Miracle-dz/UniFAR-FTUs huggingface dataset:
What are the most effective strategies for improving quality and safety of health care?

There is now a plethora of different quality improvement strategies (QIS) for optimizing health care, some clinician/patient driven, others manager/policy‐maker driven. Which of these are most effective remains unclear despite expressed concerns about potential for QIS‐related patient harm and wasting of resources. The objective of this study was to review published literature assessing the relative effectiveness of different QIS. Data sources comprising PubMed Clinical Queries, Cochrane Library and its Effective Practice and Organization of Care database, and HealthStar were searched for studies of QIS between January 1985 and February 2008 using search terms based on an a priori QIS classification suggested by experts. Systematic reviews of controlled trials were selected in determining effect sizes for specific QIS, which were compared as a narrative meta‐review. Clinician/patient driven QIS were associated with stronger evidence of efficacy and larger effect sizes than manager/policy‐maker driven QIS. The most effective strategies (>10% absolute increase in appropriate care or equivalent measure) included clinician‐directed audit and feedback cycles, clinical decision support systems, specialty outreach programmes, chronic disease management programmes, continuing professional education based on interactive small‐group case discussions, and patient‐mediated clinician reminders. Pay‐for‐performance schemes directed to clinician groups and organizational process redesign were modestly effective. Other manager/policy‐maker driven QIS including continuous quality improvement programmes, risk and safety management systems, public scorecards and performance reports, external accreditation, and clinical governance arrangements have not been adequately evaluated with regard to effectiveness. QIS are heterogeneous and methodological flaws in much of the evaluative literature limit validity and generalizability of results. Based on current best available evidence, clinician/patient driven QIS appear to be more effective than manager/policy‐maker driven QIS although the latter have, in many instances, attracted insufficient robust evaluations to accurately determine their comparative effectiveness.
Availability of Better Data on Communication Networks Can Undermine Community Enforcement

I consider a repeated trust game played between a group of insiders, arranged in a network representing their lines of communication, and a single outsider. Insiders follow a local punishment rule, shunning the outsider if it has cheated them or a neighbor. The object of interest is that the outsider may know either summary statistics about the nature of the network, or know its precise non-anonymous structure. For the outsider to have knowledge of the precise structure may, depending on the shape of the network, increase or decrease the volume of honest interaction that can be sustained. In extreme cases, a small `local' vulnerability to outside exploitation can result in a total breakdown of the chance for mutually beneficial trade across the whole network. Strategic ignorance and obfuscation of network structure may therefore be valuable to both sides, complicating the problem for a network operator seeking to monetize data on the network graph. I discuss recent decisions by Twitter and Facebook in this framework.
Do Work-related Stress and Reactivity to Stress Predict Dementia More Than 30 Years Later?

The purpose of this study was to examine associations for work-related stress, reactivity to stress, and subsequent risk of dementia. The sample consisted of members of the population-based Swedish Twin Registry who were participants in the HARMONY study (n=2049). We used case control and cotwin control designs, with information on work-related stress and reactivity to stress collected as part of a questionnaire completed in 1967. Dementia was diagnosed approximately 30 years later using a 2-stage procedure—screening for cognitive impairment followed by full clinical evaluation. We found that measures of work-related stress (job dissatisfaction and high job demands) were not associated with dementia risk. Greater reactivity to stress predicted higher risk of dementia controlling for age, education, sex, occupational status, alcohol use, and smoking status (odds ratio=1.57, 95% confidence interval 1.08-2.31). Cotwin control analyses also showed that dementia probands were more likely to report high reactivity to stress than their nondemented cotwins. We did not find evidence of an interaction between work stress and reactivity in predicting dementia. Overall, indicators of stress due to environment (ie, work) were not associated with dementia, whereas the individual characteristic of reactivity to stress predicted dementia risk.
Accelerating learning and adaptation at organizational and societal scales: really adopting Design for All

This reflective paper speculates on the problem of Design for All (also known as Universal Design) and its very low rate of uptake, in spite of widespread acknowledgement of its centrality and importance. The paper argues that framing the problem with the aid of systemic approaches will help not only to understand some of the reasons for the low uptake, but also to see ways forward to increase uptake, and thereby accelerate the learning and adaptation of the organisations that are tasked with adopting and implementing Design for All, as well as more global and proactive adoption by societal elements in general. Design for All is the term adopted by the European Union for a policy of not “designing out” vulnerable populations. Following on from the Universal Design movement in the 1970s in the United States, the EU placed emphasis on the removal of barriers of access to products and services for persons with disabilities. Furthermore, the ageing of the population has put these issues high on the political agenda. All this places a clear direction on the social aspect of design, and in turn of design’s impact on society. The problem of awareness, once very high on the agenda of those working in Design for All, is no longer such a priority. Awareness has been greatly aided by the communities and organisations of disabled and elderly users, who have made visible both the problems and the needs of these populations. Nor should, altruism be seen as a prime motivation- there has been the widespread dissemination of the message that some form of temporary disability is likely to affect all of us at some time in our lives, and, as we all hope to live long lives, we should also design for our “future selves”. Finally, a further type of outreach is education. Design for All is on the curriculum of Universities, and seeks to influence and engage younger generations of designers in their formative years.
Implant-supported welded titanium frameworks in the edentulous maxilla: a 5-year prospective multicenter study.

PURPOSE This study evaluated the 5-year clinical and radiographic performance of fixed implant-supported maxillary prostheses with either welded titanium or conventional cast-gold alloy frameworks. MATERIALS AND METHODS Fifty-eight consecutive patients were provided with 349 osseointegrated Brånemark system implants in the edentulous maxilla at six different implant centers. Twenty-eight of the patients received, at random, prostheses with laser-welded titanium frameworks, and the remaining 30 patients had prostheses with conventional cast-gold alloy frameworks. Clinical and radiographic data were collected for 5 years after prosthesis placement. RESULTS The titanium and cast-gold framework groups exhibited similar cumulative survival and success rates (CSR). The 5-year implant CSR from time of placement was 91.4% and 94.0%, respectively, and from prosthesis delivery the rate was 94.9% and 95.6%, respectively. The corresponding 5-year prosthesis CSRs were 96.4% and 93.3%. One patient from each group lost all the implants and turned to complete dentures within the first year of function. Another patient with a cast-gold framework had the prosthesis replaced after 4 years, basically because of problems with the veneering material. No fractures of implant components were observed during the follow-up period. Bone loss was on average 0.59 mm (SD 0.97 mm) during 5 years, with no statistical difference between the two groups. CONCLUSION Welded titanium frameworks presented a similar favorable clinical performance as conventional cast-gold alloy frameworks in fixed implant-supported prostheses in the edentulous maxilla after 5 years in function. Implant failures were concentrated in only a few patients in each study group.
Wireless Vehicular Adaptive Radio Resource Management Policies in Congested Channels

The strict QoS traffic safety requirements and the potential widespread adoption of wireless vehicular communication systems require the design and optimization of radio resource management policies that efficiently use the communications channel. To this end, this work proposes an adaptive radio resource management mechanism designed considering the operating conditions and the traffic safety requirements. The proposed scheme is analysed under various traffic densities, and compensation mechanisms to overcome the channel congestion effects are proposed and evaluated.
The Dynamics of Autophagy Visualised in Live Cells: from Autophagosome Formation to Fusion with Endo/lysosomes

Autophagy has been implicated in a range of disorders and hence is of major interest. However, imaging autophagy in real time has been hampered by lack of suitable markers. We have compared the potential of monodansylcadaverine, widely used as an autophagosomal marker, and the Atg8 homologue LC3, to follow autophagy by fluorescence microscopy whilst labelling late endosomes and lysosomes simultaneously using EGFP-CD63. Monodansylcadaverine labelled only acidic CD63-positive compartments in response to a range of autophagic inducers in various live or post-fixed cells, staining being identical in atg5+/+ and atg5-/- MEFs in which autophagosome formation is disabled. Monodansylcadaverine staining was essentially indistinguishable from that of LysoTracker Red, LAMP1 or LAMP2. In contrast, 60-90% of EGFP-LC3-positive punctate organelles did not colocalise with LAMP1/LAMP2/CD63 and were monodansylcadaverine-negative while EGFP-LC3 puncta that did colocalise with LAMP1/LAMP2/CD63 were also monodansylcadaverine-positive. Hence monodansylcadaverine is no different from other markers of acidic compartments and it cannot be used to follow autophagosome formation. In contrast, fusion of mRFP-LC3-labelled autophagosomes with EGFP-CD63-positive endosomes and lysosomes and sequestration of dsRed-labelled mitochondria by EGFP-LC3- and EGFP-CD63-positive compartments could be visualised in real time. Moreover, transition of EGFP-LC3-I (45 kDa) to EGFP-LC3-II (43 kDa) - traced by immunoblotting and verified by [3H]ethanolamine labelling - revealed novel insights into the dynamics of autophagosome homeostasis, including the rapid activation of autophagy by the apoptotic inducer staurosporine prior to apoptosis proper. Use of fluorescent LC3 and a counterfluorescent endosomal/lysosomal protein clearly allows the entire autophagic process to be followed by live cell imaging with high fidelity.
The schistosome in the mammalian host: understanding the mechanisms of adaptation

SUMMARY In this review, we envisage the host environment, not as a hostile one, since the schistosome thrives there, but as one in which the relationship between the two organisms consists of constant communication, through signalling mechanisms involving sense organs, surface glycocalyx, surface membrane and internal organs of the parasite, with host fluids and cells. The surface and secretions of the schistosome egg have very different properties from those of other parasite stages, but adapted for the dispersal of the eggs and for the preservation of host liver function. We draw from studies of mammalian cells and other organisms to indicate how further work might be carried out on the signalling function of the surface glycocalyx, the raft structure of the surface and existence of pores in the surface membrane, the repair of the surface membrane, the role of the membrane structure in ion channel function (including recent work on the actin cytoskeleton and calcium channels) and the possible role of P-glycoproteins in the adaptation of the parasite to its environment. We are speculative in some areas, such as the suggestions that variability in surface properties of schistosomes may relate to the existence of membrane rafts and that parasite communities may exhibit quorum sensing. This speculative approach is adopted with the hope that future work on the whole organisms and their interactions will be encouraged.
The Indebtedness of Rural Labour in India

This study examines the issue of debt distress of rural labour households (agricultural and non-agricultural labour), in all the major Indian states, using data from the 61st round, pertaining to 2004-05, of the National Sample Survey (NSS). We conduct this study at various levels and using different methodological approaches. First, using a definition of “debt distress”, set out in detail in the following section, we calculate the value of debt distress for every rural labour household (RLH) in the NSS. Then we aggregate these households to rank states, districts, and social groups according to the degree of their distress. Second, using the tools of inequality analysis, we compute the degree of inequality in the distribution of distress among indebted RLH and ask how much of this inequality can be explained by the fact households (a) live in different states and (b) belong to different social groups? Third, using the tools of regression analysis, we examine the strength of the factors impinging on whether a household is a debtor household and, if it is, the strength of the factors determining whether it obtained loans from institutional sources or from money lenders and whether it took a loan for “productive” or “non-productive” purposes.
Understanding Perceptions and Practices for Zambian Adults in Western Province at Risk for Hypertension: An Exploratory Descriptive Study

Hypertension is an important public health issue in Zambia. Despite the need for early detection, treatment, and ongoing monitoring, there is little documented research on hypertension in Zambia. The study aims were to: 1) better understand risk factors for hypertension in urban and rural communities in Mongu and Limulunga Districts, Western Province; 2) identify current health practices for hypertension and prevention in these communities; and 3) explore intersections between culture and hypertension perceptions and practices for study participants. A mixed methods approach was used; 203 adults completed surveys including demographics, anthropometric measures, blood pressure (BP), physicial activity, diet, and salt intake at five health check stations. Two focus groups were conducted with rural and urban community members to better understand their perspectives on hypertension. The prevalence of hypertension was 32.8% for survey participants. A further 24.6% had pre-hypertension. The mean total weight of salt added to food was nearly double the WHO recommendation with women adding significantly more salt to food than men. Significant differences in waist circumference were observed between men and women with men at low risk and women at substantialy high risk. In focus groups, participants cited westernized diets, lack of physical activity, stress, psychological factors, and urbanization as causative factors for hypertension. Participants lacked understanding of BP medications, healthy lifestyles, adherence to treatment, and ongoing monitoring. Focus group participants mentioned challenges in obtaining treatment for hypertension and desired to be active contributors in creating solutions. They recommended that government priorize hypertension initiatives that increase access to health education to reduce risk, enhance early detection, and support lifestyle changes and medication adherence. Our findings suggest that policy-makers need to engage communities more effectively to develop successful public health strategies to prevent, detect, and manage hypertension in Western Province, Zambia, particularly in rural areas.
Neural basis of novel and well‐learned recognition memory in schizophrenia: A positron emission tomography study

The level of familiarity of a given stimulus plays an important role in memory processing. Indeed, the novelty/familiarity of learned material has been proven to affect the pattern of activations during recognition memory tasks. We used visually presented words to investigate the neural basis of recognition memory for relatively novel and familiar stimuli in schizophrenia. Subjects were 34 healthy volunteers and 19 schizophrenia spectrum patients. Two experimental cognitive conditions were used: 1 week and again 1 day prior to the PET imaging subjects had to thoroughly learn a list of 18 words (well‐learned memory). Subjects were also asked to learn another set of 18 words presented 1 min before the PET experiment (novel memory). During the PET session, subjects had to recognize the list of 18 words among 22 new (distractor) words. Subjects also performed a control task (reading words). A nonparametric randomization test and a statistical t‐mapping method were used to determine between‐ and within‐group differences. In patients the recognition of novel material produced relatively less flow in several frontal areas, superior temporal gyrus, insular cortex, and parahippocampal areas, and relatively higher activity in parietal areas, visual cortex, and cerebellum, compared to controls. No significant differences in flow were seen when comparing well‐learned memory activations between groups. These results suggest that different neural pathways are engaged during novel recognition memory in patients with schizophrenia compared to healthy individuals. During recognition of novel material, patients failed to activate frontal/limbic regions, recruiting a set of posterior perceptual brain regions instead. Hum. Brain Mapping 12:219–231, 2001. © 2001 Wiley‐Liss, Inc.
Adaptive introgression in animals: examples and comparison to new mutation and standing variation as sources of adaptive variation

Adaptive genetic variation has been thought to originate primarily from either new mutation or standing variation. Another potential source of adaptive variation is adaptive variants from other (donor) species that are introgressed into the (recipient) species, termed adaptive introgression. Here, the various attributes of these three potential sources of adaptive variation are compared. For example, the rate of adaptive change is generally thought to be faster from standing variation, slower from mutation and potentially intermediate from adaptive introgression. Additionally, the higher initial frequency of adaptive variation from standing variation and lower initial frequency from mutation might result in a higher probability of fixation of the adaptive variants for standing variation. Adaptive variation from introgression might have higher initial frequency than new adaptive mutations but lower than that from standing variation, again making the impact of adaptive introgression variation potentially intermediate. Adaptive introgressive variants might have multiple changes within a gene and affect multiple loci, an advantage also potentially found for adaptive standing variation but not for new adaptive mutants. The processes that might produce a common variant in two taxa, convergence, trans‐species polymorphism from incomplete lineage sorting or from balancing selection and adaptive introgression, are also compared. Finally, potential examples of adaptive introgression in animals, including balancing selection for multiple alleles for major histocompatibility complex (MHC), S and csd genes, pesticide resistance in mice, black colour in wolves and white colour in coyotes, Neanderthal or Denisovan ancestry in humans, mimicry genes in Heliconius butterflies, beak traits in Darwin's finches, yellow skin in chickens and non‐native ancestry in an endangered native salamander, are examined.
Experiences faced by next of kin during their older family members' transition into long-term care in a Norwegian nursing home.

AIMS AND OBJECTIVES To describe and explore experiences of next of kin during the older persons' transition into long-term care. BACKGROUND Moving into long-term care is a challenge for both resident and next of kin. Next of kin experience transitions at the same time as they play significant parts in their family members' transition into long-term care placement. DESIGN Constructivist hermeneutical design. METHODS Ten next of kin to newly admitted eight residents were recruited by purposeful sampling and interviewed. Periodic participant observation periods following new residents on arrival day and the first week after admission and some written documentation were the backdrops to the interviews. RESULTS What happened prior to the long-term care placement as well as what happened in the initial period of transition influenced the experiences of next of kin. Characteristics of their experiences were: 'striving to handle the new situation', 'still feeling responsible', and 'maintaining dignity and continuity'. CONCLUSIONS Next of kin were unprepared for the transition and had little support from staff. Staff lacked awareness about next of kin's transition experiences. Their involvement with next of kin was unpredictable, and this added to the burdens of next of kin in this period. RELEVANCE TO CLINICAL PRACTICE Knowledge about experiences of next of kin needs to be acknowledged among healthcare professionals. Health professionals need to pay attention to what happens across institutional borders within families as well as between staff and family members. Individual family members need support in this period of change.
Party Politics Triumph over Substantive Scrutiny and Principled Policy: Examining Czech MPs’ Voting Behaviour in Regard to EU Affairs

The paper deals with the European dimension of the competition and contention between Czech political parties and argues that domestic party interests undermine the formal oversight of EU politics by the Czech national parliament. Within the current institutional arrangements, national political parties assume stances – which are expressed through voting – towards the European Union (and European integration as such) as they act in the arena of national parliaments that are supposed to make the EU more accountable in its activities. Based on an analysis of roll-calls, the paper focuses on the ways the political parties assume their stances towards the EU and how the parties check this act by voting on EU affairs. The paper examines factors that should shape parties’ behaviour (programmes, positions in the party system, and public importance of EU/European integration issues). It also focuses on party expertise in EU/European issues and asserts that EU/European integration issues are of greater importance in extra-parliamentary party competition than inside the parliament, suggesting a democratic disconnect between voters and parliamentary behaviour. The study's empirical analysis of the voting behaviour of Czech MPs also shows that the parliamentary scrutiny introduced by the Lisbon Treaty is undermined by party interests within the system.