Establishing a global quality of care benchmark report.

BACKGROUND: The Movember funded TrueNTH Global Registry (TNGR) aims to improve care by collecting and analysing a consistent dataset to identify variation in disease management, benchmark care delivery in accordance with best practice guidelines and provide this information to those in a position to enact change. We discuss considerations of designing and implementing a quality of care report for TNGR. METHODS: Eleven working group sessions were held prior to and as reports were being built with representation from clinicians, data managers and investigators contributing to TNGR. The aim of the meetings was to understand current data display approaches, share literature review findings and ideas for innovative approaches. Preferred displays were evaluated with two surveys (survey 1: 5 clinicians and 5 non-clinicians, 83% response rate; survey 2: 17 clinicians and 18 non-clinicians, 93% response rate). RESULTS: Consensus on dashboard design and three data-display preferences were achieved. The dashboard comprised two performance summary charts; one summarising site's relative quality indicator (QI) performance and another to summarise data quality. Binary outcome QIs were presented as funnel plots. Patient-reported outcome measures of function score and the extent to which men were bothered by their symptoms were presented in bubble plots. Time series graphs were seen as providing important information to supplement funnel and bubble plots. R Markdown was selected as the software program principally because of its excellent analytic and graph display capacity, open source licensing model and the large global community sharing program code enhancements. CONCLUSIONS: International collaboration in creating and maintaining clinical quality registries has allowed benchmarking of process and outcome measures on a large scale. A registry report system was developed with stakeholder engagement to produce dynamic reports that provide user-specific feedback to 132 participating sites across 13 countries

Molecular Mechanisms Associated with Nicotine Pharmacology and Dependence.

Tobacco dependence is a leading cause of preventable disease and death worldwide. Nicotine, the main psychoactive component in tobacco cigarettes, has also been garnering increased popularity in its vaporized form, as derived from e-cigarette devices. Thus, an understanding of the molecular mechanisms underlying nicotine pharmacology and dependence is required to ascertain novel approaches to treat drug dependence. In this chapter, we review the field's current understanding of nicotine's actions in the brain, the neurocircuitry underlying drug dependence, factors that modulate the function of nicotinic acetylcholine receptors, and the role of specific genes in mitigating the vulnerability to develop nicotine dependence. In addition to nicotine's direct actions in the brain, other constituents in nicotine and tobacco products have also been found to alter drug use, and thus, evidence is provided to highlight this issue. Finally, currently available pharmacotherapeutic strategies are discussed, along with an outlook for future therapeutic directions to achieve to the goal of long-term nicotine cessation

Potential for non-combustible nicotine products to reduce socioeconomic inequalities in smoking: a systematic review and synthesis of best available evidence

While some experts have emphasised the potential for e-cigarettes to facilitate cessation among smokers with low socioeconomic status (SES), there is limited evidence of their likely equity impact. We assessed the potential for electronic cigarettes and other non-combustible nicotine-containing products (NCNPs) to reduce inequalities in smoking by systematically reviewing evidence on their use by SES in countries at stage IV of the cigarette epidemic

Tobacco retail outlet advertising practices and proximity to schools, parks and public housing affect Synar underage sales violations in Washington, DC

Objective To examine the cross-sectional association between illicit sales of tobacco to minors, Washington DC tobacco outlet advertising practices, retail store type, the demographic make-up of the area surrounding each outlet, and the proximity of each outlet to high schools, recreational parks and public housing. Participants Seven hundred and fifty tobacco outlets in the DC area, n=347 of which were randomly selected for inspection by the Synar Inspection Program in 2009–2010. Main outcome measures The presence of tobacco advertisements on the interior and exterior of each outlet, and illicit tobacco sales to Synar Inspection Program youth volunteers. Results The presence of tobacco advertisements on the exterior of gas stations was much greater than on other retail store types (OR=6.68; 95% CI 4.05 to 11.01), as was the absence of any advertisements at bars or restaurants that sold tobacco (OR=0.33; 95% CI 0.22 to 0.52). Exterior tobacco advertisements were also more likely in predominantly African–American areas of the city (OR=3.11; 95% CI 2.28 to 4.25), and particularly likely on storefronts located closer to parks (OR=1.87; 95% CI 1.06 to 3.28). Illicit sales to minors were more common at gas stations (OR=3.01; 95% CI 1.5 to 6.3), outlets that displayed exterior tobacco advertisements closer to parks (OR=3.36; 95% CI 1.38 to 8.21), and outlets located closer to high schools in majority African– American block groups (OR=1.29; 95% CI 1.07 to 1.58). Conclusions Findings demonstrate that while illicit tobacco sales to minors are occurring at acceptably low rates by Synar standards, illicit sales vary considerably by retail store type, advertising approach and proximity to high schools, parks and African–American residential areas. Future work may help inform regulatory efforts to reduce youth access at the neighbourhood, city, state and national levels

Frame Synchronization in Frequency Uncertainty

This paper addresses the problem of robust frame synchronization for TDM/TDMA systems in the presence of frequency errors, accomplished through data-aided recognition of the Unique Word (UW) preamble in the transmission flow. Robust detection design is performed applying, through approximations, the Maximum Likelihood (ML) criterion coupled to Post Detection Integration (PDI), to obtain a novel detector identified as Balanced-GPDI (B-GPDI). This new approach considerably outperforms other schemes available in the literature, at the cost of a moderate complexity increase. This is possible thanks to an optimized use of coherent accumulation, which enhances the correlation term in the decision variable, along with highly accurate modeling of the energy correction factor. To limit complexity increase and memory requirements, several approximations of the exact B-GPDI are proposed and discussed in the paper, to provide the designer with practical solutions that are still able to outperform other approaches in specific application scenarios. In particular, approximations for low and high Signal-to-Noise Ratio (SNR) are presented. Different application scenarios are considered in the paper for numerical analysis. In particular, the cases of forward link Continuous Transmission (CTX) and return link Burst Transmission (BTX) are addressed

Robust frame synchronization for the DVB-S2 system with large frequency offsets

This paper tackles the problem of frame synchronization design for the Digital Video Broadcasting standard via Satellite (DVB-S2) system. In particular, the design of a novel frame detection scheme exhibiting robustness against large frequency errors is proposed. Post-detection integration (PDI) is exploited to provide coarse frame alignment with limited complexity with respect to classical approximate maximum likelihood (ML) solutions. The novel scheme, denoted as differential generalized post-detection integration, derives from a pragmatic adaptation of the well-known generalized PDI scheme (IEEE Trans. Commun. 2007; 55(11):2159-2171), which eliminates its inherent source of weakness in the presence of large frequency offsets, i.e. its non-differential component given by non-coherent PDI. The proposed approach manages to reduce the remarkable performance gap with respect to approximate ML techniques available in the literature (IEEE Trans. Commun. 2002; 50(7):1062-1065), providing the designer with an interesting performance/complexity trade-off. Performance is numerically evaluated in terms of receiver operating characteristics and mean acquisition time (MAT), handling the acquisition procedure according to a single-dwell approach. Both threshold crossing and MAX criterion are contrasted to identify the best design solution. Copyright \ua9 2008 John Wiley & Sons, Ltd