Impact of public release of performance data on the behaviour of healthcare consumers and providers.

BACKGROUND: It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers. OBJECTIVES: To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies. SELECTION CRITERIA: We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis. MAIN RESULTS: We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects. AUTHORS\u27 CONCLUSIONS: The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes

Identities and distributions of the co-invading ectomycorrhizal fungal symbionts of exotic pines in the Hawaiian Islands

Pine species have become invasive throughout the globe and threaten to replace native biota. The threat of pine invasion is particularly pressing in parts of the tropics where there are no native pines. The factors that govern pine invasion are not often well understood. However, key to pine survival is an obligate and mutualistic interaction with ectomycorrhizal fungi. Thus for pines to successfully invade new habitats compatible ectomycorrhizal fungi must already be present, or be co-introduced. The purpose of this study was to examine the community structure of non-native ectomycorrhizal fungi associated with pine invasions in the Hawaiian Islands. To accomplish this we executed a field and greenhouse study and used a molecular ecology approach to identify the fungi associating with invasive pines in Hawai‘i. We show that: (1) ectomycorrhizal fungal species richness in non-native pine plantations is far less than what is found in pine’s native range, (2) there was a significant decrease in average ectomycorrhizal fungal species richness as distance from pine plantations increased and, (3) Suillus species were the dominant fungi colonizing pines outside plantations. The keystone ectomycorrhizal fungal taxa responsible for pine establishment in Hawai‘i are within genera commonly associated with pine invasions throughout the globe. We surmise that these fungi share functional traits such as the ability for long-distance dispersal from plantations and host tree colonization via spore that lead to their success when introduced to new habitats

International Space Station Research for the Next Decade: International Coordination and Research Accomplishments

During 2011, the International Space Station reached an important milestone in the completion of assembly and the shift to the focus on a full and continuous utilization mission in space. The ISS partnership itself has also met a milestone in the coordination and cooperation of utilization activities including research, technology development and education. We plan and track all ISS utilization activities jointly and have structures in place to cooperate on common goals by sharing ISS assets and resources, and extend the impacts and efficiency of utilization activities. The basic utilization areas on the ISS include research, technology development and testing, and education/outreach. Research can be categorized as applied research for future exploration, basic research taking advantage of the microgravity and open space environment, and Industrial R&D / commercial research focused at industrial product development and improvement. Technology development activities range from testing of new spacecraft systems and materials to the use of ISS as an analogue for future exploration missions to destinations beyond Earth orbit. This presentation, made jointly by all ISS international partners, will highlight the ways that international cooperation in all of these areas is achieved, and the overall accomplishments that have come as well as future perspectives from the cooperation. Recently, the partnership has made special efforts to increase the coordination and impact of ISS utilization that has humanitarian benefits. In this context the paper will highlight tentative ISS utilization developments in the areas of Earth remote sensing, medical technology transfer, and education/outreach

A Comparative Analysis of Selected Producer Characteristics and Production Practices of Small Livestock Producers in Three Southeastern States of The US

It is germane to know the characteristics and practices of small livestock producers in order to assist them; however, there are a paucity of investigations on the subject in the Southeastern US. Thus, this study assessed selected producer characteristics and production practices of small livestock producers in three Southeastern States. The data were collected from three samples of producers in several counties of Alabama, Georgia, and Florida, and were analyzed using descriptive statistics. The results showed that, a majority of producers practiced rotational grazing, had parasite problems, quarantined newly acquired animals, and used veterinary services. Additionally, a majority sold their animals live, and many kept records manually or on a computer. The findings indicate commonalities across the three states, in terms of rotational grazing, parasite problems, quarantine, how animals are sold, and record keeping. There is a need to assist small producers in certain aspects of production practices and in value-added processe

International Space Station Benefits for Humanity

The ISS partnership has seen a substantial increase in research accomplished, crew efforts devoted to research, and results of ongoing research and technology development. The ISS laboratory is providing a unique environment for research and international collaboration that benefits humankind. Benefits come from the engineering development, the international partnership, and from the research results. Benefits can be of three different types: scientific discovery, applications to life on Earth, and applications to future exploration. Working across all ISS partners, we identified key themes where the activities on the ISS improve the lives of people on Earth--not only within the partner nations, but also in other nations of the world. Three major themes of benefits to life on earth emerged from our review: benefits to human health, education, and Earth observation and disaster response. Other themes are growing as use of the ISS continues. Benefits to human health range from advancements in surgical technology, improved telemedicine, and new treatments for disease. Earth observations from the ISS provide a wide range of observations that include: marine vessel tracking, disaster monitoring and climate change. The ISS participates in a number of educational activities aimed to inspire students of all ages to learn about science, technology, engineering and mathematics. To date over 63 countries have directly participated in some aspect of ISS research or education. In summarizing these benefits and accomplishments, ISS partners are also identifying ways to further extend the benefits to people in developing countries for the benefits of humankind

Gepotidacin for the Treatment of Uncomplicated Urogenital Gonorrhea: A Phase 2, Randomized, Dose-Ranging, Single-Oral Dose Evaluation

Background: In this phase 2 study, we evaluated the efficacy and safety of oral gepotidacin, a novel triazaacenaphthylene bacterial type II topoisomerase inhibitor, for the treatment of uncomplicated urogenital gonorrhea. Methods: Adult participants with suspected urogenital gonorrhea were enrolled and completed baseline (day 1) and test-of-cure (days 4-8) visits. Pretreatment and posttreatment urogenital swabs were collected for Neisseria gonorrhoeae (NG) culture and susceptibility testing. Pharyngeal and rectal swab specimens were collected if there were known exposures. Participants were stratified by gender and randomized 1:1 to receive a 1500-mg or 3000-mg single oral dose of gepotidacin. Results: The microbiologically evaluable population consisted of 69 participants, with NG isolated from 69 (100%) urogenital, 2 (3%) pharyngeal, and 3 (4%) rectal specimens. Microbiological eradication of NG was achieved by 97%, 95%, and 96% of participants (lower 1-sided exact 95% confidence interval bound, 85.1%, 84.7%, and 89.1%, respectively) for the 1500-mg, 3000-mg, and combined dose groups, respectively. Microbiological cure was achieved in 66/69 (96%) urogenital infections. All 3 failures were NG isolates that demonstrated the highest observed gepotidacin minimum inhibitory concentration of 1 µg/mL and a common gene mutation. At the pharyngeal and rectal sites, 1/2 and 3/3 NG isolates, respectively, demonstrated microbiological cure. There were no treatment-limiting adverse events for either dose. Conclusions: This study demonstrated that single, oral doses of gepotidacin were ≥95% effective for bacterial eradication of NG in adult participants with uncomplicated urogenital gonorrhea

International Space Station Accomplishments Update: Scientific Discovery, Advancing Future Exploration, and Benefits Brought Home to Earth

Throughout the history of the International Space Station (ISS), crews on board have conducted a variety of scientific research and educational activities. Well into the second year of full utilization of the ISS laboratory, the trend of scientific accomplishments and educational opportunities continues to grow. More than 1500 investigations have been conducted on the ISS since the first module launched in 1998, with over 700 scientific publications. The ISS provides a unique environment for research, international collaboration and educational activities that benefit humankind. This paper will provide an up to date summary of key investigations, facilities, publications, and benefits from ISS research that have developed over the past year. Discoveries in human physiology and nutrition have enabled astronauts to return from ISS with little bone loss, even as scientists seek to better understand the new puzzle of "ocular syndrome" affecting the vision of up to half of astronauts. The geneLAB campaign will unify life sciences investigations to seek genomic, proteomic, and metabolomics of the effect of microgravity on life as a whole. Combustion scientists identified a new "cold flame" phenomenon that has the potential to improve models of efficient combustion back on Earth. A significant number of instruments in Earth remote sensing and astrophysics are providing new access to data or nearing completion for launch, making ISS a significant platform for understanding of the Earth system and the universe. In addition to multidisciplinary research, the ISS partnership conducts a myriad of student led research investigations and educational activities aimed at increasing student interest in science, technology, engineering and mathematics (STEM). Over the past year, the ISS partnership compiled new statistics of the educational impact of the ISS on students around the world. More than 43 million students, from kindergarten to graduate school, with more than 28 million teachers located in 49 countries have participated in some aspect of ISS educational activities. These activities include student-developed investigations, education competitions, and classroom versions of ISS investigations, participating in ISS investigator experiments, ISS hardware development, educational demonstrations, and cultural activities. Through the many inquiry-based educational activities, students and teachers are encouraged to participate in the ISS program thus motivating the next generation of students to pursue careers in STEM