The Challenges of Capacity Building in the Aligning Forces for Quality Alliances

Summarizes the challenges and trade-offs in infrastructure and governance as well as stakeholder relations and participation, such as inclusive versus efficient decision making, in an alliance to coordinate regional healthcare improvement activities

Interpreting and Reporting Results Based on Patient-Reported Outcomes

AbstractThis article deals with the incorporation of patient-reported outcomes (PROs) into clinical trials and focuses on issues associated with the interpretation and reporting of PRO data. The primary focus and context of this information relates to the evidentiary support and reporting for a labeling or advertising claim of a PRO benefit for a new or approved pharmaceutical product. This manuscript focuses on issues associated with assessing clinical significance and common pitfalls to avoid in presenting results related to PROs. Specifically, the questions addressed by this manuscript involve: What are the best methods to assess clinical significance for PROs? How should investigators present PRO data most effectively in a Food and Drug Administration (FDA) application? In labeling or in a scientific publication? Guidelinesfor interpreting clinical significance of PROs and for comprehensively reporting on the methods, measures and results of clinical trials that incorporate PROs are important for clinicians, regulatory agencies, and most of all to patients. Clear specifications for considering a finding on a PRO measure, as clinically meaningful, need to be determined by instrument developers and psychometricians; they need to be reported for all clinical trials involving PRO end points. Clinical trial reports need to be comprehensive, clear, and sufficient to enable any reader to understand the methods, PRO measures, statistical analysis, and results

Analysis and Interpretation of Results Based on Patient-Reported Outcomes

AbstractThis article is part of a series of manuscripts dealing with the incorporation of patient-reported outcomes (PROs) into clinical trials. The issues dealt with in this manuscript concern the common pitfalls to avoid in statistical analysis and interpretation of PROs. Specifically, the questions addressed by this manuscript involve the analysis pitfalls with PRO data in clinical trials and how can they be avoided (e.g.,missing data, multiplicity, null results etc.). The manuscript provides key literature for existing resources and proposes new guidelines

Garbage Collection of Actors

This paper considers the garbage collection of concurrent objects for which it is necessary to know not only "reachability", the usual criterion for reclaiming data, but also the "state" (active or blocked) of the object. For the actor model, a more comprehensive definition than previously available is given for reclaimable actors. Two garbage collection algorithms, implementing a set of "coloring" rules, are presented and their computational complexity is analyzed. Extensions are briefly described to allow incremental, concurrent, distributed and real-time collection. It is argued that the techniques used for the actor model applies to other object-oriented concurrent models

Assessment of contaminant body burdens and histopathology of fish and shellfish species frequently used for subsistence food by Alaskan Native communities

Subsistence food items can be a health concern in rural Alaska because community members often rely on fish and wildlife resources not routinely monitored for persistent bioaccumulative contaminants and pathogens. Subsistence activities are a large part of the traditional culture, as well as a means of providing protein in the diets for Tribal members. In response to the growing concerns among Native communities, contaminant body burden and histopathological condition of chum and sockeye salmon (Oncorhynchus keta and Oncorhynchus nerka) and the shellfish cockles and softshell clams (Clinocardium nuttallii and Mya arenaria) were assessed. In the Spring of 2010, the fish and shellfish were collected from traditional subsistence harvest areas in the vicinity of Nanwalek, Port Graham, and Seldovia, AK, and were analyzed for trace metals and residues of organic contaminants routinely monitored by the NOAA National Status & Trends Program (NS&T). Additionally, the fish and shellfish were histologically characterized for the presence, prevalence and severity of tissue pathology, disease, and parasite infection. The fish and shellfish sampled showed low tissue contamination, and pathologic effects of the parasites and diseases were absent or minimal. Taken together, the results showed that the fish and shellfish were healthy and pose no safety concern for consumption. This study provides reliable chemistry and histopathology information for local resource managers and Alaska Native people regarding subsistence fish and shellfish use and management needs

Prehabilitative versus rehabilitative exercise in prostate cancer patients undergoing prostatectomy

Purpose: The study compared the efficacy of commencing supervised exercise in men with prostate cancer before and after prostatectomy on objective and patient-reported outcomes, hospital length of stay, and urinary incontinence. Methods: Forty-one men were randomised to a 6-week prehabilitation or rehabilitation exercise programme. Prehabilitation involved resistance and aerobic exercise thrice weekly pre-surgery, while rehabilitation comprised the same commencing 6-weeks post-surgery. Assessments included strength, function (chair rise, stair climb, 400-m, 6-m usual, fast, and backwards walk), body composition, fatigue and quality of life, undertaken at pre-surgery, early post-surgery and late post-surgery phase, with urinary incontinence (24-h pad test) assessed at 2, 6, and 12-weeks post-surgery. Intention-to-treat and sensitivity analyses were undertaken. Results: Of thirty-eight men (48–73 years), 29 completed all assessments with most undergoing robotic-assisted laparoscopic prostatectomy (92.1%). In the pre-surgery phase, prehabilitation improved muscle strength (leg press: 17.2 kg; chest press: 2.9 kg; p ≤ 0.001), 400-m, chair rise, 6-m fast and backward walk tests (p ≤ 0.001–0.028). Strength and function declines in the early post-surgery phase were maintained late post-surgery. Rehabilitation showed declines of these outcomes after surgery with improvement late post-surgery (leg press: 14.6 kg, p \u3c 0.001; chest press: 6.8 kg, p \u3c 0.001; 400-m walk: -12.0 s, p = 0.005), resulting in no difference between groups at 12 weeks. There were no significant differences between groups for patient-reported outcomes, hospital length of stay or urinary incontinence. Conclusion: Pre-surgical exercise enhanced strength and function, protecting against post-surgery declines. Although exercise post-surgery is beneficial for recouping strength and function, where possible men undergoing prostatectomy are encouraged to exercise pre-surgery. Trial registration: ACTRN12617001115325 registered 31 July 2017

Sample characterization of automobile and forklift diesel exhaust particles and comparative pulmonary toxicity in mice.

Two samples of diesel exhaust particles (DEPs) predominate in health effects research: an automobile-derived DEP (A-DEP) sample and the National Institute of Standards Technology standard reference material (SRM 2975) generated from a forklift engine. A-DEPs have been tested extensively for their effects on pulmonary inflammation and exacerbation of allergic asthmalike responses. In contrast, SRM 2975 has been tested thoroughly for its genotoxicity. In the present study, we combined physical and chemical analyses of both DEP samples with pulmonary toxicity testing in CD-1 mice to compare the two materials and to make associations between their physicochemical properties and their biologic effects. A-DEPs had more than 10 times the amount of extractable organic material and less than one-sixth the amount of elemental carbon compared with SRM 2975. Aspiration of 100 micro g of either DEP sample in saline produced mild acute lung injury; however, A-DEPs induced macrophage influx and activation, whereas SRM 2975 enhanced polymorphonuclear cell inflammation. A-DEPs stimulated an increase in interleukin-6 (IL-6), tumor necrosis factor alpha, macrophage inhibitory protein-2, and the TH2 cytokine IL-5, whereas SRM 2975 only induced significant levels of IL-6. Fractionated organic extracts of the same quantity of DEPs (100 micro g) did not have a discernable effect on lung responses and will require further study. The disparate results obtained highlight the need for chemical, physical, and source characterization of particle samples under investigation. Multidisciplinary toxicity testing of diesel emissions derived from a variety of generation and collection conditions is required to meaningfully assess the health hazards associated with exposures to DEPs. Key words: automobile, diesel exhaust particles, forklift, mice, pulmonary toxicity, SRM 2975

Interpreting and Reporting Results Based on Patient-Reported Outcomes

ABSTRACT This article deals with the incorporation of patient-reported outcomes (PROs) into clinical trials and focuses on issues associated with the interpretation and reporting of PRO data. The primary focus and context of this information relates to the evidentiary support and reporting for a labeling or advertising claim of a PRO benefit for a new or approved pharmaceutical product. This manuscript focuses on issues associated with assessing clinical significance and common pitfalls to avoid in presenting results related to PROs. Specifically, the questions addressed by this manuscript involve: What are the best methods to assess clinical significance for PROs? How should investigators present PRO data most effectively in a Food and Drug Administration (FDA) application? In labeling or in a scientific publication? Guidelinesfor interpreting clinical significance of PROs and for comprehensively reporting on the methods, measures and results of clinical trials that incorporate PROs are important for clinicians, regulatory agencies, and most of all to patients. Clear specifications for considering a finding on a PRO measure, as clinically meaningful, need to be determined by instrument developers and psychometricians; they need to be reported for all clinical trials involving PRO end points. Clinical trial reports need to be comprehensive, clear, and sufficient to enable any reader to understand the methods, PRO measures, statistical analysis, and results