Marketing Digital y Captación de Clientes en el Estudio Jurídico IUSTITIA LEGALIS S.A.C., Callao - 2019

La presente investigación titulada “Marketing Digital y Captación de Clientes en el Estudio Jurídico IUSTITIA LEGALIS S.A.C., Callao - 2019”, tuvo como objetivo general Determinar el nivel de relación que existe entre el marketing digital y captación de clientes en el Estudio Jurídico IUSTITIA LEGALIS S.A.C., Callao - 2019, el cual dará respuesta a la interrogante ¿Cuál es el nivel de relación del marketing digital con la captación de clientes en el Estudio Jurídico IUSTITIA LEGALIS S.A.C., Callao – 2019?. Esta investigación se realizó mediante el método hipotético deductivo con un enfoque cuantitativo, el nivel fue descriptivo correlacional, el tipo fue aplicada y técnica, y se utilizó el diseño de corte transversal. No experimental. Asimismo, se tomó como muestra a 80 clientes de la empresa, para la recolección de datos se utilizó como instrumento el cuestionario, el cual estuvo compuesto por 35 ítems en medición de la escala de Likert, luego de ello se midió el nivel de confiabilidad con el Alfa de Cronbach, teniendo como resultado aceptable. La investigación continuó desarrollándose, obteniendo en la prueba de normalidad de Kolmogorov Smirnova un valor de significancia de 0.00; por ende, lo datos no tienen una distribución normal; por ultimo para medir el nivel de correlación de la V1 y la V2, se usó la prueba de Rho de Spearman, el cual los resultados serán mostrados en la investigación, por lo tanto la investigación concluye dando a conocer que existe una correlación positiva entre las variables Marketing Digital y Captación de Clientes en el Estudio Jurídico IUSTITIA LEGALIS S.A.C., Callao – 2019

Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State

Background Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance. Methods We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus. Results Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation. Conclusions Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets and addressing conditions for innovation

Identifying nonalcoholic fatty liver disease patients with active fibrosis by measuring extracellular matrix remodeling rates in tissue and blood.

Excess collagen synthesis (fibrogenesis) in the liver plays a causal role in the progression of nonalcoholic fatty liver disease (NAFLD). Methods are needed to identify patients with more rapidly progressing disease and to demonstrate early response to treatment. We describe here a novel method to quantify hepatic fibrogenesis flux rates both directly in liver tissue and noninvasively in blood. Twenty-one patients with suspected NAFLD ingested heavy water (2 H2 O, 50-mL aliquots) two to three times daily for 3-5 weeks prior to a clinically indicated liver biopsy. Liver collagen fractional synthesis rate (FSR) and plasma lumican FSR were measured based on 2 H labeling using tandem mass spectrometry. Patients were classified by histology for fibrosis stage (F0-F4) and as having nonalcoholic fatty liver or nonalcoholic steatohepatitis (NASH). Magnetic resonance elastography measurements of liver stiffness were also performed. Hepatic collagen FSR in NAFLD increased with advancing disease stage (e.g., higher in NASH than nonalcoholic fatty liver, positive correlation with fibrosis score and liver stiffness) and correlated with hemoglobin A1C. In addition, plasma lumican FSR demonstrated a significant correlation with hepatic collagen FSR.ConclusionUsing a well-characterized cohort of patients with biopsy-proven NAFLD, this study demonstrates that hepatic scar in NASH is actively remodeled even in advanced fibrosis, a disease that is generally regarded as static and slowly progressive. Moreover, hepatic collagen FSR correlates with established risks for fibrotic disease progression in NASH, and plasma lumican FSR correlates with hepatic collagen FSR, suggesting applications as direct or surrogate markers, respectively, of hepatic fibrogenesis in humans. (Hepatology 2017;65:78-88)

Sexual Orientation/Gender Identity, Socioeconomic Status, and Health across the Life Course (SOGI-SES) User Guide: Study Overview

The Sexual Orientation/Gender Identity, Socioeconomic Status, and Health across the Life Course Study (SOGI-SES) collected new survey data to support exploration of the relationships among sexual orientation, gender identity, gender expression, same-sex romantic and sexual behaviors, socioeconomic status, and health. The study was designed and conducted under the direction of the co-PIs, Carolyn T. Halpern from the Carolina Population Center (CPC) at the University of North Carolina at Chapel Hill and Kerith J. Conron from the Williams Institute at the University of California Los Angeles (UCLA). SOGI-SES is funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute on Minority Health and Health Disparities (Grant numbers: 1R01HD087365 and R01 HD087365-03S1)

Third Annual Families and Neighborhoods Network Update

Welcome to the Third Annual Families and Neighborhoods Network Update. In this edition, which focuses on Family Development, you'll find plenty of relevant, interesting news, as well as diversity and spirituality in the context of family development.As always, we strive to provide information and resources regarding human service efforts that support families and neighborhoods. The selection of information and articles for this issue of the Network Update was based on issues raised by the seven Comprehensive Community-BasedModels (CCBMs).Among the highlights of this issue is an article by Dr. Susan Stern and Cassandra Clay, professors at Boston University School of Social Work. In their article, titled "Supporting Children and Families in a Caring Community," they challenge our thinking about family development, while guiding practitioners, policymakers, fund providers, and grassroots community-based organizations into the next century.Also in this issue, you'll find two annotated bibliographies that explore community-based, family centered strategies for integrating education and human services. These bibliographies also present practical ways to design policies that reflect the importance of the family in the development of children and society. As an additional resource, you'll also find a directory of federally-funded resource centers and clearinghouses that compile information on child andfamily welfare, health, and education issues.This issue of the Network Update also offers a personal glimpse of the seven W.K. Kellogg Foundation-funded family development sites. Each of the sites was asked to share its definition of family development, and to specify how that definition translates into services or opportunities for families. Staff members at the seven sites also were asked to discuss their philosophies about family development and how that philosophy differs from a mainstream view. Their thought provoking answers are just a few pages away

Effect of police enforcement and extreme social inequalities on violence and mental health among women who sell sex: findings from a cohort study in London, UK

OBJECTIVES: To examine legal and social determinants of violence, anxiety/depression among sex workers. METHODS: A participatory prospective cohort study among women (inclusive of transgender) ≥18 years, selling sex in the last 3 months in London between 2018 and 2019. We used logistic generalised estimating equation models to measure associations between structural factors on recent (6 months) violence from clients or others (local residents, strangers), depression/anxiety (Patient Health Questionnaire-4). RESULTS: 197 sex workers were recruited (96% cisgender-women; 46% street-based; 54% off-street) and 60% completed a follow-up questionnaire. Street-based sex workers experienced greater inequalities compared with off-street in relation to recent violence from clients (73% vs 36%); police (42% vs 7%); intimate partner violence (IPV) (56% vs 18%) and others (67% vs 17%), as well as homelessness (65% vs 7%) and recent law enforcement (87% vs 9%). Prevalence of any STI was 17.5% (17/97). For street-based sex workers, recent arrest was associated with violence from others (adjusted OR (aOR) 2.77; 95% CI 1.11 to 6.94) and displacement by police was associated with client violence (aOR 4.35; 95% CI 1.36 to 13.90). Financial difficulties were also associated with client violence (aOR 4.66; 95% CI 1.64 to 13.24). Disability (aOR 3.85; 95% CI 1.49 to 9.95) and client violence (aOR 2.55; 95% CI 1.10 to 5.91) were associated with anxiety/depression. For off-street sex workers, financial difficulties (aOR 3.66; 95% CI 1.64 to 8.18), unstable residency (aOR 3.19; 95% CI 1.36 to 7.49), IPV (aOR 3.77; 95% CI 1.30 to 11.00) and alcohol/drug use were associated with client violence (aOR 3.16; 95% CI 1.26 to 7.92), while always screening and refusing clients was protective (aOR 0.36; 95% CI 0.15 to 0.87). Disability (aOR 5.83; 95% CI 2.34 to 14.51), unmet mental health needs (aOR 3.08; 95% CI 1.15 to 8.23) and past eviction (aOR 3.99; 95% CI 1.23 to 12.92) were associated with anxiety/depression. CONCLUSIONS: Violence, anxiety/depression are linked to poverty, unstable housing and police enforcement. We need to modify laws to allow sex workers to work safely and increase availability of housing and mental health services

Clinicians Reflect on COVID-19: Lessons Learned and Looking Beyond

As a result of the unprecedented COVID-19 pandemic, clinical faculty had to abruptly adapt their clinical teaching and case supervision practices to adjust to the myriad restrictions brought on by the pandemic. This brought specialized challenges for clinicians who uniquely serve as both legal practitioners and law teachers in the law school setting. With little support and guidance, clinicians tackled never before seen difficulties in the uncharted waters of running a clinical law practice during a pandemic. In this report, we review the responses of 220 clinicians to survey questions relating to how law clinics and clinicians were treated by their institutions as they navigated these changes. Were clinical courses treated differently than other courses? Were clinical faculty treated differently than other faculty? Were some clinical courses treated differently than others? Did clinical faculty and staff experience pressure by their institutions to teach in-person or hybrid courses? In addition to summarizing the findings to these questions, this report examines the disparate impact of the COVID-19 pandemic on clinicians and sheds light on some of the distinct challenges they faced. The report concludes with a list of recommended actions that law schools may take to equip themselves to provide appropriate support for clinical faculty during inevitable future emergencies, emphasizing the importance of autonomy and discretion for clinicians; specialized attention for diverse and vulnerable clinicians; and the very serious ethical and legal obligations of clinical law practices

Sunburns and Sun Protection Behaviors among Male Hispanic Outdoor Day Laborers

Individuals who work outside are at increased risk for skin cancer due to excessive exposure to ultraviolet (UV) radiation. Little is known about UV exposures and sun safety practices of outdoor day laborers, who are disproportionately Hispanic. This study identified the correlates of sunburn and sun protection behaviors in a sample of male, Hispanic day laborers (n = 175). More than half of the participants (54.9%) experienced one or more sunburns when working during the past summer, and 62.9% reported having one or more symptoms of heat illness. The frequency of engaging in sun protection behaviors was suboptimal, including sunglasses use (M = 2.68, SD = 1.71), staying in the shade (M = 2.30, SD = 0.94), wearing sunscreen (M = 2.10, SD = 1.39), and wearing a wide-brimmed hat (M = 1.75, SD = 1.32), based on a 5-point scale (1 = never; 5 = always). Lower education level, higher levels of skin sensitivity to the sun, any symptom of heat illness, fewer barriers to wearing a wide-brimmed hat, and not wearing a wide-brimmed hat were associated with a greater number of sunburns. Factors associated with each sun protection behavior varied. Implications and directions for future research are discussed