Feedback GAP : study protocol for a cluster-randomized trial of goal setting and action plans to increase the effectiveness of audit and feedback interventions in primary care

Peer reviewedPublisher PD

Surname lists to identify South Asian and Chinese ethnicity from secondary data in Ontario, Canada: a validation study

<p>Abstract</p> <p>Background</p> <p>Surname lists are useful for identifying cohorts of ethnic minority patients from secondary data sources. This study sought to develop and validate lists to identify people of South Asian and Chinese origin.</p> <p>Methods</p> <p>Comprehensive lists of South Asian and Chinese surnames were reviewed to identify those that uniquely belonged to the ethnic minority group. Surnames that were common in other populations, communities or ethnic groups were specifically excluded. These surname lists were applied to the Registered Persons Database, a registry of the health card numbers assigned to all residents of the Canadian province of Ontario, so that all residents were assigned to South Asian ethnicity, Chinese ethnicity or the General Population. Ethnic assignment was validated against self-identified ethnicity through linkage with responses to the Canadian Community Health Survey.</p> <p>Results</p> <p>The final surname lists included 9,950 South Asian surnames and 1,133 Chinese surnames. All 16,688,384 current and former residents of Ontario were assigned to South Asian ethnicity, Chinese ethnicity or the General Population based on their surnames. Among 69,859 respondents to the Canadian Community Health Survey, both lists performed extremely well when compared against self-identified ethnicity: positive predictive value was 89.3% for the South Asian list, and 91.9% for the Chinese list. Because surnames shared with other ethnic groups were deliberately excluded from the lists, sensitivity was lower (50.4% and 80.2%, respectively).</p> <p>Conclusions</p> <p>These surname lists can be used to identify cohorts of people with South Asian and Chinese origins from secondary data sources with a high degree of accuracy. These cohorts could then be used in epidemiologic and health service research studies of populations with South Asian and Chinese origins.</p

Feedback GAP: pragmatic, cluster-randomized trial of goal setting and action plans to increase the effectiveness of audit and feedback interventions in primary care

Background Audit and feedback to physicians is a commonly used quality improvement strategy, but its optimal design is unknown. This trial tested the effects of a theory-informed worksheet to facilitate goal setting and action planning, appended to feedback reports on chronic disease management, compared to feedback reports provided without these worksheets. Methods A two-arm pragmatic cluster randomized trial was conducted, with allocation at the level of primary care clinics. Participants were family physicians who contributed data from their electronic medical records. The ‘usual feedback’ arm received feedback every six months for two years regarding the proportion of their patients meeting quality targets for diabetes and/or ischemic heart disease. The intervention arm received these same reports plus a worksheet designed to facilitate goal setting and action plan development in response to the feedback reports. Blood pressure (BP) and low-density lipoprotein cholesterol (LDL) values were compared after two years as the primary outcomes. Process outcomes measured the proportion of guideline-recommended actions (e.g., testing and prescribing) conducted within the appropriate timeframe. Intention-to-treat analysis was performed. Results Outcomes were similar across groups at baseline. Final analysis included 20 physicians from seven clinics and 1,832 patients in the intervention arm (15% loss to follow up) and 29 physicians from seven clinics and 2,223 patients in the usual feedback arm (10% loss to follow up). Ten of 20 physicians completed the worksheet at least once during the study. Mean BP was 128/72 in the feedback plus worksheet arm and 128/73 in the feedback alone arm, while LDL was 2.1 and 2.0, respectively. Thus, no significant differences were observed across groups in the primary outcomes, but mean haemoglobin A1c was lower in the feedback plus worksheet arm (7.2% versus 7.4%, p<0.001). Improvements in both arms were noted over time for one-half of the process outcomes. Discussion Appending a theory-informed goal setting and action planning worksheet to an externally produced audit and feedback intervention did not lead to improvements in patient outcomes. The results may be explained in part by passive dissemination of the worksheet leading to inadequate engagement with the intervention

Sequential damage study induced in fiber reinforced composites by shear and tensile stress using a newly developed Arcan fixture

This work presents the application of both uniaxial and bi-axial in-plane loads to unidirectional carbon fiber reinforced polymer laminates using a newly developed Arcan fixture, which is a reliable experimental set-up to obtain a uniform shear stress field in a butterfly specimen. The set-up can be used for both damage model validation and parameters identification at various fiber orientations while using the same specimens. A sequential damage study was completed to highlight the influence of diffused damage induced in pure shear on the fiber direction tensile behavior of the laminate. This was accomplished by applying load on the specimens in two steps: (i) the pure shear step and then unloading at approximately 70% of the shear failure strength, (ii) in the tensile step until final failure. A clear drop in the tensile behavior of the laminate was observed by the diffused damage induced in the first loading step of pure shear. The experimental study is also supplemented with numerical simulations using a nonlinear elasto-plastic coupled damage constitutive law by employing Puck’s failure theory for mesodamage activation. In addition to the damage pattern, the non-linear mechanical behavior in shear is predicted and found in good correspondence with the experimental results

‘Sciencenet’—towards a global search and share engine for all scientific knowledge

Summary: Modern biological experiments create vast amounts of data which are geographically distributed. These datasets consist of petabytes of raw data and billions of documents. Yet to the best of our knowledge, a search engine technology that searches and cross-links all different data types in life sciences does not exist

High-Grade Gastroenteropancreatic Neuroendocrine Neoplasms and Improved Prognostic Stratification With the New World Health Organization 2019 Classification A Validation Study From a Single-Institution Retrospective Analysis

Objectives: There is a pressing need to develop clinical management pathways for grade 3 (G3) gastroenteropancreatic neuroendocrine neoplasms (GEP NEN). Methods: We performed a retrospective study on patients with metastatic G3 GEP NEN. The relationship between baseline characteristics and progression-free survival and overall survival was analyzed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model. Results: We included 142 patients (74 well-differentiated neuroendocrine tumors [WDNETs], 68 poorly differentiated neuroendocrine carcinomas [PDNECs]). Patients with WDNET had prolonged survival compared with PDNEC (median, 24 vs 15 months, P = 0.0001), which persisted in both pancreatic and nonpancreatic cohorts. Well-differentiated morphology, Ki-67 <50% and positive somatostatin receptor imaging were independently associated with prolonged survival. Of the subgroup treated with first-line platinum-based chemotherapy, response rates were favorable (partial response, 47%; stable disease, 30%); there was no significant difference in response rates nor progression-free survival between WDNET and PDNEC despite significantly prolonged overall survival in the WDNET cohort. Conclusions: Our study corroborates the knowledge of 2 prognostically distinct subgroups within the World Health Organization 2019 G3 GEP NEN population, observed in both pancreatic and nonpancreatic gastrointestinal cohorts. Definitive management pathways are needed to reflect the differences between G3 WDNET and PDNEC

Excitation of unidirectional exchange spin waves by a nanoscale magnetic grating

Magnon spintronics is a prosperous field that promises beyond-CMOS technology based on elementary excitations of the magnetic order that act as information carriers for future computational architectures. Unidirectional propagation of spin waves is key to the realization of magnonic logic devices. However, previous efforts to enhance the Damon-Eshbach-type nonreciprocity did not realize (let alone control) purely unidirectional propagation. Here we experimentally demonstrate excitations of unidirectional exchange spin waves by a nanoscale magnetic grating consisting of Co nanowires fabricated on an ultrathin yttrium iron garnet film. We explain and model the nearly perfect unidirectional excitation by the chirality of the magneto-dipolar interactions between the Kittel mode of the nanowires and the exchange spin waves of the film. Reversal of the magnetic configurations of film and nanowire array from parallel to antiparallel changes the direction of the excited spin waves. Our results raise the prospect of a chiral magnonic logic without the need for fragile surface states

Growth kinetics of nuclei formed from different binders and powders in vertical cylindrical mixing devices

peer-reviewedGranulation is the process of forming large aggregates from fine particles using a high shear mixer. This method is used in several industries from pharmaceuticals to chemical and fertilizer production. This research will study the effect of four process variables: speed of mixer rotation in the range 100–200 rpm, powder bed mass (25–40 g), mass of the initial nucleus (0.6–2 g), and binder viscosity (water, carboxymethyl cellulose (CMC) solutions with concentrations in the range 0.5–20 g/L) on single nuclei growth kinetics in low mixing devices. The powders under study were: lactose, tea, sugar, starch, and limestone. The results show the initial size of nuclei, the initial mass of the powder bed and binder viscosity and speed of rotation all influence the rate of nuclei growth. Analysis of the stokes deformation number of the nuclei show that growth rate of the nuclei decreases as the deformation number increases whilst the percentage gain in mass of the nuclei increases with increasing deformation number. The binder viscosity was shown to have the biggest influence of the growth rate of the nuclei. Results show that difference in powder density also has an effect on the growth kinetics of nuclei. The initial position of nuclei was also shown to influence the nuclei growth rate; the closer the starting position of the nuclei to the wall of the vessel the slower the growth rate

Protective effect of stromal Dickkopf-3 in prostate cancer: opposing roles for TGFBI and ECM-1

Aberrant transforming growth factor–β (TGF-β) signaling is a hallmark of the stromal microenvironment in cancer. Dickkopf-3 (Dkk-3), shown to inhibit TGF-β signaling, is downregulated in prostate cancer and upregulated in the stroma in benign prostatic hyperplasia, but the function of stromal Dkk-3 is unclear. Here we show that DKK3 silencing in WPMY-1 prostate stromal cells increases TGF-β signaling activity and that stromal cellconditioned media inhibit prostate cancer cell invasion in a Dkk-3-dependent manner. DKK3 silencing increased the level of the cell-adhesion regulator TGF-β–induced protein (TGFBI) in stromal and epithelial cell-conditioned media, and recombinant TGFBI increased prostate cancer cell invasion. Reduced expression of Dkk-3 in patient tumors was associated with increased expression of TGFBI. DKK3 silencing reduced the level of extracellular matrix protein-1 (ECM-1) in prostate stromal cell-conditioned media but increased it in epithelial cell-conditioned media, and recombinant ECM-1 inhibited TGFBI-induced prostate cancer cell invasion. Increased ECM1 and DKK3 mRNA expression in prostate tumors was associated with increased relapse-free survival. These observations are consistent with a model in which the loss of Dkk-3 in prostate cancer leads to increased secretion of TGFBI and ECM-1, which have tumor-promoting and tumor-protective roles, respectively. Determining how the balance between the opposing roles of extracellular factors influences prostate carcinogenesis will be key to developing therapies that target the tumor microenvironment

Osmotin-loaded magnetic nanoparticles with electromagnetic guidance for the treatment of Alzheimer's disease

Alzheimer's disease (AD) is the most prevalent age-related neurodegenerative disease, pathologically characterized by the accumulation of aggregated amyloid beta (Aβ) in the brain.</p