Shadows on the wall: memory and premonition in Berioʼs Cronaca del Luogo

Berio's musical action Cronaca del Luogo ("Chronicle of the Place") was commissioned for the Salzburg festival, and premiered at the Felsenreitschule on 24 July 1999. The libretto was compiled from a wide variety of sources by Berio's wife, Talia Pecker Berio

An intraorganizational model for developing and spreading quality improvement innovations

BACKGROUND Recent policy reforms encourage quality improvement (QI) innovations in primary care, but practitioners lack clear guidance regarding spread inside organizations. PURPOSE We designed this study to identify how large organizations can facilitate intraorganizational spread of QI innovations. METHODOLOGY/APPROACH We conducted ethnographic observation and interviews in a large, multispecialty, community-based medical group that implemented three QI innovations across 10 primary care sites using a new method for intraorganizational process development and spread. We compared quantitative outcomes achieved through the group's traditional versus new method, created a process model describing the steps in the new method, and identified barriers and facilitators at each step. FINDINGS The medical group achieved substantial improvement using its new method of intraorganizational process development and spread of QI innovations: standard work for rooming and depression screening, vaccine error rates and order compliance, and Pap smear error rates. Our model details nine critical steps for successful intraorganizational process development (set priorities, assess the current state, develop the new process, and measure and refine) and spread (develop support, disseminate information, facilitate peer-to-peer training, reinforce, and learn and adapt). Our results highlight the importance of utilizing preexisting organizational structures such as established communication channels, standardized roles, common workflows, formal authority, and performance measurement and feedback systems when developing and spreading QI processes inside an organization. In particular, we detail how formal process advocate positions in each site for each role can facilitate the spread of new processes. PRACTICE IMPLICATIONS Successful intraorganizational spread is possible and sustainable. Developing and spreading new QI processes across sites inside an organization requires creating a shared understanding of the necessary process steps, considering the barriers that may arise at each step, and leveraging preexisting organizational structures to facilitate intraorganizational process development and spread.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially

Timing of Delivery and Adverse Outcomes in Term Singleton Repeat Cesarean Deliveries

To compare the maternal and neonatal risks of elective repeat cesarean delivery compared with pregnancy continuation at different gestational ages, starting from 37 weeks

Association of Polymorphisms in Neuroprotection and Oxidative Stress Genes and Neurodevelopmental Outcomes After Preterm Birth

To estimate the associations between neuronal homeostasis, neuroprotection, and oxidative stress candidate gene polymorphisms and neurodevelopmental disability

Effect of Antenatal Corticosteroids on Respiratory Morbidity in Singletons After Late-Preterm Birth

To evaluate whether neonates born to women who had previously received antenatal corticosteroids and then delivered a late-preterm birth neonate had less respiratory morbidity compared with those unexposed to antenatal corticosteroids

Diagnosing Gestational Diabetes Mellitus: Use of a Glucose Screen Without Administering the Glucose Tolerance Test

OBJECTIVETo determine if a 1-hour glucose screen value could be identified, above which gestational diabetes mellitus could be diagnosed without the 3-hour oral glucose tolerance test (GTT). METHODSDemographic, historic, obstetric, and neonatal data from 514 singleton pregnancies with glucose screen values at least 140 mg/dL followed by a GTT were reviewed (312 patients with normal GTTs and 202 with gestational diabetes mellitus). Statistical analyses used χ, Fisher exact, Student t, and Mann-Whitney tests. After determining the optimal glucose screen cutoff point using receiver operating characteristic curve analyses, patients were regrouped according to this value and analyzed further. RESULTSThe optimal cutoff point for the upper limit of the glucose screen was determined to be 186 mg/dL (95.9% specificity, 98.2% negative predictive value, 36.1% sensitivity, and 19.6% positive predictive value). Comparison of patients with elevated screens and normal GTTs versus those with gestational diabetes revealed significant differences only regarding a history of gestational diabetes mellitus and neonatal hypoglycemia in the studied pregnancy. Those with screens greater than 185 mg/dL behaved like diabetic patients and, when compared with subjects with screens of 140–185 mg/dL, also had a significantly greater proportion of large for gestational age infants. CONCLUSIONPatients with 1-hour glucose screens greater than 185 mg/dL have a high probability of gestational diabetes mellitus and the diagnosis can be made without the GTT. Using this approach could allow prompt initiation of therapy without the inconvenience and discomfort of the GTT

Congenital Syphilis: The University of Miami/Jackson Memorial Medical Center Experience, 1986-1988

Between January 1, 1986 and July 1, 1988, 56 cases of congenital syphilis were identified at the University of Miami/Jackson Memorial Medical Center. The overall rate was 18.4 cases per 10,000 births, with a threefold increase found from 1986 to 1988. A case-control study using matched pairs was done to identify differences in maternal demographics and pregnancy outcome. Congenital syphilis case mothers were predominantly black American women who lacked prenatal care (67%) and who were substance abusers (71%) significantly more often than their matched controls (P<.005). Three cases of seroconversion in pregnancy were identified. Failure to screen or inappropriate treatment occurred in four patients. Seven women were treated during pregnancyFive received benzathine penicillin G for 3 consecutive weeks and two received erythromycin. All treated patients presented for initial care in the late second or third trimester. Thirty-seven infants (66%) were live-born and 19 (34%) were stillborn. Preterm labor and premature rupture of the membranes were significantly more common in infected pregnancies than in controls (P<.005). Live born case infants had significantly lower birth weights than controls (P<.005), with 21% of case infants growth retarded. Seven neonatal deaths and one infant death occurred. The resultant perinatal mortality rate from congenital syphilis in this series was 464 per 100

Sitting Postures and Trunk Muscle Activity in Adolescents With and Without Nonspecific Chronic Low Back Pain

Study design. A cross-sectional comparative study of adolescents with non-specific chronic low back pain (NSCLBP) and healthy controls. Objective. To investigate whether 5 differences in spinal kinematic and trunk muscle activity exist in both usual and slump sitting in adolescents with NSCLBP. Summary of Background. Evidence suggests that low back pain (LBP) commonly develops in adolescence and increases the risk for LBP in adulthood. Sitting is an important consideration in adolescents with NSCLBP: currently there are no reports 10 investigating their motor control strategies in sitting. Methods. 28 adolescents (14 female) with NSCLBP and 28 matched pain-free controls were recruited from a large cohort study. Pain subjects were sub-classified based upon O’Sullivan’s classification system. Three dimensional lumbo-pelvic kinematic data and the activation of three back and two abdominal muscles were recorded during usual and 15 slump sitting. The flexion-relaxation phenomenon in sitting was also investigated. Results. Spinal posture in usual and slump sitting were similar for adolescents with and without NSCLBP. However, differences were identified in both sitting conditions when those with NSCLPB were sub-classified and compared to controls. Muscle activation differences were not consistently identified, with only lower levels of Internal Oblique 20 activation in usual sitting in NSCLBP compared to pain-free controls showing significance. Flexion relaxation was observed in both Iliocostalis and Thoracic Erector Spinae in the NSCLBP group but not controls. *Structured Abstract (300 words) 2 Conclusion. Differences with sitting posture are only seen when adolescents with NSCLBP are classified. Trunk muscle activation is not a sensitive marker for discriminating sub-25 groups of NSCLBP during adolescence.status: publishe

Intraligamentary Pregnancy

Intraligamentary pregnancy, although rare, tests the physicianʼs acumen in diagnostic and therapeutic skills. Two cases illustrating this entity are presented, the first involves an 18-week fetus, the second a partial hydatidiform mole. Although their presentation and pathogenesis may be indistinguishable, their clinical course and management is different. To the best of our knowledge, this is the first reported case of an intraligamentary pregnancy involving a partial hydatidiform mole