Application of patient safety indicators internationally: a pilot study among seven countries

Objective To explore the potential for international comparison of patient safety as part of the Health Care Quality Indicators project of the Organization for Economic Co-operation and Development (OECD) by evaluating patient safety indicators originally published by the US Agency for Healthcare Research and Quality (AHRQ). Design A retrospective cross-sectional study. Setting Acute care hospitals in the USA, UK, Sweden, Spain, Germany, Canada and Australia in 2004 and 2005/2006. Data sources Routine hospitalization-related administrative data from seven countries were analyzed. Using algorithms adapted to the diagnosis and procedure coding systems in place in each country, authorities in each of the participating countries reported summaries of the distribution of hospital-level and overall (national) rates for each AHRQ Patient Safety Indicator to the OECD project secretariat. Results Each country's vector of national indicator rates and the vector of American patient safety indicators rates published by AHRQ (and re-estimated as part of this study) were highly correlated (0.821-0.966). However, there was substantial systematic variation in rates across countries. Conclusions This pilot study reveals that AHRQ Patient Safety Indicators can be applied to international hospital data. However, the analyses suggest that certain indicators (e.g. ‘birth trauma', ‘complications of anesthesia') may be too unreliable for international comparisons. Data quality varies across countries; undercoding may be a systematic problem in some countries. Efforts at international harmonization of hospital discharge data sets as well as improved accuracy of documentation should facilitate future comparative analyses of routine database

A FRET-Based High Throughput Screening Assay to Identify Inhibitors of Anthrax Protective Antigen Binding to Capillary Morphogenesis Gene 2 Protein

Anti-angiogenic therapies are effective for the treatment of cancer, a variety of ocular diseases, and have potential benefits in cardiovascular disease, arthritis, and psoriasis. We have previously shown that anthrax protective antigen (PA), a non-pathogenic component of anthrax toxin, is an inhibitor of angiogenesis, apparently as a result of interaction with the cell surface receptors capillary morphogenesis gene 2 (CMG2) protein and tumor endothelial marker 8 (TEM8). Hence, molecules that bind the anthrax toxin receptors may be effective to slow or halt pathological vascular growth. Here we describe development and testing of an effective homogeneous steady-state fluorescence resonance energy transfer (FRET) high throughput screening assay designed to identify molecules that inhibit binding of PA to CMG2. Molecules identified in the screen can serve as potential lead compounds for the development of anti-angiogenic and anti-anthrax therapies. The assay to screen for inhibitors of this protein–protein interaction is sensitive and robust, with observed Z' values as high as 0.92. Preliminary screens conducted with a library of known bioactive compounds identified tannic acid and cisplatin as inhibitors of the PA-CMG2 interaction. We have confirmed that tannic acid both binds CMG2 and has anti-endothelial properties. In contrast, cisplatin appears to inhibit PA-CMG2 interaction by binding both PA and CMG2, and observed cisplatin anti-angiogenic effects are not mediated by interaction with CMG2. This work represents the first reported high throughput screening assay targeting CMG2 to identify possible inhibitors of both angiogenesis and anthrax intoxication

Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management

BACKGROUND: Cyclic Vomiting Syndrome (CVS) is a disorder characterized by recurrent, stereotypic episodes of incapacitating nausea, vomiting and other symptoms, separated by intervals of comparative wellness. This report describes the clinical features, co-morbidities and problems encountered in management of 41 adult patients who met the diagnostic criteria for CVS. METHODS: This is a retrospective study of adults with CVS seen between 1994 and 2003. Follow-up data were obtained by mailed questionnaires. RESULTS: Age of onset ranged from 2 to 49 years. The duration of CVS at the time of consultation ranged from less than 1 year to 49 years. CVS episodes were stereotypic in respect of their hours of onset, symptomatology and length. Ninety-three percent of patients had recognizable prodromes. Half of the patients experienced a constellation of symptoms consisting of CVS episodes, migraine diathesis, inter-episodic dyspeptic nausea and a history of panic attacks. Deterioration in the course of CVS is indicated by coalescence of episodes in time. The prognosis of CVS is favorable in the majority of patients. CONCLUSION: CVS is a disabling disorder affecting adults as well as children. Because its occurrence in adults is little known, patients experience delayed or mis-diagnosis and ineffectual, sometimes inappropriately invasive management

A greve, o carnaval e os comícios: O mundo do trabalho portuário em Buenos Aires e a configuração de uma comunidade obreira, verão de 1904

Objetivo/contexto: El presente trabajo indaga sobre el proceso de configuración de una comunidad obrera en el puerto de Buenos Aires, resultado de la acción de los trabajadores y habitantes del barrio obrero a inicios del siglo XX. Originalidad: En el cruce de diversas historiografías (historia social, cultural y política), aquí se propone mirar de manera conjunta la dimensión laboral, la conflictividad obrera, el tiempo de la fiesta o carnaval y la participación electoral, para pensar, desde esta multiplicidad de eventos y experiencias, la aparición de una comunidad obrera radicalizada y con una particular identificación gestada en la movilización durante una época específica a comienzos del siglo XX. Metodología: A partir de una coyuntura significativa, como fueron los meses de fines de 1903 e inicios de 1904 en el barrio portuario, y basado en un variado conjunto de documentos (periódicos comerciales, barriales, gremiales, de las izquierdas, revistas de actualidad, informes policiales, fotografías, entre otros), el artículo reconstruye la experiencia obrera en los escenarios de la protesta, el carnaval y la votación para diputados celebrada durante ese verano. Al mismo tiempo, se ponderan aquí la dimensión territorial de la configuración comunitaria y los lugares centrales de la trama conformada por la protesta, la fiesta y las elecciones. Conclusiones: El análisis permite identificar que las sociabilidades obreras en el puerto consolidaron una comunidad, afincada en solidaridades familiares, corporativas, partidistas y vecinales obreras, en tiempos de movilización gremial, política y festiva, y de confrontación radicalizada con el Estado y las empresas.Objective/context: This paper inquires about the process of emergence of a working-class community in the port of Buenos Aires, resulting from actions by workers and inhabitants of the working-class neighborhood at the beginning of the 20th century. Originality: At the crossroads of diverse historiographies (social, cultural and political history), this paper proposes a joint regard at the labor dimension, worker disputes, carnival celebrations and electoral participation, and to use this multiplicity of events and experiences to think about the emergence of a radicalized worker community, with a particular identity gestated in the mobilization during a specific time at the beginning of the 20th century. Methodology: The months from late 1903 to early 1904 were an important juncture in the port district, and based on a diverse set of documents (commercial, neighborhood, trade and left-wing newspapers, news magazines, police reports, photographs, among others), this paper reconstructs the worker experience in three settings converging in the summer months: protest, carnival and legislative polls. At the same time, it ponders the territorial dimension of community configuration and the key places that formed the backdrop to a story of protest, celebration, and elections. Conclusions: This analysis shows us that worker sociabilities around the port consolidated a community based on family, corporate, partisan, neighborhood and worker solidarities, in times of labor, political and festive mobilization, and of radicalized confrontation with the State and with corporations.Objetivo/contexto: O presente trabalho indaga sobre o processo de configuração de uma comunidade obreira no porto de Buenos Aires, resultado da ação dos trabalhadores e habitantes do bairro obreiro no início do século XX. Originalidade: No cruzamento de diversas historiografias (história social, cultural e política), propõe-se aqui observar, de maneira conjunta, a dimensão laboral, a conflituosidade obreira, o tempo da festa ou carnaval e a participação eleitoral para pensar, a partir dessa multiplicidade de eventos e experiências, a aparição de uma comunidade obreira radicalizada e com uma identificação particular gestada na mobilização durante uma época específica no começo do século XX. Metodologia: A partir de uma conjuntura significativa, como foi o final de 1903 e início de 1904 no bairro portuário e baseado em um variado conjunto de documentos (jornais comerciais, de bairros, de grêmios, das esquerdas, revistas de atualidades, relatórios policiais, fotografias, entre outros), o artigo reconstrói a experiência obreira nos cenários do protesto, do carnaval e da votação para deputados celebrada nesse verão. Ao mesmo tempo, ponderam-se aqui a dimensão territorial da configuração comunitária e os lugares centrais da trama formada pelo protesto, pela festa e pelas eleições. Conclusões: A análise permite identificar que as sociabilidades obreiras no porto consolidaram uma comunidade, estabelecida em solidariedades familiares, corporativas, partidaristas e de vizinhanças obreiras, em tempos de mobilização gremial, política e festiva, e de confronto radicalizado com o Estado e com as empresas.Fil: Caruso, Laura Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de San Martin. Instituto de Altos Estudios Sociales. Centro de Estudios de Historia E Historia del Arte.; Argentin

A digital microfluidic system for serological immunoassays in remote settings

Serosurveys are useful for assessing population susceptibility to vaccine-preventable disease outbreaks. Although at-risk populations in remote areas could benefit from this type of information, they face several logistical barriers to implementation, such as lack of access to centralized laboratories, cold storage, and transport of samples. We describe a potential solution: a compact and portable, field-deployable, point-of-care system relying on digital microfluidics that can rapidly test a small volume of capillary blood for disease-specific antibodies. This system uses inexpensive, inkjet-printed digital microfluidic cartridges together with an integrated instrument to perform enzyme-linked immunosorbent assays (ELISAs). We performed a field validation of the system’s analytical performance at Kakuma refugee camp, a remote setting in northwestern Kenya, where we tested children aged 9 to 59 months and caregivers for measles and rubella immunoglobulin G (IgG). The IgG assays were determined to have sensitivities of 86% [95% confidence interval (CI), 79 to 91% (measles)] and 81% [95% CI, 73 to 88% (rubella)] and specificities of 80% [95% CI, 49 to 94% (measles)] and 91% [95% CI, 76 to 97% (rubella)] (measles, n = 140; rubella, n = 135) compared with reference tests (measles IgG and rubella IgG ELISAs from Siemens Enzygnost) conducted in a centralized laboratory. These results demonstrate a potential role for this point-of-care system in global serological surveillance, particularly in remote areas with limited access to centralized laboratories

Ten new insights in climate science 2020 – a horizon scan

Non-technical summary We summarize some of the past year's most important findings within climate change-related research. New research has improved our understanding of Earth's sensitivity to carbon dioxide, finds that permafrost thaw could release more carbon emissions than expected and that the uptake of carbon in tropical ecosystems is weakening. Adverse impacts on human society include increasing water shortages and impacts on mental health. Options for solutions emerge from rethinking economic models, rights-based litigation, strengthened governance systems and a new social contract. The disruption caused by COVID-19 could be seized as an opportunity for positive change, directing economic stimulus towards sustainable investments. Technical summary A synthesis is made of ten fields within climate science where there have been significant advances since mid-2019, through an expert elicitation process with broad disciplinary scope. Findings include: (1) a better understanding of equilibrium climate sensitivity; (2) abrupt thaw as an accelerator of carbon release from permafrost; (3) changes to global and regional land carbon sinks; (4) impacts of climate change on water crises, including equity perspectives; (5) adverse effects on mental health from climate change; (6) immediate effects on climate of the COVID-19 pandemic and requirements for recovery packages to deliver on the Paris Agreement; (7) suggested long-term changes to governance and a social contract to address climate change, learning from the current pandemic, (8) updated positive cost–benefit ratio and new perspectives on the potential for green growth in the short- and long-term perspective; (9) urban electrification as a strategy to move towards low-carbon energy systems and (10) rights-based litigation as an increasingly important method to address climate change, with recent clarifications on the legal standing and representation of future generations. Social media summary Stronger permafrost thaw, COVID-19 effects and growing mental health impacts among highlights of latest climate science

MIBiG 3.0 : a community-driven effort to annotate experimentally validated biosynthetic gene clusters

With an ever-increasing amount of (meta)genomic data being deposited in sequence databases, (meta)genome mining for natural product biosynthetic pathways occupies a critical role in the discovery of novel pharmaceutical drugs, crop protection agents and biomaterials. The genes that encode these pathways are often organised into biosynthetic gene clusters (BGCs). In 2015, we defined the Minimum Information about a Biosynthetic Gene cluster (MIBiG): a standardised data format that describes the minimally required information to uniquely characterise a BGC. We simultaneously constructed an accompanying online database of BGCs, which has since been widely used by the community as a reference dataset for BGCs and was expanded to 2021 entries in 2019 (MIBiG 2.0). Here, we describe MIBiG 3.0, a database update comprising large-scale validation and re-annotation of existing entries and 661 new entries. Particular attention was paid to the annotation of compound structures and biological activities, as well as protein domain selectivities. Together, these new features keep the database up-to-date, and will provide new opportunities for the scientific community to use its freely available data, e.g. for the training of new machine learning models to predict sequence-structure-function relationships for diverse natural products. MIBiG 3.0 is accessible online at https://mibig.secondarymetabolites.org/

Improving the quality and use of immunization and surveillance data : summary report of the Working Group of the Strategic Advisory Group of Experts on Immunization

CITATION: Scobie, H. M. et al. 2020. Improving the quality and use of immunization and surveillance data : summary report of the Working Group of the Strategic Advisory Group of Experts on Immunization. Vaccine, 38(46):7183-7197, doi:10.1016/j.vaccine.2020.09.017.The original publication is available at https://www.sciencedirect.comConcerns about the quality and use of immunization and vaccine-preventable disease (VPD) surveillance data have been highlighted on the global agenda for over two decades. In August 2017, the Strategic Advisory Group of Experts (SAGE) established a Working Group (WG) on the Quality and Use of Global Immunization and Surveillance Data to review the current status and evidence to make recommendations, which were presented to SAGE in October 2019. The WG synthesized evidence from landscape analyses, literature reviews, country case-studies, a data triangulation analysis, as well as surveys of experts. Data quality (DQ) was defined as data that are accurate, precise, relevant, complete, and timely enough for the intended purpose (fit-for-purpose), and data use as the degree to which data are actually used for defined purposes, e.g., immunization programme management, performance monitoring, decision-making. The WG outlined roles and responsibilities for immunization and surveillance DQ and use by programme level. The WG found that while DQ is dependent on quality data collection at health facilities, many interventions have targeted national and subnational levels, or have focused on new technologies, rather than the people and enabling environments required for functional information systems. The WG concluded that sustainable improvements in immunization and surveillance DQ and use will require efforts across the health system — governance, people, tools, and processes, including use of data for continuous quality improvement (CQI) — and that the approaches need to be context-specific, country-owned and driven from the frontline up. At the country level, major efforts are needed to: (1) embed monitoring DQ and use alongside monitoring of immunization and surveillance performance, (2) increase workforce capacity and capability for DQ and use, starting at the facility level, (3) improve the accuracy of immunization programme targets (denominators), (4) enhance use of existing data for tailored programme action (e.g., immunization programme planning, management and policy-change), (5) adopt a data-driven CQI approach as part of health system strengthening, (6) strengthen governance around piloting and implementation of new information and communication technology tools, and (7) improve data sharing and knowledge management across areas and organizations for improved transparency and efficiency. Global and regional partners are requested to support countries in adopting relevant recommendations for their setting and to continue strengthening the reporting and monitoring of immunization and VPD surveillance data through processes periodic needs assessment and revision processes. This summary of the WG’s findings and recommendations can support “data-guided” implementation of the new Immunization Agenda 2030.World Health Organizationhttps://www.sciencedirect.com/science/article/pii/S0264410X20311592Publisher's versio