Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes

Objective To investigate the impact of factors outside the control of primary care on performance indicators proposed as measures of the quality of primary care. Design Multiple regression analysis relating admission rates standardised for age and sex for asthma, diabetes, and epilepsy to socioeconomic population characteristics and to the supply of secondary care resources. Setting 90 family health services authorities in England, 1989-90 to 1994-5. Results At health authority level socioeconomic characteristics, health status, and secondary care supply factors explained 45% of the variation in admission rates for asthma, 33% for diabetes, and 55% for epilepsy. When health authorities were ranked, only four of the 10 with the highest age-sex standardised admission rates for asthma in 1994-5 remained in the top 10 when allowance was made for socioeconomic characteristics, health status, and secondary care supply factors. There was also substantial year to year variation in the rates. Conclusion Health outcomes should relate to crude rates of adverse events in the population. These give the best indication of the size of a health problem. Performance indicators, however, should relate to those aspects of care which can be altered by the staff whose performance is being measured

A systematic review of criteria used to report complications in soft tissue and oncologic surgical clinical research studies in dogs and cats.

ObjectiveTo evaluate reporting of surgical complications and other adverse events in clinical research articles describing soft tissue and oncologic surgery in dogs and cats.Study designSystematic literature review.SampleEnglish-language articles describing soft tissue and oncologic surgeries in client-owned dogs and cats published in peer-reviewed journals from 2013 to 2016.MethodsCAB, AGRICOLA, and MEDLINE databases were searched for eligible articles. Article characteristics relevant to complications were abstracted and summarized, including reported events, definitions, criteria used to classify events according to severity and time frame, and relevant citations.ResultsOne hundred fifty-one articles involving 10 522 animals were included. Canine retrospective case series of dogs predominated. Ninety-two percent of articles mentioned complications in study results, but only 7.3% defined the term complication. Articles commonly described complications according to time frame and severity, but terminology and classification criteria were highly variable, conflicting between studies, or not provided. Most (58%) reported complications could have been graded with a published veterinary adverse event classification scheme, although common intraoperative complications were notable exceptions.ConclusionDefinitions and criteria used to classify and report soft tissue and oncologic surgical complications are often absent, incomplete, or contradictory among studies.Clinical significanceLack of consistent terminology contributes to inadequate communication of important information about surgical complications. Standardization of terminology and consistency in severity scoring will improve comparative evaluation of clinical research results

The Christmas 2018 eruption at Mt. Etna: enlightening how the volcano factory works through a multi‐parametric inspection

The 24–27 December 2018 flank eruption at Mount Etna (Southern Italy) has been investigated through a multidisciplinary approach in which olivine chemical zoning and diffusion chronometry data were integrated with models inferred by GNSS (Global Navigation Satellite System) measurements. Inspection of the olivine chemical zoning from core to rim allowed the identification of some dominant ways of transfer and interaction between magmas pertaining to different magmatic environments. Most of crystal cores are representative of crystallization at pressure of 290–230 and 160–120 MPa. Olivine rims suggest re‐equilibration at shallow pressure (≤30 MPa). Geodetic‐based models indicate pressurization of near‐vertical prolate spheroidal sources centered at ∼7.2 km below sea level (bsl) between 9 June 2017 and 28 June 2018 and later at ∼5.1 km bsl between 28 June 2018 and the eruption onset. Geodetic data also highlight a change in the inflation rate since late June 2018 and later around November 2018, which has been here related to both replenishment phases and magma uprising across the plumbing system. Timescales of magma replenishment are in agreement with prolonged recharge from deep levels upward to shallow environments started about 6 months before the eruption, with further replenishment involving the upper magmatic environments just 3–16 days before the eruption. At present, the eruptive activity at the volcano is primarily controlled by pressure imbalances affecting extensive sections of the plumbing system, with possibility to develop persistent eruptive activity at the summit versus flank eruptions depending on fortuitous interruptions of the steady magma recharge/discharge rate at shallow levels

Studying the evolution of AGB stars in the Gaia epoch

We present asymptotic giant branch (AGB) models of solar metallicity, to allow the interpretation of observations of Galactic AGB stars, whose distances should be soon available after the first release of the Gaia catalogue. We find an abrupt change in the AGB physical and chemical properties, occurring at the threshold mass to ignite hot bottom burning,i.e. $3.5M_{\odot}$. Stars with mass below $3.5 M_{\odot}$ reach the C-star stage and eject into the interstellar medium gas enriched in carbon , nitrogen and $^{17}O$. The higher mass counterparts evolve at large luminosities, between $3\times 10^4 L_{\odot}$ and $10^5 L_{\odot}$. The mass expelled from the massive AGB stars shows the imprinting of proton-capture nucleosynthesis, with considerable production of nitrogen and sodium and destruction of $^{12}C$ and $^{18}O$. The comparison with the most recent results from other research groups are discussed, to evaluate the robustness of the present findings. Finally, we compare the models with recent observations of galactic AGB stars, outlining the possibility offered by Gaia to shed new light on the evolution properties of this class of objects.Comment: 21 pages, 11 figure, 3 tables, accepted for publication in MNRAS (2016 July 11

The HMGB1/RAGE pro-inflammatory axis in the human placenta: Modulating effect of low molecular weight heparin

We evaluated whether physiological and pre-eclamptic (PE) placentae, characterized by exacerbated inflammation, presented alterations in pro-inflammatory High Mobility Group Box 1 (HMGB1) and its Receptor of Advanced Glycation End products (RAGE) expression. Moreover, we investigated, in physiological placental tissue, the ability of Low Molecular Weight Heparin (LMWH) to modify HMGB1 structural conformation thus inhibiting RAGE binding and HMGB1/RAGE axis inflammatory activity. HMGB1, RAGE, IL-6 and TNFα (HMGB1/RAGE targets) mRNA expression were assessed by Real Time PCR. HMGB1, RAGE protein levels were assessed by western blot assay. Physiological term placental explants were treated by 0.5 U LMWH for 24 or 48 h. HMGB1 and RAGE expression and association were evaluated in LMWH explants by RAGE immunoprecipitation followed by HMGB1 immunoblot. HMGB1 spatial localization was evaluated by immuofluorescent staining (IF). HMGB1 expression was increased in PE relative to physiological placentae while RAGE was unvaried. 24 h LMWH treatment significantly up-regulated HMGB1 expression but inhibited HMGB1/RAGE complex formation in physiological explants. RAGE expression decreased in treated relative to untreated explants at 48 h. IF showed HMGB1 localization in both cytoplasm and nucleus of mesenchymal and endothelial cells but not in the trophoblast. IL-6 and TNFα gene expression were significantly increased at 24 h relative to controls, while they were significantly down-regulated in 48 h vs. 24 h LMWH explants. Our data depicted a new molecular mechanism through which LMWH exerts its anti-inflammatory effect on PE placentae, underlying the importance of HMGB1/RAGE axis in PE inflammatory response

BEHAVIOUR OF Aeromonas hydrophila IN SALTED SWORDFISH SAMPLES

A challenge test for Aeromonas hydrophila in salted swordfish samples was carried out. Particularly, 24 samples (250g) were experimentally contaminated, salted and stored at two different temperature regimes (fluctuating – F group - and non fluctuating – NF group – regime). The count of A. hydrophila, Enterobacteria and Lactic acid bacteria (LAB) as well as the determination of pH and aw were performed at 0, 19 43, 163, 187, 230, 320 and 368 hours whereas the temperature was monitored continuously by using 6 data-loggers. In both group, the mean concentrations of A. hydrophila did not exceed Log 3 cfu/g and decreased below the mean value of Log 1 cfu/g after 368 hours. However in the F group the A. hydrophila growth was slower and the decrease appeared slightly higher than NF group and this suggests the temperature fluctuations induces a more pronounced behaviour variability of A. hydrophila under stressing conditions

Like-Triple Diabetes as First Manifestation of MODY2 in an Overweight Teenager With Transient Multiple Antibodies. Diabetes Care 2014; 37: e66-e67

Ctr Referencia Estadual Assistencia Ao Diabet & E, Salvador, BA, BrazilUniversidade Federal de São Paulo, Ctr Diabet, São Paulo, BrazilUniversidade Federal de São Paulo, Ctr Diabet, São Paulo, BrazilWeb of Scienc

Donkey milk fermentation by lactococcus lactis subsp. Cremoris and lactobacillus rhamnosus affects the antiviral and antibacterial milk properties

Background: Milk is considered an important source of bioactive peptides, which can be produced by endogenous or starter bacteria, such as lactic acid bacteria, that are considered effective and safe producers of food-grade bioactive peptides. Among the various types of milk, donkey milk has been gaining more and more attention for its nutraceutical properties. Methods: Lactobacillus rhamnosus 17D10 and Lactococcus lactis subsp. cremoris 40FEL3 were selected for their ability to produce peptides from donkey milk. The endogenous peptides and those obtained after bacterial fermentation were assayed for their antioxidant, antibacterial, and antiviral activities. The peptide mixtures were characterized by means of LC-MS/MS and then analyzed in silico using the Milk Bioactive Peptide DataBase. Results: The peptides produced by the two selected bacteria enhanced the antioxidant activity and reduced E. coli growth. Only the peptides produced by L. rhamnosus 17D10 were able to reduce S. aureus growth. All the peptide mixtures were able to inhibit the replication of HSV-1 by more than 50%. Seventeen peptides were found to have 60% sequence similarity with already known bioactive peptides. Conclusions: A lactic acid bacterium fermentation process is able to enhance the value of donkey milk through bioactivities that are important for human health