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

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

Clinicopathological characteristics of histiocytic sarcoma affecting the central nervous system in dogs.

BackgroundHistiocytic sarcoma affecting the central nervous system (CNS HS) in dogs may present as primary or disseminated disease, often characterized by inflammation. Prognosis is poor, and imaging differentiation from other CNS tumors can be problematic.ObjectiveTo characterize the clinicopathological inflammatory features, breed predisposition, and survival in dogs with CNS HS.AnimalsOne hundred two dogs with HS, 62 dogs with meningioma.MethodsRetrospective case series. Records were reviewed for results of cerebrospinal fluid (CSF) analysis, CBC, treatment, and outcome data.ResultsPredisposition for CNS HS was seen in Bernese Mountain Dogs, Golden Retrievers, Rottweilers, Corgis, and Shetland Sheepdogs (P ≤ .001). Corgis and Shetland Sheepdogs had predominantly primary tumors; Rottweilers had exclusively disseminated tumors. Marked CSF inflammation was characteristic of primary rather than disseminated HS, and neoplastic cells were detected in CSF of 52% of affected dogs. Increased neutrophil to lymphocyte ratios were seen in all groups relative to controls (P <.008) but not among tumor subtypes. Definitive versus palliative treatment resulted in improved survival times (P < .001), but overall prognosis was poor.Conclusions and clinical importanceClinicopathological differences between primary and disseminated HS suggest that tumor biological behavior and origin may be different. Corgis and Shetland Sheepdogs are predisposed to primary CNS HS, characterized by inflammatory CSF. High total nucleated cell count and the presence of neoplastic cells support the use of CSF analysis as a valuable diagnostic test. Prognosis for CNS HS is poor, but further evaluation of inflammatory mechanisms may provide novel therapeutic opportunities

Monitoring Tropical Forest Recovery Capacity Using RADAR Satellite Images

Recent extreme droughts combined with accelerating human exploitation are pushing tropical forests to the point where they cannot recover, making them vulnerable to large unprecedented wildfires. This causes an urgent need to monitor the recovery capacity of tropical forests. While time series-based break detection approaches have demonstrated potential to measure tropical forest recovery capacity, they have not yet been applied over large amounts of satellite data. To address this challenge, the SURF computing infrastructure, i.e., the SPIDER cluster and the Sentinel-1 data cube prepared by the EODC GmbH was used. Those resources were available within the C-SCALE project as a part of a use case defined and designed together with EOSC experts. The provided resources were extremely useful for the RETURN use case. This aims at exploring time series of satellite radar (Sentinel-1) images from the EU Copernicus Earth Observation (EO) Programme to understand the recovery capacity of the Amazon rainforest. The outcomes of the RETURN research are important to help identify areas with slower forest recovery in the Amazon basin and potentially understand their causes

Intramedullary craniovertebral junction metastasis leading to the diagnosis of underlying renal cell carcinoma

Background: Intramedullary spinal cord metastases represent 4–8.5% of the central nervous system metastases and affect only 0.1–0.4% of all patients. Those originating from renal cell carcinoma (RCC) are extremely rare. Of the eight patients described in the literature with metastatic RCC and intramedullary cord lesion, only five were found in the cervical spine. Here, the authors add a 6th case involving an RCC intramedullary metastasis at the C1–C2 level. Case Description: A 78-year-old male patient presented with intermittent cervicalgia of 5 months duration accompanied by few weeks of a progressive severe right hemiparesis, up to hemiplegia. The magnetic resonance imaging (MRI) examination revealed an intramedullary expansive lesion measuring 10 mm×15 mm at the C1–C2 level; it readily enhanced with contrast. A total body computed tomography (CT) scan documented an 85 mm mass involving the right kidney, extending to the ipsilateral adrenal gland, and posteriorly infiltrating the ipsilateral psoas muscle. The subsequent CT-guided fine-needle biopsy confirmed the diagnosis of an RCC (Stage IV). The patient next underwent total surgical total removal of the C1–C2 intramedullary mass, following which he exhibited a slight motor improvement, with the right hemiparesis (2/5). He died after 14 months due to global RCC tumor progression. Conclusion: The present case highlights that a patient without a prior known diagnosis of RCC may present with an intramedullary C1–C2 metastasis. In such cases, global staging is critical to determine whether primary lesion resection versus excision of metastases (e.g., in this case, the C1–C2 intramedullary tumor) are warrante

Contextualized Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year after Discharge

Objective To evaluate the effect of providing a greater percentage of therapy as contextualized treatment on acute traumatic brain injury (TBI) rehabilitation outcomes. Design Propensity score methods are applied to the TBI-Practice-Based Evidence (TBI-PBE) database, a database consisting of multi-site, prospective, longitudinal observational data. Setting Acute inpatient rehabilitation. Participants Patients enrolled in the TBI-PBE study (n=1843), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, receiving their first IRF admission in the US, and consented to follow-up 3 and 9 months post discharge from inpatient rehabilitation. Interventions Not applicable. Main Outcome Measures Participation Assessment with Recombined Tools-Objective- -17, FIMTM Motor and Cognitive scores, Satisfaction with Life Scale and Patient Health Questionnaire-9. Results Increasing the percentage of contextualized treatment during inpatient TBI rehabilitation leads to better outcomes, specifically in regard to community participation. Conclusions Increasing the proportion of treatment provided in the context of real-life activities appears to have a beneficial impact on outcome. Although the effect sizes are small, the results are consistent with other studies supporting functional-based interventions effecting better outcomes. Furthermore, any positive findings, regardless of size or strength, are endorsed as important by consumers (survivors of TBI). While the findings do not imply that decontextualized treatment should not be used, when the therapy goal can be addressed with either approach, the findings suggest that better outcomes may result if the contextualized approach is used