coefficient at tunnel entrance with semi shelter.
A wave based prediction technique for the dynamic response analysis of plates with random point mass distributions

The Finite Element Method and the Statistical Energy Analysis are most commonly used for the analysis of the dynamical behaviour of mechanical structures. However, the ﬁrst is limited to applications in the low-frequency range, while the latter is only applicable high frequencies. In the mid-frequency range there is a lack of methods techniques to model assemblies with the combination of components with a low-frequency behaviour and components with a high-frequency behaviour. This paper presents a deterministic Wave Based Method for efﬁcient Monte Carlo simulations of the dynamic response of ﬂexible plates with point masses distributed randomly. The effect of random point mass distributions on the dynamic response can be representa-tive for the typical variability encountered in mechanical systems. The performance of the proposed method is illustrated through a numerical validation example.
Water cooled DBC direct bonded copper substrates

Between two insulating DBC substrates (Al/sub 2/O/sub 3/ or AlN) there are structured copper foils bonded together by DBC technology, to build a three dimensional system of micro channels. The large internal surface of the highly conductive copper allows an extremely efficient cooling of the DBC substrates. The DBC layout is customer specified and both DBCs are mounted to the top and the bottom of the water cooler. This compact cooling system designed to the customer's requirements gives four times the system offered efficient cooling of conventional module assemblies with liquid cooling. Due to the low weight and the relatively small dimensions the water cooled DBC substrate is an ideal solution for very high power applications. In detail we describe the following items: (i) the 3D MCI cooler; (ii) water for cooling; measurement of heat dissipation and flow rates; (iii) results of water flow measurement; and (iv) results of thermal dissipation measurement.
State of the Art of Patient-reported Outcomes in Acromegaly or GH Deficiency: A Systematic Review and Meta-analysis

Abstract Context Insight into the current landscape of patient-reported outcome (PRO) measures (PROM) and differences between PROs and conventional biochemical outcomes is pivotal for future implementation of PROs in research and clinical practice. Therefore, in studies among patients with acromegaly and growth hormone deficiency (GHD), we evaluated (1) used PROMs, (2) their validity, (3) quality of PRO reporting, (4) agreement between PROs and biochemical outcomes, and (5) determinants of discrepancies. Evidence Acquisition We searched 8 electronic databases for prospective studies describing both PROs and biochemical outcomes in acromegaly and GHD patients. Quality of PRO reporting was assessed using the International Society for Quality of Life Research (ISOQOL) criteria. Logistic regression analysis was used to evaluate determinants. Evidence Synthesis Ninety studies were included (acromegaly: n = 53; GHD: n = 37). Besides nonvalidated symptom lists (used in 37% of studies), 36 formal PROMs were used [predominantly Acromegaly Quality of Life Questionnaire in acromegaly (43%) and Quality of Life-Assessment of Growth Hormone Deficiency in Adults in GHD (43%)]. Reporting of PROs was poor, with a median of 37% to 47% of ISOQOL items being reported per study. Eighteen (34%) acromegaly studies and 12 (32%) GHD studies reported discrepancies between PROs and biochemical outcomes, most often improvement in biochemical outcomes without change in PROs. Conclusions Prospective studies among patients with acromegaly and GHD use a multitude of PROMs, often poorly reported. Since a substantial proportion of studies report discrepancies between PROs and biochemical outcomes, PROMs are pivotal in the evaluation of disease activity. Therefore, harmonization of PROs in clinical practice and research by development of core outcome sets is an important unmet need.
Motor neuron disease risk and magnetic field exposures

Abstract Background Many studies have investigated magnetic field exposure and the risks of motor neuron disease (MND). Meta-analyses have found positive associations but a causal relationship has not been established. Aims To investigate the risks of MND and occupational exposure to magnetic fields in a large UK cohort. Methods Mortality of 37 986 employees of the former Central Electricity Generating Board of England and Wales was investigated for the period 1987–2018. Employees were first employed in the period 1942–82 and were still in employment on the 1 November, 1987. Detailed calculations enabled estimates to be made of magnetic field exposures. Observed deaths were compared with expected numbers based on mortality rates for the general population of England and Wales and Poisson regression was used to calculate rate ratios (relative risks) for categories of lifetime, lagged (distant) and lugged (recent) magnetic field exposure. Results Mortality from MND in the total cohort was similar to national rates (observed 69, expected 71.3, SMR 97, 95% CI 76–122). There were no statistically significant trends of risks increasing with lifetime, recent or distant magnetic field exposure, although positive associations were observed for some categories of recent exposure. Conclusions The study did not find that the cohort had elevated risks of MND as a consequence of occupational lifetime exposure to magnetic fields, although a possible role for recent exposures could usefully be investigated in other datasets.
A workplace Acceptance and Commitment Therapy (ACT) intervention for improving healthcare staff psychological distress: A randomised controlled trial

The levels of psychological distress and burnout among healthcare staff are high, with negative implications for patient care. A growing body of evidence indicates that workplace programmes based on Acceptance and Commitment Therapy (ACT) are effective for improving employees’ general psychological health. However, there is a paucity of research examining the specific psychological and/or behavioural processes through which workplace ACT programmes transmit their beneficial effects. The aim of this randomised controlled trial was to investigate the outcomes and putative processes of change in a 4-session ACT training programme designed to reduce psychological distress among healthcare staff (n = 98). Ninety-eight employees of a healthcare organisation were randomly allocated to the ACT intervention or to a waiting list control group. Study measures were administered on four occasions (baseline, mid-intervention, post-intervention, and follow-up) over a three-month evaluation period. Results showed that the ACT intervention led to a significant decrease in symptoms of psychological distress and a less pronounced reduction in burnout. These effects were mediated primarily via an improvement in mindfulness skills and values-based behaviour and moderated by participants’ initial levels of distress. At four-week post-intervention, 48% of participants who received the ACT intervention showed reliable improvements in psychological distress, with just under half of the aforementioned improvements (46.15%) meeting criteria for clinically significant change. The results advance ACT as an effective stress management intervention for healthcare staff. The findings should be confirmed in a large scale randomised controlled trial with longer follow-up and cost-effectiveness analyses.
Association of measured quality with financial health among U.S. hospitals

Background High-quality care is a clear objective for hospital leaders, but hospitals must balance investing in quality with financial stability. Poor hospital financial health can precipitate closure, limiting patients’ access to care. Whether hospital quality is associated with financial health remains poorly understood. The objective of this study was to compare financial performance at high-quality and low-quality hospitals. Methods We performed a retrospective observational cohort study of U.S. hospitals using the American Hospital Association and Hospital Compare datasets for years 2013 to 2018. We used multilevel mixed-effects linear and logistic regression models with fixed year effects and random intercepts for hospitals to identify associations between hospitals’ measured quality outcomes—30-day hospital-wide readmission rate and the patient safety indicator-90 (PSI-90)—and their financial margins and risk of financial distress in the same year and the subsequent year. Our sample included 20,919 observations from 4,331 unique hospitals. Results In 2018, the median 30-day readmission rate was 15.2 (interquartile range [IQR] 14.8–15.6), the median PSI-90 score was 0.96 (IQR 0.89–1.07), the median operating margin was -1.8 (IQR -9.7–5.9), and 750 (22.7%) hospitals experienced financial distress. Hospitals in the best quintile of readmission rates experienced higher operating margins (+0.95%, 95% CI [0.51–1.39], p < .001) and lower odds of distress (odds ratio [OR] 0.56, 95% CI [0.45–0.70], p < .001) in the same year as compared to hospitals in the worst quintile. Hospitals in the best quintile of PSI-90 had higher operating margins (+0.62%, 95% CI [0.17–1.08], p = .007) and lower odds of financial distress (OR 0.70, 95% CI [0.55–0.89], p = .003) as compared to hospitals in the worst quintile. The results were qualitatively similar for the same-year and lag-year analyses. Conclusion Hospitals that deliver high-quality outcomes may experience superior financial performance compared to hospitals with poor-quality outcomes.
An unsupervised machine learning approach to evaluate sports facilities condition in primary school

Sports facilities have been acknowledged as one of the crucial environmental factors for children’s physical education, physical fitness, and participation in physical activity. Finding a solution for the effective and objective evaluation of the condition of sports facilities in schools (SSFs) with the responding quantitative magnitude is an uncertain task. This paper describes the utilization of an unsupervised machine learning method to objectively evaluate the condition of sports facilities in primary school (PSSFC). The statistical data of 845 samples with nine PSSFC indicators (indoor and outdoor included) were collected from the Sixth National Sports Facility Census in mainland China (NSFC), an official nationwide quinquennial census. The Fuzzy C-means (FCM) algorithm was applied to cluster the samples in accordance with the similarity of PSSFC. The clustered data were visualized by using t-stochastic neighbor embedding (t-SNE). The statistics results showed that the application of t-SNE and FCM led to the acceptable performance of clustering SSFs data into three types with differences in PSSFC. The effects of school category, location factors, and the interaction on PSSFC were analyzed by two-way analysis of covariance, which indicated that regional PSSFC has geographical and typological characteristics: schools in the suburbs are superior to those in the inner city, schools with more grades of students are configured with better variety and larger size of sports facilities. In conclusion, we have developed a combinatorial machine learning clustering approach that is suitable for objective evaluation on PSSFC and indicates its characteristics.
Antidepressants and health-related quality of life (HRQoL) for patients with depression: Analysis of the medical expenditure panel survey from the United States

Background Despite the empirical literature demonstrating the efficacy of antidepressant medications for treatment of depression disorder, these medications’ effect on patients’ overall well-being and health-related quality of life (HRQoL) remains controversial. This study investigates the effect of antidepressant medication use on patient-reported HRQoL for patients who have depression. Methods A comparative cohort, secondary database analysis was conducted using data from the United States’ Medical Expenditures Panel Survey for patients who had depression. HRQoL was measured using the SF-12 and reported as physical and mental component summaries (PCS and MCS). A cohort of patients that used antidepressant medications were compared to a cohort of patients that did not. Univariate and multivariate difference-in-differences (D-I-D) analyses were used to assess the significance of the mean difference of change on the PCS and MCS from baseline to follow-up. Results On average, 17.5 million adults were diagnosed with depression disorder each year during the period 2005–2016. The majority were female (67.9%), a larger proportion of whom received antidepressant medications (60.5% vs. 51.5% of males). Although use of antidepressants was associated with some improvement on the MCS, D-I-D univariate analysis revealed no significant difference between the two cohorts in PCS (–0.35 vs. –0.34, p = 0.9595) or MCS (1.28 vs. 1.13, p = 0.6405). The multivariate D-I-D analyses ensured the robustness of these results. Conclusion The real-world effect of using antidepressant medications does not continue to improve patients’ HRQoL over time. Future studies should not only focus on the short-term effect of pharmacotherapy, it should rather investigate the long-term impact of pharmacological and non-pharmacological interventions on these patients’ HRQoL.