Miracle-dz/UniFAR-FTUs huggingface dataset:
An exploratory analysis for Lean and Six Sigma implementation in hospitals: Together is better?

Background: Despite the increasing interest for Lean and Six Sigma implementations in hospitals, there has been little empirical evidence that goes beyond descriptive case studies to address the current status and the effectiveness of the implementations. Purpose: The aim of this study was to explore existing patterns of Lean and Six Sigma implementation in U.S. hospitals and compare the performance of the different patterns. Methodology/Approach: We collected data from 215 U.S. hospitals via a survey that includes measurement items developed from related literature. Using the cross-sectional data, we conducted a cluster analysis, followed by t tests, chi-square tests, and regression analyses for cluster verification. Results: The cluster analysis identifies two clusters, a Moderate Six Sigma group and a Lean Six Sigma group. Results show that the Lean Six Sigma group outperforms the Moderate Six Sigma group across many performance dimensions: responsiveness capability, patient safety, and possibly cost saving. In addition, the Lean Six Sigma group tends to be composed of larger, private teaching hospitals located in more urban areas, and they employ more resources for quality improvement. Conclusion: Our research contributes to the quality management literature by supporting the possible complementary relationship between Lean and Six Sigma in hospitals. Practice Implications: Our study encourages practitioners and managers to pay more attention to Lean implementation. Although Lean seems to be conducted in a limited fashion in many hospitals, it should be expanded and combined with Six Sigma for better results.
The N-terminal Input Domain of the Sensor Kinase KdpD of Escherichia coli Stabilizes the Interaction between the Cognate Response Regulator KdpE and the Corresponding DNA-binding Site*

The sensor kinase/response regulator system KdpD/KdpE of Escherichia coli regulates expression of the kdpFABC operon, which encodes the high affinity K+ transport system KdpFABC. The membrane-bound sensor kinase KdpD consists of an N-terminal input domain (comprising a large cytoplasmic domain and four transmembrane domains) and a cytoplasmic C-terminal transmitter domain. Here we show that the cytoplasmic N-terminal domain of KdpD (KdpD/1-395) alone supports semi-constitutive kdpFABC expression, which becomes dependent on the extracellular K+ concentration under K+-limiting growth conditions. However, it should be noted that the non-phosphorylatable derivative KdpD/H673Q or the absence of KdpD abolishes kdpFABC expression completely. KdpD/1-395 mediated kdpFABC expression requires the corresponding response regulator KdpE with an intact phosphorylation site. Experiments with an Escherichia coli mutant unable to synthesize acetyl phosphate as well as transposon mutagenesis suggest that KdpE is phosphorylated in vivo by low molecular weight phosphodonors in the absence of the full-length sensor kinase. Various biochemical approaches provide first evidence that kdpFABC expression mediated by KdpD/1-395 is due to a stabilizing effect of this domain on the binding of KdpE∼P to its corresponding DNA-binding site. Such a stabilizing effect of a sensor kinase domain on the DNA-protein interaction of the cognate response regulator has never been observed before for any other sensor kinase. It describes a new mechanism in bacterial two-component signal transduction.
Intestinal epithelial cytoskeleton selectively constrains lumen-to-tissue migration of neutrophils.

Migration of neutrophils (polymorphonuclear leukocytes; PMN) across polarized epithelia is asymmetrical: basolateral-to-apical (physiologically directed) migration is far more efficient than migration in the reverse direction, suggesting the presence of luminal retention signal(s). Following pilot observations, we used polarized intestinal epithelial monolayers (T84) to examine whether asymmetrical constraint of migration afforded by the epithelial cytoskeleton might underlie such retention signals. Rearrangement of epithelial cortical F-actin accompanied PMN transepithelial migration (in either direction) and was prevented by preloading monolayers with the F-actin stabilizing agent phallacidin. Although phallacidin preloading did not influence physiologically directed PMN transepithelial migration, such treatment greatly enhanced migration in the reverse direction (i.e., effective loss of luminal retention signal). 1,2-Bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (BAPTA) preloading also prevented epithelial cortical actin rearrangements and selectively resulted in loss of luminal retention signal(s). BAPTA preloading did not influence resistance or forskolin-induced Cl- secretion, and phallacidin preloading did not influence resistance or carbachol-induced Cl- secretion, suggesting that barrier function and surface polarity were maintained under these conditions. These and supplementary data suggest that epithelial actin (but not microtubule) cytoskeletal reordering asymmetrically influences PMN migration and underlies, at least in part, the observed signal that biases for retention of PMN in the luminal space.
Geographical targeting to improve progression through the sexually transmitted infection/HIV treatment continua in different populations

Purpose of reviewThe purpose of this study is to review and synthesize the recent literature on the use of geographical targeting to improve progression through HIV and sexually transmitted disease (STD) prevention and treatment continua in different populations. Recent findingsGeographical targeting can help identify obstacles to progression through prevention and treatment continua for each stage and in specific geographic locations. Macro-level geographical targeting can help maximize allocative efficiency, while micro-level targeting of hot spots increases effectiveness of interventions. Migration into and out of geographical areas of interest constitutes a challenge to geographical targeting in that stage-specific monitoring strategies tend to yield inaccurate results when people leave the area. Despite these issues, it is possible to identify failures in each stage of the continuum by specific spatial location such as census tracts and focus improvement efforts accordingly. SummaryVulnerabilities, risk behaviours and infections all cluster across age, race-ethnicity, socioeconomic status, key populations, risk networks and geographic space. Spatial concentration may be the most important in this context, as it allows prevention programmes to identify and reach target populations more easily. Geographical targeting can be employed at both macro and micro levels and in combination with targeting of key populations and high-risk networks.
Post-exposure prophylaxis for HIV infection

Post-exposure prophylaxis (PEP) with antiretrovirals is now widely used worldwide after either occupational contact (with blood or another blood-containing fluid), or nonoccupational contact (mainly sexual or injection-drug use). It is assumed to reduce the risk of HIV transmission by at least 80%, although its efficacy has not been completely proven. Several countries have issued guidelines to help the clinician in their decision to offer PEP and to improve its cost–effectiveness. This article reviews the different antiretroviral combinations used, their safety profile, the recommendations and indications of PEP. The initial evaluation of an exposed individual is presented, as well as the follow-up during and after treatment.
Alcohol intoxication and severity of injury in victims of assault

470 victimes d'agressions examinees dans des services d'urgence ont ete interrogees sur l'absorption d'alcool dans les 12 h precedentes et leur alcoolemie est dosee. Les lesions sont classees en 5 categories d'apres leur gravite et leur multiplicite. Les resultats montrent que les lesions les moins graves sont plus souvent notees chez les non-buveurs, et les plus graves et les plus nombreuses chez les sujets ayant absorbe plus d'alcool
The Swedish primary teacher education programme: at the crossroads between two education programme traditions

ABSTRACT In 2011, new teacher education programmes were introduced in Sweden. This policy case study examines the outcome of the reform, focusing on the pedagogic discourses in the examination practise of the primary teacher education programme, but also on the possible effects of dividing teacher education for primary teachers into two specialisations: for teachers of grades F-3 and 4–6. The point of departure is that the Swedish, and Nordic, teacher education programmes have been shaped by two traditions: the seminar tradition and the academic tradition. The study is based on Bernstein’s theories of pedagogic discourses and how these affect teachers’ professional knowledge base and professional identities. The results show that the primary teacher education above all prepares student teachers for everyday classroom life, but also that the examination practice and the pedagogic discourses differ to some extent between the two specialisations and that the primary teacher education (PTE) students who choose to specialise in grades 4–6 now encounter pedagogic discourses that more resemble an academic tradition than what is encountered by students who choose to specialise in F-3.
Effective behavioral interventions for decreasing dementia‐related challenging behavior in nursing homes

This paper provides a selective review of behavioral intervention research aimed at successfully decreasing dementia‐related challenging behaviors in nursing homes. The authors include separate discussions of behavioral excesses (disruptive vocalization, wandering, physical and verbal aggression) and deficits (excess dependency, therapeutic activities, social interaction/communication). Descriptions of interventions used to address each behavior problem are followed by methodological evaluations of the research. Discussions are augmented by inclusion of the authors' ongoing intervention research. The paper concludes with a description of a comprehensive program for teaching behavior management skills to nurse aides and a motivational system for maintaining the performance of these skills over the long term. Copyright © 1999 John Wiley & Sons, Ltd.
Compulsory Voting: A Defence

Abstract Turnout is in decline in established democracies around the world. Where, in the mid-1800s, 70–80 percent of eligible voters regularly participated in US Presidential elections, turnout has averaged just 53.7 percent since 1972. Average turnout in general elections in the UK has fallen from 76.6 percent during the period 1945–92, to 64.7 percent since 1997. Average turnout in Canadian federal elections has fallen from 74.5 percent during the period 1940–79, to 62.5 percent since 2000. For most democrats, these numbers are a cause for alarm. Compulsory voting is amongst the most effective means of raising turnout. However, compulsory voting is also controversial. Most of us think that coercion may only be employed against the citizenry if it is backed by a justification of the right kind. Opponents of compulsory voting charge that no such justification is available. This article resists this line of argument in two ways. First, I offer an argument from free-riding which, though gestured towards by others, and widely criticized, has yet to be defended in any depth. Second, I consider a range of objections to compulsory voting as such, arguing that none succeeds.
[The characteristics of a comprehensive geriatric assessment in patients with mild cognitive impairment with a cerebral white matter lesion].

AIM Vascular dementia may be referred to as "treatable dementia" because its development and progress can be inhibited by intervention in the early stage. In particular, cerebral white matter lesions are readily encountered the clinical setting. In this study, we aimed to clarify the phenomenon and symptoms of patients with mild cognitive impairment (MCI) with cerebral white matter lesions prior to the onset of dementia. METHODS The subjects included 181 cases diagnosed with MCI among 643 consecutive new patients of the Center for Comprehensive Care on Memory Disorder at Kyorin University Hospital from January 1, 2013 to January 31, 2014. Patients with particular diseases were excluded. An interview, physical examination, comprehensive geriatric assessment, brain MRI and SPECT were performed for all subjects. The cerebral white matter lesions were evaluated using the modified Fazekas scale. We defined Grades 0 and 1 as the group without apparent cerebral white matter lesions and Grades 2 and 3 as the group with apparent cerebral white matter lesions. We compared the laboratory findings and outcomes of these two groups. RESULTS The age of the group with apparent cerebral white matter lesions was significantly higher than the group without apparent cerebral white matter lesions (P<0.05). No significant difference was observed regarding gender, MMSE, or "vegetable" term retrieval. A significant difference was observed in the total score and the subordinate component of the 21-item fall risk index and geriatric depression scale between the groups (P<0.05). Additionally, a significant difference was observed regarding the subordinate component of the instrumental ADL, the Dementia Behavior Disturbance Scale and the Zarit Care Burden Scale between the groups (P<0.05). CONCLUSIONS Our results suggest that the presence of white matter lesions at the stage of MCI has a significant relationship to care burden due to the deterioration of ADL, risk of falling, and the presence of depression and behavior disorders. We speculate that our results are useful for the explanation of the characteristics of MCI with white matter lesion to the patients and the care givers. Furthermore, these results may lead to improvements in the appropriate approach, intervention and appropriate nursing of such patients.
Social and developmental biology of the myxobacteria

Myxobacteria are soil bacteria whose unusually social behavior distinguishes them from other groups of procaryotes. Perhaps the most remarkable aspect of their social behavior occurs during development, when tens of thousands of cells aggregate and form a colorful fruiting body. Inside the fruiting body the vegetative cells convert into dormant, resistant myxospores. However, myxobacterial social behavior is not restricted to the developmental cycle, and three other social behaviors have been described. Vegetative cells have a multigene social motility system in which cell-cell contact is essential for gliding in multicellular swarms. Cell growth on protein is cooperative in that the growth rate increases with the cell density. Rippling is a periodic behavior in which the cells align themselves in ridges and move in waves. These social behaviors indicate that myxobacterial colonies are not merely collections of individual cells but are societies in which cell behavior is synchronized by cell-cell interactions. The molecular basis of these social behaviors is becoming clear through the use of a combination of behavioral, biochemical, and genetic experimental approaches.
Molecular Bases of Brain Preconditioning

Preconditioning of the brain induces tolerance to the damaging effects of ischemia and prevents cell death in ischemic penumbra. The development of this phenomenon is mediated by mitochondrial adenosine triphosphate-sensitive potassium (KATP+) channels and nitric oxide signaling (NO). The aim of this study was to investigate the dynamics of molecular changes in mitochondria after ischemic preconditioning (IP) and the effect of pharmacological preconditioning (PhP) with the KATP+-channels opener diazoxide on NO levels after ischemic stroke in rats. Immunofluorescence-histochemistry and laser-confocal microscopy were applied to evaluate the cortical expression of electron transport chain enzymes, mitochondrial KATP+-channels, neuronal and inducible NO-synthases, as well as the dynamics of nitrosylation and nitration of proteins in rats during the early and delayed phases of IP. NO cerebral content was studied with electron paramagnetic resonance (EPR) spectroscopy using spin trapping. We found that 24 h after IP in rats, there is a two-fold decrease in expression of mitochondrial KATP+-channels (p = 0.012) in nervous tissue, a comparable increase in expression of cytochrome c oxidase (p = 0.008), and a decrease in intensity of protein S-nitrosylation and nitration (p = 0.0004 and p = 0.001, respectively). PhP led to a 56% reduction of free NO concentration 72 h after ischemic stroke simulation (p = 0.002). We attribute this result to the restructuring of tissue energy metabolism, namely the provision of increased catalytic sites to mitochondria and the increased elimination of NO, which prevents a decrease in cell sensitivity to oxygen during subsequent periods of severe ischemia.
Molecular profiling and targeted therapy for advanced thoracic malignancies: a biomarker-derived, multiarm, multihistology phase II basket trial.

PURPOSE We conducted a basket clinical trial to assess the feasibility of such a design strategy and to independently evaluate the effects of multiple targeted agents against specific molecular aberrations in multiple histologic subtypes concurrently. PATIENTS AND METHODS We enrolled patients with advanced non-small-cell lung cancer (NSCLC), small-cell lung cancer, and thymic malignancies who underwent genomic characterization of oncogenic drivers. Patients were enrolled onto a not-otherwise-specified arm and treated with standard-of-care therapies or one of the following five biomarker-matched treatment groups: erlotinib for EGFR mutations; selumetinib for KRAS, NRAS, HRAS, or BRAF mutations; MK2206 for PIK3CA, AKT, or PTEN mutations; lapatinib for ERBB2 mutations or amplifications; and sunitinib for KIT or PDGFRA mutations or amplification. RESULTS Six hundred forty-seven patients were enrolled, and 88% had their tumors tested for at least one gene. EGFR mutation frequency was 22.1% in NSCLC, and erlotinib achieved a response rate of 60% (95% CI, 32.3% to 83.7%). KRAS mutation frequency was 24.9% in NSCLC, and selumetinib failed to achieve its primary end point, with a response rate of 11% (95% CI, 0% to 48%). Completion of accrual to all other arms was not feasible. In NSCLC, patients with EGFR mutations had the longest median survival (3.51 years; 95% CI, 2.89 to 5.5 years), followed by those with ALK rearrangements (2.94 years; 95% CI, 1.66 to 4.61 years), those with KRAS mutations (2.3 years; 95% CI, 2.3 to 2.17 years), those with other genetic abnormalities (2.17 years; 95% CI, 1.3 to 2.74 years), and those without an actionable mutation (1.85 years; 95% CI, 1.61 to 2.13 years). CONCLUSION This basket trial design was not feasible for many of the arms with rare mutations, but it allowed the study of the genetics of less common malignancies.
Multiresolution Analysis of Event-Related Potentials by Wavelet Decomposition

Wavelet analysis is presented as a new tool for analyzing event-related potentials (ERPs). The wavelet transform expands ERPs into a time-scale representation, which allows the analyst to zoom in on the small scale, fine structure details of an ERP or zoom out to examine the large scale, global waveshape. The time-scale representation is closely related to the more familiar time-frequency representation used in spectrograms of time-varying signals. However, time-scale representations have special properties that make them attractive for many ERP applications. In particular, time-scale representations permit theoretically unlimited time resolution for the detection of short-lived peaks and permit a flexible choice of wavelet basis functions for analyzing different types of ERPs. Generally, time-scale representations offer a formal basis for designing new, specialized filters for various ERP applications. Among recently explored applications of wavelet analysis to ERPs are (a) the precise identification of the time of occurrence of overlapping peaks in the auditory brainstem evoked response; (b) the extraction of single-trial ERPs from background EEG noise; (c) the decomposition of averaged ERP waveforms into orthogonal detail functions that isolate the waveform's experimental behavior in distinct, orthogonal frequency bands; and (d) the use of wavelet transform coefficients to concisely extract important information from ERPs that predicts human signal detection performance. In this tutorial we present an intuitive introduction to wavelets and the wavelet transform, concentrating on the multiresolution approach to wavelet analysis of ERP data. We then illustrate this approach with real data. Finally, we offer some speculations on future applications of wavelet analysis to ERP data.
Lipopolysaccharide induction of tissue factor gene expression in monocytic cells is mediated by binding of c-Rel/p65 heterodimers to a kappa B-like site

Exposure of monocytic cells to bacterial lipopolysaccharide (LPS) activates the NF-kappa B/Rel family of proteins and leads to the rapid induction of inflammatory gene products, including tissue factor (TF). TF is the primary cellular initiator of the coagulation protease cascades. Here we report the characterization of a nuclear complex from human monocytic cells that bound to a kappa B-like site, 5'-CGGAGTTTCC-3', in the 5'-flanking region of the human TF gene. This nuclear complex was activated by LPS with kinetics that preceded induction of the TF gene. In vitro binding studies demonstrated that the TF site bound translated c-Rel and p65 homodimers but not p50/p65 heterodimers or p50 homodimers. Base-pair substitutions in the TF site indicated that the presence of a cytosine at position 1 precluded binding of NF-kappa B. In fact, under low-ionic-strength conditions, the TF complex did not migrate with translated p50/p65 dimers but instead comigrated with c-Rel/p65 dimers. Antibodies against the NF-kappa B and Rel proteins and UV cross-linking studies revealed the presence of c-Rel and p65 and the absence of p50 in the TF complex and further showed that c-Rel/p65 heterodimers selectively bound to the TF kappa B-like site. Functional studies indicated that the TF site conferred LPS inducibility on a heterologous promoter and was transactivated by c-Rel or p65. Taken together, our results demonstrated that binding of c-Rel/p65 heterodimers to a novel kappa B-like site mediated LPS induction of TF gene expression in monocytic cells.
A Light Emitting Diode (LED) Based Spatial Frequency Domain Imaging System for Optimization of Photodynamic Therapy of Nonmelanoma Skin Cancer: Quantitative Reflectance Imaging

Photodynamic therapy (PDT) offers the potential for enhanced treatment of nonmelanoma skin cancer (NMSC) with minimal scarring. Yet, PDT has not achieved consistent long term effectiveness to gain widespread clinical acceptance for treatment of skin cancer. Therapeutic response varies between practitioners, patients and lesions. One important contributing factor is the absence of quantitative tools to perform in vivo dosimetry. To this end, we have developed a new quantitative imaging device that can be used to investigate parameters related to optimizing dosimetry.
Multilevel RTS in Proton Irradiated CMOS Image Sensors Manufactured in a Deep Submicron Technology

A new automated method able to detect multilevel random telegraph signals (RTS) in pixel arrays and to extract their main characteristics is presented. The proposed method is applied to several proton irradiated pixel arrays manufactured using a 0.18 mum CMOS process dedicated to imaging. Despite the large proton energy range and the large fluence range used, similar exponential RTS amplitude distributions are observed. A mean maximum amplitude independent of displacement damage dose is extracted from these distributions and the number of RTS defects appears to scale well with total nonionizing energy loss. These conclusions allow the prediction of RTS amplitude distributions. The effect of electric field on RTS amplitude is also studied and no significant relation between applied bias and RTS amplitude is observed.