Miracle-dz/UniFAR-FTUs huggingface dataset:
More Than Just Hospitals: An Examination of Cluster Components and Configurations

MORE THAN JUST HOSPITALS: AN EXAMINATION OF CLUSTER COMPONENTS AND CONFIGURATIONS By Patrick Davis Shay, Ph.D., MS A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2014 Director: Stephen S. Mick, Ph.D., Professor, Department of Health Administration Over the past 25 years, health care organization scholars have observed the dramatic emergence of hospital-based clusters in local markets throughout the U.S. These important organizational forms require same-system ownership of multiple general, acute care hospitals operating within a single local market, and as such they include multi-hospital systems that are entirely contained in a single urban market as well as clustered extensions or subsystems of larger regional and national systems. However, despite their noted growth as powerful forces in local markets, relatively few studies have examined these clusters, and as a result there remains a significant gap in our knowledge regarding their continued growth or the diverse components and configurations they may exhibit. This study endeavors to both describe and explain the diversity observed across hospitalbased clusters. To fulfill this objective, a national inventory of clusters is updated to reflect cluster membership as of 2012, and a catalog of cluster components – including their hospitalbased and non-hospital-based sites – is created, acknowledging that clusters today consist of more than just general, acute care hospitals. Cluster analysis methods are then employed to develop a taxonomy of cluster forms, using a sample of 114 clusters from local markets in Florida, Maryland, Nevada, Texas, Virginia, and Washington. Applying a conceptual framework informed by concepts from contingency theory and strategic management theory, cluster analysis methods yield a five-group solution, which is then externally validated using a multi-theoretical perspective synthesizing arguments from population ecology, institutional theory, industrial organization economics, transaction cost economics, and resource dependence theory. Results from descriptive and multinomial logistic regression analyses identify organizational and environmental factors that are significantly associated with various cluster forms. The study’s results suggest that today’s hospital-based clusters continue to grow and vary according to the dimensions of differentiation-configuration and integration-coordination. These findings provide a foundation for future examinations of hospital-based clusters, including their provision of services within and outside of hospital walls. These results also accentuate the importance of accounting for geographic considerations when examining health care organization forms, and they display the utility and value of employing a multi-theoretical perspective to examine and explain such complex forms.
Fetal Food - Preemie's Prerequisite? Studies on human fetal and neonatal protein metabolism

In 1960, the terms ‘neonatology’ and ‘neonatologist’ were first coined in a textbook on newborns. In hindsight, that decade turned out to be the start of modern care for prematurely born babies. Since then, survival chances for premature infants improved dramatically: for 1-kg-weighing infants from hardly any to approximately 90% nowadays. In addition, due to ongoing research, many infants born too early now have good health outcome, although there is also a large group facing mild handicaps and a smaller group facing more severe handicaps. In the Netherlands, the incidence of all live births delivered preterm – that is before 37 weeks of gestation – was 7.3% in 2004. Infants born alive very preterm (<32 weeks) make up 1.1% of the 194.007 births in the Netherlands that same year. These very preterm infants spent on average 28 days on a neonatal intensive care unit (NICU). In the United States, the current incidence of births delivered preterm amounts 12.8% and is thus higher than in the Netherlands. Moreover, the percentage is on the rise: between 1981 and 2005 it increased with 35% (Figure 1). Although we are aware of several factors responsible for this increase (see below), prematurity is becoming a problem affecting society more and more.
SU‐E‐J‐124: 18F‐FDG PET Imaging to Improve RT Treatment Outcome for Locally Advanced Lung Cancer

Purpose: To investigate spatial correlation between high uptake regions of pre- and 10-days-post therapy{sup 1} {sup 8}F-FDG PET in recurrent lung cancer and to evaluate the feasibility of dose escalation boosting only regions with high FDG uptake identified on baseline PET. Methods: Nineteen patients with stages II– IV inoperable lung cancer were selected. Volumes of interest (VOI) on pre-therapy FDG-PET were defined using an isocontour at ≥50% of SUVmax. VOI of pre- and post-therapy PET images were correlated for the extent of overlap. A highly optimized IMRT plan to 60 Gy prescribed to PTV defined on the planning CT was designed using clinical dose constraints for the organs at risk. A boost of 18 Gy was prescribed to the VOI defined on baseline PET. A composite plan of the total 78 Gy was compared with the base 60 Gy plan. Increases in dose to the lungs, spinal cord and heart were evaluated. IMRT boost plan was compared with proton RT and SBRT boost plans. Results: Overlap fraction of baseline PET VOI with the VOI on 10 days-post therapy PET was 0.8 (95% CI: 0.7 – 0.9). Using baseline VOI as a boosting volume, dose could be escalated to 78 Gymore » for 15 patients without compromising the dose constraints. For 4 patients, the dose limiting factors were V20Gy and Dmean for the total lung, and Dmax for the spinal cord. An increase of the dose to OARs correlated significantly with the relative size of the boost volume. Conclusion: VOI defined on baseline 18F-FDG PET by the SUVmax-≥50% isocontour may be a biological target volume for escalated radiation dose. Dose escalation to this volume may provide improved tumor control without breaching predefined dose constraints for OARs. The best treatment outcome may be achieved with proton RT for large targets and with SBRT for small targets. « less
The Relationship between Diet Quality and the Comorbidity of Diabetes in Adults with Heart Failure

THE RELATIONSHIP BETWEEN DIET QUALITY AND THE COMORBIDITY OF DIABETES IN ADULTS WITH HEART FAILURE by Jessica Hill Background: Heart failure and diabetes are common coexisting diseases. Elevated levels of glucose in the blood caused by insulin resistance can damage blood vessels and nerves, and eventually lead to heart disease. A poor diet and obesity can also contribute to the progression of diabetes and heart disease. Objective: The purpose of this study was to determine if diet and lifestyle factors between adult heart failure patients with and without diabetes who are participating in the EducatioN, and Supportive Partners Improving Self-CaRE (ENSPIRE) study are associated with comorbidities such as diabetes, and if so then how current dietary recommendations in this population should be modified based on diabetes status. Methods: Using data collected from the EducatioN and Supportive Partners Improving Self-CaRE (ENSPIRE) study from 2006 to 2009 which was a prospective, randomized, controlled clinical trial, a secondary data analysis was conducted. Daily dietary intake of calories, sodium, carbohydrate, fat, sugar, and fiber was assessed via a 3-day food record. Differences in anthropometric measures, smoking history, education level and health literacy score between the two groups were also assessed. 117 heart failure patients were included in the analysis. Of these, 39% had diabetes. Statistical analysis: Statistical analyses included the t-test, Chi-square analysis, and Mann Whitney U test used to compare anthropometric data, lifestyle factors, and disease
Glucocorticoid therapy for acute myocardial infarction.

: Several uncontrolled early studies established that corticosteroid administration to patients with ischemic heart disease and cardiogenic shock was relatively safe. Whether or not the glucocorticoids were of benefit or not remained unclear when mortality was used as an index of efficacy. Hemodynamically, glucocorticoids may decrease peripheral vascular resistance, increase cardiac output and coronary blood flow, but leave myocardial contractility unchanged. The mean arterial pressure may vary unpredictably. The increase in coronary blood flow may certainly be advantageous in treating patients with acute myocardial infarction. The decrease in infarct size recently reported, if confirmed in man, would also be desirable. However, there is a paucity of good data concerning the effects of corticosteroids in man postinfarction. In addition, through unproved mechanisms, the corticosteroids decrease the extent and severity of myocardial ischemic injury. While these fundamental actions may not result in improved mortality, ongoing studies suggest that minimization of ischemic injury may ultimately prove to be most rewarding in the prevention of cardiogenic shock.
Comprar Cardiovascular Imaging, 2-Volume Set: Expert Radiology Series Expert Consult- Online and Print | Vincent Ho | 9781416053354 | Saunders

Tienda online donde Comprar Cardiovascular Imaging, 2-Volume Set: Expert Radiology Series Expert Consult- Online and Print al precio 291,90 € de Vincent Ho | Gautham Reddy, tienda de Libros de Medicina, Libros de Cardiologia - Diagnostico por la Imagen
Über organische Lösungs- und Ionisierungsmittel. I.

Unsere Kenntnisse über die n ic l i twäss r igen Lösungen der Elektrolyte haben im Laufe der letzten Jahrzehnte eine gänzliche Umarbeitung erfahren, und unsere Anschauungen einer vollkommenen Umwertung unterliegen müssen. Während noch 1882 Lenz) anlässlich seiner elektrischen Studien über alkoholisch-wässrige Salzlösungen den Schluss ziehen konnte, dass für absolut alkoholische Lösungen ein Nich t l e i t en des elektrischen Stromes wahrscheinlich sei, schrieb 1890 Ciamician) folgendes: „Die electrische Dissociation findet hauptsächlich in wässrigen Lösungen statt. Es ist ferner bemerkenswert, dass organische Verbindungen, als Lösungsmittel verwendet, zwar eine ge r inge Leitung verursachen, dabei jedoch ein verschiedenes Verhalten zeigen. " "Während noch 1893 Ostwald) in seinem grossen klassischen Lehrbuch den nichtwässrigen Lösungsmitteln — in dem ca. 500 Seiten umfassenden Abschnitt „Elektrochemie" — nur drei Seiten widmete und das gesamte überaus bescheidene Tatsachenmaterial mit den Worten einleitete: „Das Wasser nimmt in Bezug auf seine Fähigkeit, elektrolytische Lösungen zu bilden, oder Stoffe in Ionen zu spalten, eine ausgezeichnete Stellung ein, welche keinem andern Stoffe in annähernd gleichem Grade zukommt," — können wir heute mit der blossen Aufzählung der inzwischen, während des letzten Jahrzehntes, gemachten Experimentaluntersuchungen viele Druckseiten füllen! Heute wissen wir, dass Wasser allein es nicht tut, oder — um mit Fa raday 4 ) zu reden —: „Das Wasser ist also in dieser Beziehung nur eine unter einer sehr zahlreichen Klasse von Substanzen und keineswegs die alleinige und wesentliche. " Es gibt eine nach Dutzenden zählende Schar von anorganischen und organischen Lösungsmitteln, denen die Fähigkeit zukommt, elektrolytische Lösungen zu bilden, — ja, noch mehr, gerade die am
A Quantitative Analysis of an Eating Disorder Prevention Program

A Quantitative Analysis of an Eating Disorder Prevention Program Jennalee Murray Department of Counseling Psychology and Special Education, BYU Education Specialist Eating disorders affect millions of people in the United States alone. This study aimed to test the effectiveness of a preventative curriculum for eating disorders called Eating Disorders: Physical, Social, and Emotional Consequences, A High School Curriculum about Anorexia, Bulimia, and Compulsive Eating (EDPSEC). Participants included an experimental group of 27 students in their ninth grade health class and a control group of 21 students. The research examined the integrity of the curriculum administration and changes in participating students’ attitudes and behaviors. The outcome measures used were students’ scores on the Eating Attitudes Test (EAT-26) and the Eating Survey (ES). Results indicate high treatment integrity (85%) and significant change on students’ EAT-26 scores, but not students’ ES scores. Students’ EAT-26 and ES scores correlated highly. Although a more robust sample and wider testing of the curriculum is needed, this study indicates that a school-based preventative program can yield positive results in changing some students’ attitudes toward disordered eating.
Los receptores tipo Toll en el desarrollo y función del sistema hematopoyético

Los virus, bacterias, hongos y parasitos son agentes infecciosos a los que un individuo se encuentra constantemente expuesto. Su reconocimiento es llevado a cabo por un numero creciente de receptores celulares que identifican patrones (PRRs), habitualmente ausentes en los mamiferos, llamados patrones moleculares asociados a patogenos (PAMPs), y son conservados estructuralmente a traves de la evolucion. Los PRRs pueden encontrarse en la matriz extracelular, solubles en el citoplasma y/o en membranas celulares. Entre los membranales se incluyen los receptores tipo Toll (TLRs), los cuales inducen como resultado de su estimulacion la produccion de citocinas proinflamato-rias y la expresion de moleculas coestimuladoras en celulas maduras que resultan en senales de alerta inmunologica. El momento ontogenico en el que las celulas del sistema inmune adquieren el repertorio funcional de dichos receptores es un tema de gran interes actual, especialmente por las posibles implicaciones de su estimulacion en las decisiones de los destinos celulares durante el desarrollo. Las observaciones recientes de regulacion de la hematopoyesis por TLRs sugieren su participacion en las etapas mas tempranas de diferenciacion de las celulas sanguineas y, particularmente, en la contribucion al reabastecimiento inmediato del sistema inmune innato bajo condiciones emergentes, revolucionando el conocimiento sobre los mecanismos de respuesta a la infeccion. Esta revision presenta los hallazgos cientificos mas importantes desde el descubrimiento de los TLRs hasta el uso de sus agonistas y antagonistas para el tratamiento de enfermedades infecciosas, autoinmunes y neoplasicas. De especial interes es el progreso en el conocimiento de la adquisicion del repertorio de los TLRs en celulas hematopoye-ticas primitivas, troncales y progenitoras, y las consecuencias de su estimulacion.
Integrated Primary Care: Why You Should Care and How to Get Started

Many mental health practitioners who are interested in primary care may not know how to get involved. Integrated Primary Care (IPC) is a model that normalizes mental and behavioral health issues in primary care with the goal of improved health outcomes; it shows promise for addressing mental health care disparities. Recognizing that mental and physical health problems are interwoven, utilizing the primary care system of medical health delivery offers an opportunity for patients to have greater access to behavioral services. Recent movements have increased the demand for integration of physical and behavioral health. This article reviews research on access issues, adherence, and the effectiveness of IPC with particular attention to newer studies and those examining culturally diverse groups. Finally, it offers suggestions for counselors seeking to integrate their practice with the primary care setting in a culturally sensitive way.
Texas Physicians' Awareness and Utilization of Genetic Services

The number of disorders for which genetic testing is available has increased nearly 500% in the past 15 years. Access to the majority of genetic tests and services hinge on physicians’ ability to identify patients at risk for genetic disease and provide appropriate testing and counseling or refer to genetics specialists. Recent research demonstrates the need for referrals to genetics specialists by showing that many physicians lack skills required to perform appropriate genetic services, such as making proper risk assessments, providing genetic counseling, ordering genetic testing and interpreting results. However, little research exists on physicians’ awareness and utilization of genetic services. In this study, an electronic survey evaluating practicing physicians’ awareness of, utilization of, and perceived barriers to genetic services in Texas was distributed via state physician organizations. Of the 157 participants, approximately half reported they were moderately or very aware of genetic testing and services in their area. Very few reported awareness of telemedicine services. Over two-thirds reported never or rarely referring to genetic counselors or other genetic specialists, despite 75% reporting they had noticed an increased impact of genetics on their field and 61% reporting they had discussed genetics more in their day-to-day practice in the last 5-10 years. Only 20% reported genetics was very integral to their specialty. Over three-fourths of all participants indicated interest in learning more about genetics, genetic testing and genetic services. Among the most frequently chosen barriers to genetic counselors were awareness-related barriers such as not knowing how to refer to a genetic counselor. Responses to many items varied significantly by medical specialty. The results identify a need to increase awareness of genetic services and referral logistics. Specific findings can help direct outreach efforts to educate clinicians, such as developing clinically meaningful, specialty-specific educational objectives.
Promoting screening of cognitive impairment and dementia in Vermont: A proposal for ongoing continuing medical education (CME)

Our research demonstrated PCPs may be misinformed about the usefulness and implications of dementia screening and diagnosis. In an effort to further educate physicians, we propose instituting a mandatory continuing medical education (CME) hour focused on screening for dementia. Our project surveyed 72 physicians to determine their attitudes towards screening, the assessment tools they use, and their attitudes towards a required CME hour.
Biblia, buey y bala… recargados: Jair Bolsonaro, la ola conservadora en Brasil y América Latina

La llegada de Jair Messias Bolsonaro al Planalto plantea un giro politico en la region y serios desafios al progresismo continental. El proyecto del presidente electo entronca con la tradicion desigualitaria que caracterizo el modelo brasileno de capitalismo jerarquico y autoritario. Ahora, mas que el peligro de que surjan otros Bolsonaros en la region, el riesgo es una «bolsonarizacion» de los discursos politicos, en el marco de una amplia reaccion antiprogresista.
Modulación central de un sistema sensorial por un comando motor. Una intención con dos resultados

Introduccion y desarrollo. Los mecanismos neuronales que subyacen a los procesos de integracion sensoriomotora (ISM) son esenciales para el control motor y pautan la organizacion general del sistema nervioso. La medula espinal, los nucleos de relevo sensorial en el tronco encefalico y talamo, asi como los centros superiores de control motor, son algunos niveles, de complejidad creciente, en los que se verifican procesos de ISM durante la ejecucion de un acto motor. Los mecanismos que subyacen a las estrategias mas complejas de ISM, en general, se conocen poco. La respuesta de escape en peces teleosteos constituye un modelo experimental de eleccion para el analisis de las bases neuronales de la conducta, y particularmente de los mecanismos y consecuencias funcionales de diversas estrategias de ISM. Se describen los niveles de ISM que operan en este sistema en la mayoria de los teleosteos y se refiere en detalle una estrategia novedosa que ocurre en Gymnotus carapo, pez electrico sudamericano de descarga debil. En esta especie, la activacion de la celula de Mauthner, responsable de la fase inicial del comportamiento de escape, produce una poderosa modulacion del sistema sensorial que organiza la electrorrecepcion activa, su principal modalidad sensorial. Conclusion. Las claves de organizacion del sistema nervioso para la elaboracion de comportamientos efectores, aun aquellos relativamente sencillos, incluyen estrategias complejas de ISM que determinan de su desempeno y cuyos mecanismos comienzan a develarse
Predicting the weights of the physical parts of broilers.

RFL Rundschau fur Fleischhygiene und Lebensmitteluberwachung, 42, 63-66 FRIES, R. (2002): Reducing Salmonella transfer during industrial poultry meat production. World’s Poultry Science Journal 58, 527-540 FRIES, R. ( 2006): Hygienegrundsatze. In: Zentralverband der Deutschen Gefl ugelwirtschaft e.V. (ed.) Gefl ugeljahrbuch 2007 Eugen Ulmer, Stuttgart, pp. 184-195, ISBN: 3-8001-5324-4 FRIES, R. (2007): Derzeitiger Einsatz von Camerasystemen in der Gefl ugelfl eischgewinnung In: Proc. 6. Fachtagung Fleischund Gefl ugelfl eischhygiene.Berlin, 1.3. -2.3. 2007, FRIES, R. , and A. KOBE (1993): Ratifi cation of Broiler Carcase Condemnations in Poultry Meat Inspection. Brit. Poult. Sci. 34, 105-109 JAKOB, H. P., R. MORGENSTERN, P. ALBICKER und R. K. HOOP (1998): Konfi skationsursachen bei geschlachteten Broilern aus zwei grossen schweizerischen Mastorganisationen. Schweiz. Arch. Tierheilk. , 140, 60-64 LAWRENCE, K.C. , WINDHAM, W.R. and D.P. SMITH (2002): Contaminant Detection on Poultry Carcass Surfaces. New Food 3, 21-24 NATIONAL ADVISORY COMMITTEE ON MICROBIOLOGICAL CRITERIA FOR FOODS (1997) Generic HACCP Application in Broiler Slaughter and Processing. J. of Food Protection 60, 579-604 NATIONAL ADVISORY COMMITTEE ON MICROBIOLOGICAL CRITERIA FOR FOODS (1998) Hazard Analysis and Critical Control Point Principles and Application Guidelines. J. of Food Protection 61, 762-775 PARK, B. , and CHEN, Y. -R. (2000): Real-time Dual-Wavelength Image Processing for Poultry Safety Inspection. J. of Food Processing Engineering 23, 329-351 STAFFEHL, A. , G. ARNDT, und R. FRIES (2007): Kamerasysteme in der Uberwachung von Gefl ugelfl eisch: Stand laufender Untersuchungen In: Proc. 6. Fachtagung Fleischund Gefl ugelfl eischhygiene.Berlin, 1.3. -2.3. 2007, THORNTON, G. (2004): Digital Eye Guards against Faecal Contamination. Poultry International 43, 20-26 VAN HOOF, J. and R. ECTORS (2002): Automated vision inspection of broiler carcasses. Fleischwirtsch. Int., 4, 49-53 WATKINS, B. , Y.C. LU, andd Y.R. CHEN (1999): Economic Value and CVost of Automated on-Line Poultry Inspection for the US Broiler Industry. Food Control 10, 69-80
Trastornos del sueño en la enfermedad de Parkinson: trastorno de conducta del sueño REM y síndrome de piernas inquietas

Introduccion. De sobra es conocido que pacientes con enfermedad de Parkinson (EP) y otras enfermedades neurodegenerativas presentan con alta frecuencia trastornos del sueno, siendo posible que compartan mecanismos fisiopatologicos comunes con los signos motores. Desarrollo. En el caso del trastorno de conducta del sueno REM, numerosos estudios han demostrado que puede preceder en mas de diez anos a la aparicion de signos motores. Si bien no se ha demostrado un aumento del riesgo a padecer EP en pacientes con sindrome de piernas inquietas, la mayor prevalencia de este sindrome en la EP y la buena respuesta a agonistas dopaminergicos hacen suponer una relacion entre ambas entidades. Conclusion. El impacto de estas entidades en la calidad de vida de los pacientes hacen que su conocimiento, diagnostico y tratamiento sean de gran importancia.