bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing Hospitalist-Resident to Hospitalist-Midlevel Practitioner Team Performance on Length of Stay and Direct Patient Care Cost
Authors: Iannuzzi Michael C. , Iannuzzi James C. , Holtsbery Andrew , Wright Stuart M. , Knohl Stephen J. 
Published: December 2014

Abstract

Background
A perception exists that residents are more costly than midlevel providers (MLPs). Since graduate medical education (GME) funding is a key issue for teaching programs, hospitals should conduct cost-benefit analyses when considering staffing models.

Objective
Our aim was to compare direct patient care costs and length of stay (LOS) between resident and MLP inpatient teams.

Methods
We queried the University HealthSystems Consortium clinical database (UHC CDB) for 13 553 “inpatient” discharges at our institution from July 2010 to June 2013. Patient assignment was based on bed availability rather than “educational value.” Using the UHC CDB data, discharges for resident and MLP inpatient teams were compared for observed and expected LOS, direct cost derived from hospital charges, relative expected mortality (REM), and readmissions. We also compared patient satisfaction for physician domain questions using Press Ganey data. Bivariate analysis was performed for factors associated with differences between the 2 services using χ2 analysis and Student t test for categorical and continuous variables, respectively.

Results
During the 3-year period, while REM was higher on the hospitalist-resident services (P &lt; .001), LOS was shorter by 1.26 days, and per-patient direct costs derived from hospital charges were lower by $617. Patient satisfaction scores for the physician-selected questions were higher for resident teams. There were no differences in patient demographics, daily discharge rates, readmissions, or deaths.

Conclusions
Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. The findings offer guidance when considering GME costs and inpatient staffing models.
Diaphragmatic Endometriosis: Review of the Literature and First Case of Robot-Assisted Laparoscopic Treatment
Authors: Cela Vito , Simi Giovanna , Obino Maria Elena Rosa , Uccelli Alessia , D'Isidoro Cristiano , Morelli Luca , Pluchino Nicola , Freschi Letizia 
Published: December 2014

Background Thoracic endometriosis is a rare disorder affecting women in reproductive age. The etiopathogenesis of this disease is not well understood. The symptoms appear, but not necessarily, during periods in person affected by the condition. Methods A 35-year-old woman came to our clinic, the Infertility and Assisted Reproduction Center of the University of Pisa, for infertility treatment. She described a clinical history of abdominal pain with irradiation up to the right shoulder, depending on her breathing or position, during menstruation. She also reported that she did not experience these symptoms while taking an oral contraceptive. Pelvic ultrasound examination and thorax X-ray were normal. The patient also underwent thoracic and abdominal pelvis magnetic resonance imaging (MRI). Thoracic MRI revealed a nodule on the right hemidiaphragm. It was decided to perform surgical removal of the nodule. Robotic-assisted surgery was used because of its multiple advantages in comparison with laparoscopic surgery, such as a 3-dimensional view, a decrease in surgeon fatigue and tremors, and an increase of wrist motion with improved dexterity and greater surgical precision. The surgery was performed in May 2012. The patient was put on the left lateral bedside. Pneumoperitoneum with CO2 was established with an intra-abdominal pressure of 12 mm Hg using a Veress needle. Robotic trocars of 8-mm diameter were introduced at the diaphragmatic level and connected to the robot arms. Her pelvic and abdominal organs appeared healthy. The right hemidiaphragm presented adherence with the liver due to endometriosis disease. We removed the adhesion, and we performed the excision of the diaphragmatic endometriotic nodule. The nodule was extracted through an endobag. Operative time lasted 2 hours. Conclusions The postoperative evolution was satisfactory, and the patient left the hospital on the third postoperative day. No complications occurred. We showed that this approach is feasible and safe, without conversion to laparotomy.
De balans van tien jaar Europees aanhoudingsbevel: efficiency en rechtsbescherming in balans?
Authors: Glerum Vincent 
Published: December 2014

De balans van tien jaar Europees aanhoudingsbevel: efficiency en rechtsbescherming in balans?
Na tien jaar EAB onderzoekt deze bijdrage of de vereenvoudiging en versnelling van de justitiële samenwerking in strafzaken in evenwicht zijn met de rechtsbescherming van de opgeëiste persoon. Waar het Hof van Justitie vooral uitgaat van het vertrouwen in de nationale rechtsorde van de uitvaardigende lidstaat, volgt uit recente Uniewetgeving dat dit vertrouwen soms onvoldoende is. Ook de oplossingen van de Uniewetgever richten zich hoofdzakelijk op rechtsbescherming in de uitvaardigende lidstaat. Voor het evenwicht tussen efficiency en rechtsbescherming is vooral een in de uitvoerende lidstaat toe te passen weigeringsgrond inzake grondrechtenschendingen van groot belang.Pb. EG 2002, L 190/1
Recht op toegang tot een advocaat in het strafproces.
Authors: Boksem Jan 
Published: December 2014

Recht op toegang tot een advocaat in het strafproces. Enkele gedachten naar aanleiding van de implementatie van Richtlijn 2013/48/EU.
Op 22 oktober 2013 werd Richtlijn 2013/48/EU (hierna: de Richtlijn) vastgesteld. Deze Richtlijn bevat onder meer minimumvoorschriften betreffende het recht van de verdachte op toegang tot een advocaat in strafprocedures. De advocaat moet op zijn beurt de fundamentele aspecten van de verdediging onverkort kunnen waarborgen. De Richtlijn dient uiterlijk op 27 november 2016 in de nationale wetgeving te zijn geïmplementeerd. In deze bijdrage wordt stilgestaan bij de (mogelijke) gevolgen van de implementatie van de Richtlijn voor de Nederlandse rechtsorde.Richtlijn 2013/48/EU van het Europees Parlement en de Raad van 22 oktober 2013 betreffende het recht op toegang tot een advocaat in strafprocedures en in procedures ter uitvoering van een Europees aanhoudingsbevel en het recht om een derde op de hoogte te laten brengen vanaf de vrijheidsbeneming en om met derden en consulaire autoriteiten te communiceren tijdens de vrijheidsbeneming, Pb. EU 2013, L 294.
Met gemeen overleg der Staten-Generaal
Authors: van der Staaij C.G. , de Wildt W.M.J. 
Published: December 2014

Met gemeen overleg der Staten-Generaal. Wetgeving als politiek instrument
Het ideaal van de parlementaire medebetrokkenheid bij wetgeving hangt samen met een oud calvinistisch principe: om tirannie te voorkomen moet de macht gedeeld worden tussen meer personen of instituties. Om die gezamenlijke verantwoordelijkheid te handhaven moet de regering ervoor waken te veel macht naar zich toe te halen via vergaande delegatiebepalingen. Ook is het belangrijk dat zorgvuldiger recht wordt gedaan aan adviezen van de Afdeling advisering van de Raad van State. En alertheid op vergaande Europese regelgeving is geboden. Terwijl de Eerste Kamer politieker is geworden, zou de Tweede Kamer duidelijke keuzes moeten maken over het niveau van regelgeving. Het is een teken van wetgevingsarmoede als er veelvuldig voorhangbepalingen worden geregeld. Wat meer juristen met hart voor wetgevingskwaliteit op de lijsten van politieke partijen zou per saldo wel eens meer effect kunnen hebben dan de zoveelste publicitair ingegeven mondelinge vraag of motie. In ‘gemeen overleg’ over wetgeving is politieke profilering zeker mogelijk.
200 jaar Staten-Generaal en zelfregulering: betrokkenheid op afstand
Authors: Hamer M.I. , Drahos M. , Thomassen I. 
Published: December 2014

200 jaar Staten-Generaal en zelfregulering: betrokkenheid op afstand
De Staten-Generaal dragen via het controleren van de regering en door (mede)wetgeving bij aan het borgen van publieke belangen. Literatuur en praktijk laten echter zien dat publieke belangen onder voorwaarden ook effectief kunnen worden geborgd door zelfregulering. Dit artikel geeft een beschouwing op de gevolgen van zelfregulering voor het democratische gehalte van beleid, op vraagstukken rondom representativiteit bij zelfreguleringsinitiatieven en op kansen en risico’s betreffende de effectiviteit van borging van publieke belangen. Deze drie aspecten worden belicht vanuit de ervaringen met vier vormen van zelfregulering binnen de Sociaal-Economische Raad (SER).
Het venijn zit in de staart: staartteksten in opsommingsbepalingen
Authors: Borman T.C. 
Published: December 2014

Het venijn zit in de staart: staartteksten in opsommingsbepalingen
Aan de hand van twee petites histoires uit de wetgevingspraktijk wordt stilgestaan bij het fenomeen ‘staartteksten’. Dat zijn slotzinsnedes die soms voorkomen in opsommingsbepalingen. De staarttekst is dan de slotzinsnede die betrekking heeft op de gehele voorafgaande tekst van een artikellid dat bestaat uit een aanhef met een opsomming. Aangetoond wordt dat het van groot belang is om een staarttekst vooraf te laten gaan door een ‘harde return’ (de Enter-toets op het toetsenbord). Alleen dan is duidelijk dat de staarttekst een los onderdeel is van de bepaling en wordt niet de indruk gewekt dat die tekst deel uitmaakt van het laatste onderdeel van de opsomming. Zo kan veel discussie en verwarring worden voorkomen. Maar nog beter is het om bij de compositie van wetteksten zo veel mogelijk de situatie te vermijden dat er na een onderdeelsgewijze opsomming nog een staarttekst moet volgen. Dan is immers zeker dat er op dat punt niets fout gaat.
Conceptions et postures des enseignants du primaire à propos de l’intelligence
Authors: Issaieva Élisabeth , Crahay Marcel 
Published: December 2014

L’importance des conceptions de l’intelligence des enseignants est souvent évoquée dans les écrits de recherche mais peu explorée de manière empirique. En s’inspirant de différents courants qui abordent la question de l’intelligence et de son développement, cette recherche se propose d’investiguer les conceptions des enseignants du primaire avec l’aide d’un questionnaire et selon deux problématiques complémentaires : d’abord, en s’intéressant à la structuration de leurs conceptions et en recourant à des analyses factorielles (exploratoires et confirmatoires), et ensuite en examinant le positionnement qu’ils adoptent face aux conceptions ainsi identifiées, en réalisant des analyses typologiques. Les résultats montrent que les enseignants conçoivent l’intelligence selon cinq dimensions distinctes, mais qu’ils sont enclins à les combiner pour les intégrer dans leur posture personnelle. L’intérêt de ces résultats est discuté en fin d’article, ainsi que l’utilité du questionnaire élaboré en vue d’appréhender les conceptions de l’intelligence des enseignants.
Post-glacial diatom-inferred aquatic changes in Sicamous Creek Lake, British Columbia, Canada
Authors: Voit Andrea C. , Hebda Richard J. , Racca Julien M.J. , Pienitz Reinhard , Walker Ian R. , Raeder Uta , Heinrichs Markus L. 
Published: December 2014

Diatom analyses of sediments from a high elevation lake situated in an Engelmann Spruce - Subalpine Fir (ESSF) forest of south-central British Columbia, Canada, reveal long-term climate and water chemistry change. During the transition from the late-glacial / Pleistocene to the xerothermic early Holocene, small, benthic Fragilaria diatoms species that grew under low light conditions in Sicamous Creek Lake gave way to planktonic Cyclotella species that require open-water conditions. Warm temperatures in the mesothermic Holocene are indicated by smaller Cyclotella species and large, benthic pennate diatoms. Diatom communities reflected Neoglacial cooling in the late Holocene, with abundant Nitzschia fonticola and Achnanthes minutissima. Small, benthic Fragilaria regained abundance, suggesting cooling and conditions similar to the late-glacial interval. Diatom community composition responded to the deposition of the Mt. Mazama and Mt. St. Helens tephras, though the Mazama eruption caused greater change in relative abundance of various taxa within the assemblage. Correspondence analysis shows distinct communities have occurred since the initiation of sedimentation, likely due to climate controlled landscape and vegetation changes; diatom-inferred pH values using various models and training sets show limited acidification change occurred through the lake’s history.
Traitement des eaux de consommation par filtration lente sur sable à plusieurs étapes
Authors: Disa-Disa Pascal , Culot Marc , Lobo Joseph , Kalala Ignace , Kawita Christophe , Ekoko Gracien , Mulaji Crispin 
Published: December 2014

La possibilité d’éliminer la turbidité et les coliformes, en utilisant un système de filtration lente sur sable à plusieurs étapes, a été étudiée à l’échelle du laboratoire. Le but de l’étude était de montrer que cette technologie constitue une solution de traitement efficace de l’eau en milieu rural et dans de petites agglomérations des pays en voie de développement. Dans cette étude, un système a été monté et testé. Ce système était constitué de deux filtres lents à sable en série, lesquels sont précédés de deux filtres à granulométrie grossière à flux ascendant. L’efficacité de cette technologie a été évaluée par la mesure de la turbidité et le dénombrement des coliformes totaux et thermotolérants. Les résultats obtenus ont montré : (i) d’excellents abattements de la turbidité malgré le niveau élevé de celle de l’eau brute (de 20 unités de turbidité néphélométrique (NTU) à plus de 100 NTU); (ii) une bonne élimination des coliformes, en fonction de la maturité biologique des filtres utilisés; (iii) de plus, il a été constaté que la turbidité de l’effluent à la sortie du second filtre lent à sable était largement en dessous de la norme de l’Organisation Mondiale de la Santé (OMS) concernant l’eau potable.
Globalement, chaque étape individuelle du système de filtration à plusieurs étapes joue un rôle important dans le processus global de réduction de la turbidité, ainsi que du nombre de coliformes. Il a été remarqué que le filtre à granulométrie grossière, en plus de son rôle protecteur de filtre lent à sable contre les matières en suspension, constitue aussi une barrière importante de traitement dans la diminution du nombre de coliformes. L’addition d’un second filtre lent à sable en série a apporté une efficacité supplémentaire au processus de traitement, en ramenant la turbidité d’effluent proche de 1 NTU et en permettant d’obtenir des abattements additionnels de coliformes.
Antiretroviral treatment outcome in HIV‐1‐infected patients routinely followed up in capital cities and remote areas of Senegal, Mali and Guinea‐Conakry
Authors: Diouara Abou Abdallah Malick , Ndiaye Halimatou Diop , Guindo Ibrehima , Bangoura Nestor , Cissé Mohamed , Edmond Tchiakpe , Bougoudogo Flabou , Mboup Souleymame , Peeters Martine , Ayouba Ahidjo , Kane Ndèye Coumba Touré 
Published: December 2014

IntroductionAccess to antiretroviral treatment (ART) becomes more and more effective in resource‐limited settings (RLS). However, this global effort would be even more profitable if the access to laboratory services especially in decentralized settings was strengthened. We report the virological outcome and HIV‐1 drug resistance in three West African countries using dried blood spots (DBS) samples.MethodsWe included HIV‐1‐infected adults on ART ≥6 months and followed up in capital cities and decentralized sites in Senegal, Mali and Guinea‐Conakry. Patients were consecutively enrolled and DBS were collected in field conditions and kept at ambient temperature before transfer to the reference laboratory. Viral load (VL) was quantified using the NucliSENS EasyQ HIV‐1 v1.2. Genotyping of HIV‐1 pol gene was performed using in‐house protocol.ResultsOf the 407 participants, 119, 152 and 136 were from Senegal, Mali and Guinea‐Conakry, respectively. The median treatment duration was 36 months [IQR: 6–136]. Virological failure (VF) (VL≥3log10 copies/mL) was observed in 26% (95% confidence interval (CI), 18–35; n=31), 11% (95% CI, 6–17; n=16) and 24% (95% CI, 17–32; n=33) of patients in Senegal, Mali and Guinea‐Conakry, respectively (p=0.001). Of samples presenting VL≥3log10 copies/mL (n=80), 70 were successfully genotyped. At least one drug resistance mutation (DRM) was detected in the following proportions: 70% (95% CI, 50–86; n=19), 93% (95% CI, 68–100; n=14) and 68% (95% CI, 48–84; n=19) in Senegal, Mali and Guinea‐Conakry, respectively (p=0.22). Twenty‐six per cent (26%; 95% CI, 16–38; n=18) of patients in VF harboured wild‐type viruses, which is likely indicative of weak adherence. Phylogenetic analysis showed the predominance of CRF02_AG subtype (73%; 95% CI, 61–83; n=51).ConclusionsWe describe the ART outcome in capital and rural settings of Senegal, Mali and Guinea‐Conakry. Our results in all of the three countries highlight the need to reinforce the ART adherence in order to minimize the occurrence of drug resistance. In addition, these findings provide additional evidence that the use of DBS as a sampling support could assist virological monitoring of patients on ART in remote areas.
Systemic Government and the Civil Servant. A New Pattern for Systemic Design
Authors: Veale Jonathan A 
Published: December 2014

This article examines the emerging application of systemic design methodology within government as practiced by the Alberta Public Service in Edmonton, Canada. A case study, from a practitioner’s perspective, for systemic policy design is presented as an innovation facing approach useful for cultural change and decision-support. Lessons about applying systemic design within government and essential capabilities and qualities of practitioners are outlined. For some systemic designers, government might be the best place to effect systemic change especially those particularly concerned about advancing stewardship and innovation within the culture of government. This article is useful to public sector practitioners interested in applying systemic methodology to complex and long-term policy predicaments.
From Product to Service Design: A Thinking Paradigm Shift
Authors: Rodriguez Liliana , Peralta Carlos 
Published: December 2014

Society, industry and the economy are all experiencing changes caused by a shift from products to services. While a “problem-solving” approach is commonly used for the development of products, new design approaches are needed as the primary unit of exchange moves from goods to services. This research argues that a fundamental transformation in the design world is taking place, manifested in a thinking paradigm shift from problem solving (designing products) towards systems thinking (designing services). This paper draws on design literature to identify concepts of systems thinking and problem solving to help understand core elements in the shift from product to service design. It also reports on a series of semi-structured interviews with designers working in five design consultancies that have moved from product design to services design. The results show a change in the way designers think and approach projects when facing the challenges of designing services, confirming a movement from problem solving to systems thinking. However, systems thinking is not replacing problem solving but complementing it. The results also indicate that the growing complexity of the issues designers deal with influences the adoption of systems thinking in responding to service design challenges, as well as current changes in people’s ideas about sustainability and society.
Exploring the Germline Genetics of In Situ and Invasive Cutaneous Melanoma
Authors: Ingold Nathan , Seviiri Mathias , Ong Jue Sheng , Neale Rachel E. , Pandeya Nirmala , Whiteman David C. , Olsen Catherine M. , Martin Nicholas G. , Duffy David L. , Khosrotehrani Kiarash , Hayward Nicholas , Montgomery Grant W. , MacGregor Stuart , Law Matthew H. 
Published: August 2024

ImportanceIt is unknown whether germline genetic factors influence in situ melanoma risk differently than invasive melanoma risk.ObjectiveTo determine whether differences in risk of in situ melanoma and invasive melanoma are heritable.Design, Setting, and ParticipantsThree genome-wide association study meta-analyses were conducted of in situ melanoma vs controls, invasive melanoma vs controls, and in situ vs invasive melanoma (case-case) using 4 population-based genetic cohorts: the UK Biobank, the FinnGen cohort, the QSkin Sun and Health Study, and the Queensland Study of Melanoma: Environmental and Genetic Associations (Q-MEGA). Melanoma status was determined using International Statistical Classification of Diseases and Related Health Problems codes from cancer registry data. Data were collected from 1987 to 2022, and data were analyzed from September 2022 to June 2023.ExposureIn situ and invasive cutaneous melanoma.Main Outcomes and MeasuresTo test whether in situ and invasive melanoma have independent heritable components, genetic effect estimates were calculated for single-nucleotide variants (SNV; formerly single-nucleotide polymorphisms) throughout the genome for each melanoma. Then, SNV-based heritability was estimated, the genetic correlation between melanoma subtypes was assessed, and polygenic risk scores (PRS) were generated for in situ vs invasive status in Q-MEGA participants.ResultsA total of 6 genome-wide significant loci associated with in situ melanoma and 18 loci with invasive melanoma were identified. A strong genetic correlation (genetic r = 0.96; 95% CI, 0.76-1.15) was observed between the 2 classifications. Notably, loci near IRF4, KLF4, and HULC had significantly larger effects for in situ melanoma compared with invasive melanoma, while MC1R had a significantly larger effect on invasive melanoma compared with in situ melanoma. Heritability estimates were consistent for both, with in situ melanoma heritability of 6.7% (95% CI, 4.1-9.3) and invasive melanoma heritability of 4.9% (95% CI, 2.8-7.2). Finally, a PRS, derived from comparing invasive melanoma with in situ melanoma genetic risk, was on average significantly higher in participants with invasive melanoma (odds ratio per 1-SD increase in PRS, 1.43; 95% CI, 1.16-1.77).Conclusions and RelevanceThere is much shared genetic architecture between in situ melanoma and invasive melanoma. Despite indistinguishable heritability estimates between the melanoma classifications, PRS suggest germline genetics may influence whether a person gets in situ melanoma or invasive melanoma. PRS could potentially help stratify populations based on invasive melanoma risk, informing future screening programs without exacerbating the current burden of melanoma overdiagnosis.