National quality and performance system for Divisions of General Practice: early reflections on a system under development

Governments are increasingly introducing performance management systems to improve the quality and outcomes of health care. Two types of approaches have been described: assurance systems that use summative information for external accountability and internally driven systems that use formative information for continuous quality improvement. Australia recently introduced a National Quality and Performance System (NQPS) for Divisions of General Practice that has the dual purposes of increasing accountability and improving performance. In this article, we ask whether the framework can deliver on its objectives for achieving accountability and fostering performance improvement. We examine the system in terms of four factors identified in a recent systematic review of indicator systems known to improve their use. These are: involving stakeholders in development; having clear objectives; approach to data collection and analysis including using 'soft data' to aid interpretation; and feeding back information. RESULTS: We found that early consultative processes influenced system development. The system promotes the collection of performance information against defined program objectives. Data includes a mix of qualitative and quantitative indicators that are fitted to a conceptual framework that facilitates an approach to performance assessment that could underpin continuous quality improvement at the Division level. Feedback of information to support the development of quality improvement activities has not been fully developed. CONCLUSION: The system currently has elements that, with further development, could support a more continuous quality improvement or assurance based approach. Careful consideration needs to be given to the development of methods for analysis and review of performance indicators, performance assessment and engagement with consumers. The partnership arrangement that supported early development could be expected to serve as an important vehicle for further development

Infographic. All health professionals should talk about physical activity with patients

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Tumor Response to Combination Celecoxib and Erlotinib Therapy in Non-small Cell Lung Cancer Is Associated with a Low Baseline Matrix Metalloproteinase-9 and a Decline in Serum-Soluble E-Cadherin

IntroductionCyclooxygenase-2 overexpression may mediate resistance to epidermal growth factor receptor tyrosine kinase inhibition through prostaglandin E2-dependent promotion of epithelial to mesenchymal transition (EMT). Suppression of epithelial markers, such as E-cadherin, can lead to resistance to erlotinib. Prostaglandin E2 down-regulates E-cadherin expression by up-regulating transcriptional repressors, including ZEB1 and Snail. Furthermore, E-cadherin can be modulated by matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs), promoting tumor invasion and metastasis. Markers of EMT and tumor invasion were evaluated in patient serum from a phase I clinical trial investigating the combination of celecoxib and erlotinib in non-small cell lung cancer (NSCLC) patients.MethodsSamples from 22 subjects were evaluated. Soluble E-cadherin (sEC) was evaluated by enzyme linked immunosorbent assay in patient serum at baseline, week 4, and week 8 of treatment. Other markers of EMT and angiogenesis were evaluated by enzyme linked immunosorbent assay, including MMP-9, TIMP-1, and CCL15.ResultsSerum sEC, MMP-9, TIMP-1, and CCL15 levels were determined at baseline and week 8. Patients with a partial response to therapy had a significant decrease in sEC, TIMP-1, and CCL15 at week 8. In patients who responded to the combination therapy, baseline MMP-9 was significantly lower compared with nonresponders (p = 0.006).ConclusionssEC, MMP-9, TIMP-1, and CCL15 levels correlate with response to combination therapy with erlotinib and celecoxib in patients with NSCLC. A randomized phase II trial is planned comparing erlotinib and celecoxib with erlotinib plus placebo in advanced NSCLC. This study will prospectively assess these and other biomarkers in serum and tumor tissue

A Community-Building Framework for Collaborative Research Coordination across the Education and Biology Research Disciplines

Since 2009, the U.S. National Science Foundation Directorate for Biological Sciences has funded Research Coordination Networks (RCN) aimed at collaborative efforts to improve participation, learning, and assessment in undergraduate biology education (UBE). RCN-UBE projects focus on coordination and communication among scientists and educators who are fostering improved and innovative approaches to biology education. When faculty members collaborate with the overarching goal of advancing undergraduate biology education, there is a need to optimize collaboration between participants in order to deeply integrate the knowledge across disciplinary boundaries. In this essay we propose a novel guiding framework for bringing colleagues together to advance knowledge and its integration across disciplines, the “Five ‘C’s’ of Collaboration: Commitment, Collegiality, Communication, Consensus, and Continuity.” This guiding framework for professional network practice is informed by both relevant literature and empirical evidence from community-building experience within the RCN-UBE Advancing Competencies in Experimentation–Biology (ACE-Bio) Network. The framework is presented with practical examples to illustrate how it might be used to enhance collaboration between new and existing participants in the ACE-Bio Network as well as within other interdisciplinary networks

Spatial variation in avian bill size is associated with humidity in summer among Australian passerines

Background: Climate imposes multiple selection pressures on animal morphology. Allen&rsquo;s Rule proposes thatgeographic variation in the appendage size of endotherms, relative to body size, is linked to climatic variation,thereby facilitating heat exchange and body temperature regulation. Thus relatively larger appendages tend to befound in animals in warmer climates. Despite growing understanding of the role of the avian bill as an organ forheat exchange, few studies have tested the ecological significance of bill size for heat dissipation across speciesand environmental gradients. Amongst those that have, most have focused on the relationship with ambienttemperature, but there is growing evidence that humidity also has a strong influence on heat dissipation. Inparticular, increasing humidity reduces the potential for evaporative cooling, favouring radiative and convectiveheat loss via the bill, and hence potentially favouring larger bills in humid environments. Here, we usedphylogenetically-controlled analyses of the bill morphology of 36 species of Australian passerines to explore therelationship between bill size and multiple aspects of climate.Results: Humidity during the hot summer months (December-February) was positively associated with relative billsurface area across species. There was no overall association between bill size and summer temperatures per se, butthe association with humidity was mediated by temperature, with a significant interaction indicating strongerassociations with humidity at cooler summer temperatures. This is consistent with the idea that larger bills maybecome disadvantageous in humid conditions as ambient temperature approaches body temperature. Relative billsize was similar among closely related species, with phylogeny explaining 63.3% of the variance, and there wassignificant variation among species in their response to humidity. However, the relationship between relative billsize and humidity was not associated with phylogeny.Conclusions: Our results are consistent with the idea that body temperature regulation underlies continent-widepatterns of bill size variation in a broad range of Australian passerines, and suggests that Allen&rsquo;s Rule may apply tohumidity gradients as well as temperature gradients. They add to growing evidence that a narrow focus ontemperature alone in studies of responses to climate change may limit our understanding of species&rsquo; sensitivities toclimatic variation, and of their capacity to adapt

The Basic Competencies of Biological Experimentation: Concept-Skill Statements

This biological experimentation competencies map is a model created by members of the ACE-Bio Network of seven areas a competent biologist calls in when doing experimentation in biology. Each competency is represented by a summary word on a uniquely colored segment of the model. For presentation convenience, the seven major areas within experimentation in biology are mapped onto tables in a linear manner. However, this is not meant to convey a particular order that one must follow during experimentation. The areas are given equal weight and flexible order of their use throughout the process of experimentation. This work is meant to provide a framework for ACE Bio Network participants and other instructors or academic leaders in the biological sciences to study implementation of experimentation activities and assessments across diverse institutional and curricular contexts. In addition to the document in pdf format, another link provides the file in MSWord format so that users can easily modify it to guide assessment of student learning about experimentation, undergraduate biology instruction, curriculum development, professional faculty development, program evaluation, or review of research literature in a way that is appropriate to their own context