ABSTRACT
In the present work we reassess the taxonomic status of one species of Hesperiidae, subfamily Pyrginae, originally described from Cuba. As part of a larger project on the Greater Antillean butterflies, we obtained COI barcode sequences for Cuban specimens of Chiomara mithrax (Möschler, 1879). The comparison of these sequences revealed deep divergences from others belonging to continental specimens. Inspired by these results we performed morphological comparisons including genitalia structures, which revealed correlating differences between specimens from Cuba and the continent. Therefore, we propose the necessary changes in its taxonomy.
Subject(s)
Butterflies , Lepidoptera , Animals , Cuba , GenitaliaABSTRACT
The passage of the Affordable Care Act saw the creation of Accountable Care Organizations (ACOs), a new approach to healthcare delivery moving from fee-for-service toward population health. This paper presents a case study of the Memorial Hermann ACO (MHACO), launched in response to the Medicare Shared Savings Program, with goals to align physician and hospital incentives, practice evidence-based medicine, develop care coordination, and increase efficiency. Building blocks included an affiliated primary care network, a clinical integration program (involving shared electronic medical record platforms and quality data reporting), and significant investments in information technology. Presented is the approach taken to form MHACO; the management structure, technology developed, and a 2-year experience. Incorporated in July 2012, the MHACO involved 22 000 Medicare patients. In 2015, Centers for Medicare and Medicaid Services released data showing a composite quality score between 80 and 85 (from a maximum 100) and nearly $53 million in total savings (or 11% of expected expenditure), making MHACO one of the most successful nationally.1 In fewer than 5 years, almost 500 ACOs have developed, and by some estimates, a quarter of Medicare patients are currently enrolled in an ACO. Although ACOs to date have focused on primary care, the future will increasingly involve specialists. At Memorial Hermann, neurosurgeons took an early role in forming collaborative partnerships with the hospital, and started programs that served as precursors to the ACO model. This paper ends with an overview of ACO development, likely changes going forward, and a discussion of the role of specialists in general, and of neurosurgeons in particular.
Subject(s)
Accountable Care Organizations , Neurosurgery , Patient Protection and Affordable Care Act , Professional Role , Humans , United StatesABSTRACT
BACKGROUND: Zn-deficiency has been associated with numerous alterations during pregnancy including low birth weight; however, the research relating neonatal zinc status and birth weight has not produced reliable results. OBJECTIVE: To compare the serum Zn-levels of cord blood in healthy newborns and low birth weight newborns, and to assess a possible relationship between zinc concentration and neonatal birth weight and gestational age. MATERIAL AND METHODS: 123 newborns divided in "study group" (n=50) with <2500g birth weight neonates and "control group" (n=73) with ≥2500g birth weight neonates were enrolled. Study group was subdivided according to gestational age in preterm (<37 weeks) and full-term (≥37 weeks). Serum cord blood samples were collected and the Zn-levels were analyzed using flame Atomic Absorption Spectrophotometry method and the result was expressed in µmol/L. The Zn-levels were compared between the groups (Mann-Whitney-U test) and the Zn-levels were correlated with the birth weight and gestational age (Spearman's rank correlations). RESULTS: Statistically significant low positive correlation between Zn-levels and birth weight (ρ=0.283; p=0.005) was found. No statistically significant difference between Zn-levels of study and control groups [17.00±0.43 vs. 18.16±0.32 (p=0.053)] was found. Statistically significant low positive correlation between Zn-levels and gestational age (ρ=0.351; p=0.001) was found. No statistically significant difference between Zn-levels of preterm as compare to full-term newborns [16.33±0.42 vs. 18.43±0.93 (p=0.079)] was found. Zn-level of preterm subgroup was significantly lower compared to control group (p=0.001). CONCLUSIONS: Despite low birth weight preterm neonates had significantly lower serum zinc levels of cord blood than healthy term neonates, the correlation between cord blood zinc levels and birth weight and gestational age was lower. The results are not enough to relate the change in cord blood zinc concentration to the birth weight values or gestational period. In relation to complicated pregnancies, further studies regarding zinc levels in blood in our population are required.
Subject(s)
Birth Weight , Fetal Blood/metabolism , Gestational Age , Zinc/blood , Adult , Female , Humans , Infant, Newborn , Pregnancy , Statistics, NonparametricABSTRACT
El documento proporciona de una forma sencilla la definición del concepto de la calidad de la atención, así como del "paquete mínimo" y las actividades para el primer de atención y hospitales de referencia, tambien da una explicación de la estrategia de implementación del sistema integrado de servicios de salud
Subject(s)
Basic Health Services , Decision Making , Efficiency, Organizational , Health Services Accessibility , Community Participation , Quality of Health Care , Health StrategiesABSTRACT
Estudio de tipo descriptivo y de corte transversal. Se investigaron los fármacos consumidos durante su embarazo en las madres con partos atendidos en el hospital Bertha Calderón en agosto de 1990. La muestra fueron 583 mujeres a las que se les atendió su parto en este período, la información se recogió durante una entrevista basada en un cuestionario que cada madre contestó en las 48 horas post-parto. Los resultados indican que el número de mujeres con antecedentes patologicos fue bajo del 7.3 por ciento y en su mayoría consumieron fármacos por causas patologicos. El 15 por ciento no consumió ningún fármaco y el fármaco de mayor riesgo fue la aspirina y la alka seltzer, encontrandose relación entre el consumo de los medicamentos y del recien nacido.
