Miracle-dz/UniFAR-FTUs huggingface dataset:
Daytime warming lowers community temporal stability by reducing the abundance of dominant, stable species

Daytime warming and nighttime warming have the potential to influence plant community structure and ecosystem functions. However, their impacts on ecological stability remain largely unexplored. We conducted an eight‐year field experiment to compare the effects of daytime and nighttime warming on the temporal stability of a temperate steppe in northern China. Our results showed that the cover and stability of dominant species, stability of subordinate species, and compensatory dynamics among species strongly influenced community‐level stability. However, daytime, but not nighttime, warming significantly reduced community temporal stability mainly through the reduction in the abundance of dominant, stable species. These findings demonstrate the differential effects of daytime and nighttime warming on community stability and emphasize the importance of understanding the changes of dominant species for accurately predicting community dynamics under climate warming.
Latent Trajectories of Common Mental Health Disorder Risk Across 3 Decades of Adulthood in a Population-Based Cohort.

Importance Epidemiologic evidence indicates that most of the general population will experience a mental health disorder at some point in their lives. However, few prospective population-based studies have estimated trajectories of risk for mental disorders from young through middle adulthood to estimate the proportion of individuals who experience persistent mental disorder across this age period. Objectives To describe the proportion of the population who experience persistent mental disorder across adulthood and to estimate latent trajectories of disorder risk across this age period. Design, Setting, and Participants A population-based, prospective cohort study was conducted between 1979 and 2008 in the canton of Zurich, Switzerland. A stratified random sample of 591 Swiss citizens was enrolled in 1978 at ages 19 years (men) and 20 years (women); 7 interviews were performed during a 29-year period. Men were sampled from military enrollment records and women from electoral records. From those initially enrolled, participants with high levels of psychiatric symptoms were oversampled for follow-up. Data analysis was performed from July 28, 2015, to June 8, 2016. Main Outcomes and Measures Latent trajectories, estimated using growth mixture modeling, of past-year mood/anxiety disorder (ie, major depressive episode, phobias, panic, generalized anxiety disorder, and obsessive-compulsive disorder), substance use disorder (ie, drug abuse or dependence and alcohol abuse or dependence), and any mental disorder (ie, any of the above) assessed during in-person semistructured interviews at each wave. Diagnoses were based on DSM-III, DSM-III-R, and DSM-IV criteria. Results Of the 591 participants at baseline, 299 (50.6%) were female. Persistent mental health disorder across multiple study waves was rare. Among 252 individuals (42.6%) who participated in all 7 study waves, only 1.2% met criteria for disorder every time. Growth mixture modeling identified 3 classes of risk for any disorder across adulthood: low (estimated prevalence, 40.0%; 95% CI, -8.7% to 88.9%), increasing-decreasing (estimated prevalence, 15.3%; 95% CI, 1.0% to 29.6%), and increasing (estimated prevalence, 44.7%; 95% CI, -0.9% to 90.1%). Although no classes were characterized by persistently high disorder risk, for those in the increasing-decreasing class, risk was high from the late 20s to early 40s. Sex-specific models indicated 4 trajectory classes for women but only 3 for men. Conclusions and Relevance Persistently high mental health disorder risk across 3 decades of adulthood was rare in this population-based sample. Identifying early determinants of sex-specific risk trajectories would benefit prevention efforts.
Sustainable healthcare accreditation: messages from Europe in 2009.

BACKGROUND Healthcare accreditation has grown rapidly since the 1980s but critics question the value of accreditation rather than certification or inspection. Research has focused more on evidence of impact on provider institutions than on health systems; little has been published on the determinants of growth or decline of accreditation organizations and programmes. OBJECTIVE To describe the development of national accreditation organizations in Europe in relation to incentives, funding and market position in 2009; to identify trends over time using data from previous surveys. METHODS Contacts in 24 countries, identified by previous surveys, were invited to complete a web-based questionnaire comprising 183 items seeking numerical data or posing multiple choice options. Preliminary results were verified with respondents and agreed for publication. MAIN OUTCOME MEASURES National healthcare environment, incentives, government policy, legislation, regulation; programme governance, development, funding. RESULTS The survey identified 18 active national accreditation organizations in Europe. Older ones tend to be independent, profession-dominated and self-financing; they have shown little growth in activity and coverage of the potential market. Newer ones have broad stakeholder governance, support from government policy and growth sustained by legal or financial incentives-giving wide coverage across the healthcare system. The traditional collegial model of accreditation is moving towards a semi-regulatory model of external assessment which could integrate minimal standards of licensing, public safety and accountability with aspirational standards for organizational development and improvement. CONCLUSIONS The principal challenges to sustainable accreditation appear to be market size, consistency of policy support, programme funding and financial incentives for participation.
Accreditation and ISO certification: do they explain differences in quality management in European hospitals?

BACKGROUND Hospital accreditation and International Standardisation Organisation (ISO) certification offer alternative mechanisms for improving safety and quality, or as a mark of achievement. There is little published evidence on their relative merits. OBJECTIVE To identify systematic differences in quality management between hospitals that were accredited, or certificated, or neither. Research design ANALYSIS of compliance with measures of quality in 89 hospitals in six countries, as assessed by external auditors using a standardized tool, as part of the EC-funded METHODS of Assessing Response to Quality Improvement Strategies project. MAIN OUTCOME MEASURES Compliance scores in six dimensions of each hospital-grouped according to the achievement of accreditation, certification or neither. RESULTS Of the 89 hospitals selected for external audit, 34 were accredited (without ISO certification), 10 were certificated under ISO 9001 (without accreditation) and 27 had neither accreditation nor certification. Overall percentage scores for 229 criteria of quality and safety were 66.9, 60.0 and 51.2, respectively. Analysis confirmed statistically significant differences comparing mean scores by the type of external assessment (accreditation, certification or neither); however, it did not substantially differentiate between accreditation and certification only. Some of these associations with external assessments were confounded by the country in which the sample hospitals were located. CONCLUSIONS It appears that quality and safety structures and procedures are more evident in hospitals with either the type of external assessment and suggest that some differences exist between accredited versus certified hospitals. Interpretation of these results, however, is limited by the sample size and confounded by variations in the application of accreditation and certification within and between countries.
Solutions for ecosystem‐level protection of ocean systems under climate change

The Paris Conference of Parties (COP21) agreement renewed momentum for action against climate change, creating the space for solutions for conservation of the ocean addressing two of its largest threats: climate change and ocean acidification (CCOA). Recent arguments that ocean policies disregard a mature conservation research field and that protected areas cannot address climate change may be oversimplistic at this time when dynamic solutions for the management of changing oceans are needed. We propose a novel approach, based on spatial meta‐analysis of climate impact models, to improve the positioning of marine protected areas to limit CCOA impacts. We do this by estimating the vulnerability of ocean ecosystems to CCOA in a spatially explicit manner and then co‐mapping human activities such as the placement of renewable energy developments and the distribution of marine protected areas. We test this approach in the NE Atlantic considering also how CCOA impacts the base of the food web which supports protected species, an aspect often neglected in conservation studies. We found that, in this case, current regional conservation plans protect areas with low ecosystem‐level vulnerability to CCOA, but disregard how species may redistribute to new, suitable and productive habitats. Under current plans, these areas remain open to commercial extraction and other uses. Here, and worldwide, ocean conservation strategies under CCOA must recognize the long‐term importance of these habitat refuges, and studies such as this one are needed to identify them. Protecting these areas creates adaptive, climate‐ready and ecosystem‐level policy options for conservation, suitable for changing oceans.
Studies pertaining to the ACOVE quality criteria: a systematic review.

PURPOSE To identify and uniformly describe studies employing the Assessing Care Of Vulnerable Elders (ACOVE) quality indicators within a comprehensive thematic model that reflects how the indicators were used. DATA SOURCES A systematic search of MEDLINE, EMBASE and CINAHL was conducted. STUDY SELECTION English-language studies meeting our criteria published prior to January 2010. Data extraction Included studies were analyzed and described by two independent researchers. RESULTS OF DATA SYNTHESIS A total of 41 articles met our selection criteria. Studies were classified into the themes 'Application of indicators' (32 studies) and ' ANALYSIS and development of indicators' (13 studies). 'Application' studies included assessing quality of care, influencing behavior of health professionals and examining the association of quality of care with other factors. 'Analysis and development' included studies developing new indicator sets, and those adapting and validating the original quality indicators to new settings. CONCLUSIONS The indicators were used in a wide range of applications with two main foci: the assessment of quality of care for elderly patients, and investigating the feasibility of similar indicators and their adaptation to new settings. Very few of the studies published to date have addressed the goal of care improvement. We foresee an important role for application of indicators that proactively help health-care professionals to deliver the right care at the right time, for example by resorting to decision support systems.
Causes of inappropriate hospital days: development and validation of a French assessment tool for rehabilitation centres.

OBJECTIVE To develop and validate a list of criteria to assess the causes of inappropriate hospital days for patients admitted to rehabilitation centres and sub-acute care units. DESIGN The tool was developed by a multidisciplinary panel of 33 experts, using a formalized consensus method. It collects both the needs of patients (distinguishing healthcare needs (9 criteria) and accommodation needs (9 criteria)) and the reasons for inappropriateness (19 criteria). Inappropriate days were identified using the tool to assess appropriateness of hospital days validated previously. Reliability was studied by measuring agreement between two independent simultaneous ratings. SETTING The validation study was performed on a randomized sample of 576 hospital days from 22 wards in France. MAIN OUTCOME MEASURES Inter-rater reliability was evaluated using the κ-statistic and prevalence-adjusted and bias-adjusted kappa (PABAK). RESULTS For patient accommodation needs, the inter-rater reliability was estimated by a κ-value of 0.80 (95% confidence interval (95% CI) 0.66-0.92) and a PABAK of 0.80 (95% CI 0.63-0.91). There was good agreement on the reasons for inappropriateness, with κ-values from 0.30 to 0.60 and PABAK from 0.46 to 0.69. The κ-coefficient varied from 0.33 to 0.49 for the assessment of patient healthcare needs, with PABAK ranging from 0.49 to 0.72. CONCLUSIONS The instrument is suitable and valid to assess the causes of inappropriate hospital days in rehabilitation centres and sub-acute care units. The study showed that the tool can be easily used by healthcare workers, which makes it useful for quality improvement.
Do the energy fluxes and surface conductance of boreal coniferous forests in Europe scale with leaf area?

Earth observing systems are now routinely used to infer leaf area index (LAI) given its significance in spatial aggregation of land surface fluxes. Whether LAI is an appropriate scaling parameter for daytime growing season energy budget, surface conductance (Gs), water‐ and light‐use efficiency and surface–atmosphere coupling of European boreal coniferous forests was explored using eddy‐covariance (EC) energy and CO2 fluxes. The observed scaling relations were then explained using a biophysical multilayer soil–vegetation–atmosphere transfer model as well as by a bulk Gs representation. The LAI variations significantly alter radiation regime, within‐canopy microclimate, sink/source distributions of CO2, H2O and heat, and forest floor fluxes. The contribution of forest floor to ecosystem‐scale energy exchange is shown to decrease asymptotically with increased LAI, as expected. Compared with other energy budget components, dry‐canopy evapotranspiration (ET) was reasonably ‘conservative’ over the studied LAI range 0.5–7.0 m2 m−2. Both ET and Gs experienced a minimum in the LAI range 1–2 m2 m−2 caused by opposing nonproportional response of stomatally controlled transpiration and ‘free’ forest floor evaporation to changes in canopy density. The young forests had strongest coupling with the atmosphere while stomatal control of energy partitioning was strongest in relatively sparse (LAI ~2 m2 m−2) pine stands growing on mineral soils. The data analysis and model results suggest that LAI may be an effective scaling parameter for net radiation and its partitioning but only in sparse stands (LAI <3 m2 m−2). This finding emphasizes the significance of stand‐replacing disturbances on the controls of surface energy exchange. In denser forests, any LAI dependency varies with physiological traits such as light‐saturated water‐use efficiency. The results suggest that incorporating species traits and site conditions are necessary when LAI is used in upscaling energy exchanges of boreal coniferous forests.
Quality of physical resources of health facilities in Indonesia: a panel study 1993-2007.

OBJECTIVE The merits of mixed public and private health systems are debated. Although private providers have become increasingly important in the Indonesian health system, there is no comprehensive assessment of the quality of private facilities. This study examined the quality of physical resources of public and private facilities in Indonesia from 1993 to 2007. DESIGN AND SETTING Data from the Indonesian Family Life Surveys in 1993, 1997, 2000 and 2007 were used to evaluate trends in the quality of physical resources for public and private facilities, stratified by urban/rural areas and Java-Bali/outer Java-Bali regions. MAIN OUTCOME MEASURES The quality of six categories of resources was measured using an adapted MEASURE Evaluation framework. RESULTS Overall quality was moderate, but higher in public than in private health facilities in all years regardless of the region. The higher proportion of nurses and midwives in private practice was a determinant of scope of services and facilities available. There was little improvement in quality of physical resources following decentralization. CONCLUSIONS Despite significant increases in public investment in health between 2000 and 2006 and the potential benefits of decentralization (2001), the quality of both public and private health facilities in Indonesia did not improve significantly between 1993 and 2007. As consumers commonly believe the quality is better in private facilities and are increasingly using them, it is essential to improve quality in both private and public facilities. Implementation of minimum standards and effective partnerships with private practice are considered important.
Effectiveness of a multi-level intervention to improve tobacco policy in alcohol addiction treatment centers

Sample: Pretreatment: Data of N= 200 employees from 40 alcohol addiction treatment centers Instruments: Tobacco policy was measured by a modified questionnaire, developed from evidence and Background: It was demonstrated that tobacco policy is connected to smoking prevalence in companies and ● Posttreatment: Data of N=184 employees from 38 centers (matching pre-post: N=115) 10 employees were excluded because the center dropped out before posttreatment assessment. recommendations of international guidelines (ENSH, 2003; Fiore et al., 2000; Hopkins et al., 2001; Task Force on Community Preventive Service, 2000; U.S. Department of Health and Human Services, 2000). public buildings. Smoking bans (Fichtenberg and Glantz, 2002) and restrictive structural measures (Serra, Cabezas, Bonfill and Pladevall-Vila, 2000) are very effective in order to reduce 6 employees left the center and were no longer available for assessment. Tobacco policy was devided in seven category groups: smoking. Structual based interventions seem to be an efficient way to increase cessation rates and the multi● Design: 20 centers (waiting control group) Pretreatment assessment Posttreatment assessment Smoking restrictions Smoking-related training of employees Consequences Non-smoker protection level intervention is regarded the most promising way. Supported by management and executives, it seems even more successful. (Serra, Cabezas, Bonfill and Pladevall-Vila, 2000) In alcohol addiction treatment centers, individual specific smoking cessation interventions, do not ● (Pra) Assessment of smokers Commitment of center Smoking cessation offers for patients seem to be effective in the subgroup of smokers (Metz et al., 2006; Prochaska et al., 2004). The implementation of a multi-level intervention and its influence on structual measures and tobacco 40 alcohol addiction treatment centers ONE YEAR MULTI-LEVEL INTERVENTION Each group consists of 5-12 categorial items („yes“, „no“, „I do not know“), where „yes“ answers were policy has not been investigated in the setting of alcohol addiction treatment centers, so far.
Integrated care for older populations and its implementation facilitators and barriers: A rapid scoping review

Purpose Inform health system improvements by summarizing components of integrated care in older populations. Identify key implementation barriers and facilitators. Data sources A scoping review was undertaken for evidence from MEDLINE, the Cochrane Library, organizational websites and internet searches. Eligible publications included reviews, reports, individual studies and policy documents published from 2005 to February 2017. Study selection Initial eligible documents were reviews or reports concerning integrated care approaches in older/frail populations. Other documents were later sourced to identify and contextualize implementation issues. Data extraction Study findings and implementation barriers and facilitators were charted and thematically synthesized. Results of data synthesis Thematic synthesis using 30 publications identified 8 important components for integrated care in elderly and frail populations: (i) care continuity/transitions; (ii) enabling policies/governance; (iii) shared values/goals; (iv) person-centred care; (v) multi-/inter-disciplinary services; (vi) effective communication; (vii) case management; (viii) needs assessments for care and discharge planning. Intervention outcomes and implementation issues (barriers or facilitators) tend to depend heavily on the context and programme objectives. Implementation issues in four main areas were observed: (i) Macro-level contextual factors; (ii) Miso-level system organization (funding, leadership, service structure and culture); (iii) Miso-level intervention organization (characteristics, resources and credibility) and (iv) Micro-level factors (shared values, engagement and communication). Conclusion Improving integration in care requires many components. However, local barriers and facilitators need to be considered. Changes are expected to occur slowly and are more likely to be successful where elements of integrated care are well incorporated into local settings.
Attitudes towards accreditation among hospital employees in Denmark: a cross-sectional survey

Objective To evaluate attitudes towards accreditation and the Danish Quality Model (DDKM) among hospital employees in Denmark. Negative attitudes led the Danish Government to abolish accreditation in 2015. Design A cross-sectional survey was carried out via web-based questionnaire. Setting All hospital managers, quality improvement staff (quality managers and employees), and hospital surveyors in Denmark; and clinicians (doctors and nurses) within nine selected specialties. Participants Overall response rate was 29% with 5055 of 17 646 valid responses included in the data analysis. The response rate was 82% (5055/6188) among respondents who clicked on the link in the mail containing the questionnaire. Methods A short questionnaire was designed using a 7-point Likert scale ranging from 1 'strongly disagree' to 7 'strongly agree'. To compare mean values between respondent groups, regression analysis using dummy coding of respondent groups and calculation of standardized mean difference effect sizes were performed. Results Overall attitudes were supportive, with physicians more skeptical. There were different patterns of attitudes in the five Danish regions and between medical professions. A small group of physicians was extremely negative. Conclusion Clinical attitudes are important, and can affect Government decisions. On the basis of our study, future attention should be paid to attitudes towards accreditation (and attitudes towards other means of quality improvement). Attitudes may reflect political agendas and impede the take-up of improvement programs, cause their demise, or reduce their effectiveness.
Evaluación metabólica ambulatoria de 27 pacientes con urolitiasis de alto riesgo de recurrencia en el Centro Médico del ISSEMyM

Rev Mex Urol 2011;71(6):314-318 314 Correspondencia: Abraham López Zepeda. 1. Privada de Nicolás Bravo N°2 Interior 101. Colonia San Salvador Tizatlalli, 52172. Metepec, Estado de México. Servicio de Urología. Centro Médico del Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM). Toluca, Edo. Mex. Evaluación metabólica ambulatoria de 27 pacientes con urolitiasis de alto riesgo de recurrencia en el Centro Médico del ISSEMyM