Standardization of Road Danger Signs in the European Union

The aim of this research is to find a solution for the standardization of road signs in the EU zone by a comparative analysis of different national sign systems to establish a common set from a single country. This work is based on the idea that road sign standardization might increase the safety level of transnational journeys and foster the relationships among the various members of the EU Community. This paper presents the outcome of the first step of the research, which focuses on the harmonization of danger signs. In more detail, a multicriteria approach is applied to rank 19 EU Member States on the basis of three main aspects: the installation cost of new signs, new sign learning issues and the effectiveness of sign systems. The study allows for the installation cost by quantifying the degree of similarity among road sign systems and the roadway network extension, on which new signs should be placed.</span

Drawing in Alzheimer-type dementia

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An RNA-seq study in Friedreich ataxia patients identified hsa-miR-148a-3p as a putative prognostic biomarker of the disease

friedreich ataxia (FRDA) is a life-threatening hereditary ataxia; its incidence is 1:50,000 individuals in the caucasian population. a unique therapeutic drug for FRDA, the antioxidant omaveloxolone, has been recently approved by the US food and drug administration (FDA). FRDA is a multi-systemic neurodegenerative disease; in addition to a progressive neurodegeneration, FRDA is characterized by hypertrophic cardiomyopathy, diabetes mellitus and musculoskeletal deformities. cardiomyopathy is the predominant cause of premature death. the onset of FRDA typically occurs between the ages of 5 and 15. given the complexity and heterogeneity of clinical features and the variability of their onset, the identification of biomarkers capable of assessing disease progression and monitoring the efficacy of treatments is essential to facilitate decision making in clinical practice. we conducted an RNA-seq analysis in peripheral blood mononuclear cells from FRDA patients and healthy donors, identifying a signature of small non-coding RNAs (sncRNAs) capable of distinguishing healthy individuals from the majority of FRDA patients. among the differentially expressed sncRNAs, microRNAs are a class of small non-coding endogenous RNAs that regulate posttranscriptional silencing of target genes. In FRDA plasma samples, hsa-miR-148a-3p resulted significantly upregulated. the analysis of the receiver operating characteristic (ROC) curve, combining the circulating expression levels of hsa-miR-148a-3p and hsa-miR-223-3p (previously identified by our group), revealed an area under the curve (AUC) of 0.86 (95%, confidence Interval 0.77-0.95; p-value &lt; 0.0001). an in silico prediction analysis indicated that the IL6ST gene, an interesting marker of neuroinflammation in FRDA, is a common target gene of both miRNAs. our findings support the evaluation of combined expression levels of different circulating miRNAs as potent epi-biomarkers in FRDA. moreover, we found hsa-miR-148a-3p significantly over-expressed in Intermediate and late-onset friedreich ataxia patients' group (IOG and LOG, respectively) compared to healthy individuals, indicating it as a putative prognostic biomarker in this pathology

Helena’s Many Daughters: More Mitogenome Diversity behind the Most Common West Eurasian mtDNA Control Region Haplotype in an Extended Italian Population Sample

The high number of matching haplotypes of the most common mitochondrial (mt)DNA lineages are considered to be the greatest limitation for forensic applications. This study investigates the potential to solve this constraint by massively parallel sequencing a large number of mitogenomes that share the most common West Eurasian mtDNA control region (CR) haplotype motif (263G 315.1C 16519C). We augmented a pilot study on 29 to a total of 216 Italian mitogenomes that represents the largest set of the most common CR haplotype compiled from a single country. The extended population sample confirmed and extended the huge coding region diversity behind the most common CR motif. Complete mitogenome sequencing allowed for the detection of 163 distinct haplotypes, raising the power of discrimination from 0 (CR) to 99.6% (mitogenome). The mtDNAs were clustered into 61 named clades of haplogroup H and did not reveal phylogeographic trends within Italy. Rapid individualization approaches for investigative purposes are limited to the most frequent H clades of the dataset, viz. H1, H3, and H7

Quality target negotiation in health care : evidence from the English NHS

We examine how public sector third-party purchasers and hospitals negotiate quality targets when a fixed proportion of hospital revenue is required to be linked to quality. We develop a bargaining model linking the number of quality targets to purchaser and hospital characteristics. Using data extracted from 153 contracts for acute hospital services in England in 2010/11, we find that the number of quality targets is associated with the purchaser’s population health and its budget, the hospital type, whether the purchaser delegated negotiation to an agency, and the quality targets imposed by the supervising regional health authority

Longitudinal changes of SARA scale in Friedreich ataxia: Strong influence of baseline score and age at onset

BACKGROUND: The Scale for Assessment and Rating of Ataxia (SARA) is widely used in different types of ataxias and has been chosen as the primary outcome measure in the European natural history study for Friedreich ataxia (FA). METHODS: To assess distribution and longitudinal changes of SARA scores and its single items, we analyzed SARA scores of 502 patients with typical-onset FA (<25 years) participating in the 4-year prospective European FA Consortium for Translational Studies (EFACTS). Pattern of disease progression was determined using linear mixed-effects regression models. The chosen statistical model was re-fitted in order to estimate parameters and predict disease progression. Median time-to-change and rate of score progression were estimated using the Kaplan-Meier method and weighted linear regression models, respectively. RESULTS: SARA score at study enrollment and age at onset were the major predictive factors of total score progression during the 4-year follow-up. To a less extent, age at evaluation also influenced the speed of SARA progression, while disease duration did not improve the prediction of the statistical model. Temporal dynamics of total SARA and items showed a great variability in the speed of score increase during disease progression. Gait item had the highest annual progression rate, with median time for one-point score increase of 1 to 2 years. INTERPRETATION: Analyses of statistical properties of SARA suggest a variable sensitivity of the scale at different disease stages, and provide important information for population selection and result interpretation in future clinical trials

Practice patterns and 90-day treatment-related morbidity in early-stage cervical cancer

To evaluate the impact of the Laparoscopic Approach to Cervical Cancer (LACC) Trial on patterns of care and surgery-related morbidity in early-stage cervical cancer

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Solid state NMR investigations on thermal decomposition products of flame retarded polymers

In der vorliegenden Arbeit wurden Untersuchungen an Rückständen von thermisch abgebauten, flammgeschützten Polymeren vorgenommen, mit dem Ziel, die Struktur und den Phasenbestand der eingebauten Flammschutzmittel und der Polymere sowie deren Wechselwirkungen als Funktion der Temperatur und umgebenden Atmosphäre (N2 und Luft) zu charakterisieren. Ein wichtiges Werkzeug, das Informationen über den amorphen Zustand der Abbauprodukte und deren thermisch bedingte Phasenumwandlungen in andere amorphe oder kristalline Strukturen sowie Aussagen über die Nahordnungen der betrachteten Kernspinsorte liefert, stellt in dieser Arbeit der Einsatz der Festkörper-NMR-Spektroskopie dar. Hierbei sind neben Einzelimpuls- (SP), rotor-synchronisierte Spin-Echo- (RSE) und Kreuzpolarisationstechniken (CP) auch REDOR- (Rotational echo double resonance) und TRAPDOR- (Transfer of population in double resonance) Messungen zur Anwendung gekommen. Zusätzlich konnten aus den 11B- und 31P-NMR-Experimenten quantitative Aussagen über den relativen Borat- und Phosphor bzw. Phosphat-Anteil im festen Rückstand getroffen werden, wobei insbesondere für die 31P-Kerne eine quantitative Erfassung der kristallinen und amorphen Phosphatphasen durchgeführt wurde. Im ersten System wurden die Flammschutzmittel roter Phosphor (Prot) und Mg(OH)2 in HIPS kombiniert. Aus den Ergebnissen umfangreicher NMR-Experimente konnte abgeleitet werden, dass der größte Teil des eingesetzten Prot hauptsächlich in amorphen (Mg-Ortho-, -Di-, -Ketten- und Ringphosphaten) und weniger in kristallinen Phosphatphasen verbleibt. Zudem konnte für den Parameter der Temperatur und aus der Verfügbarkeit von Sauerstoff (N2-Atmosphäre/Luft) einen deutlicher Einfluss auf den Abbauprozess und die Bildung der Phosphatphasen (kristallin/amorph) nachgewiesen werden. Aus dem Vergleich der Ergebnisse der Temperversuche mit den Ergebnissen der Verbrennungsversuche im Cone Calorimeter konnte ein anaerober Abbauweg bestätigt werden. In einem zweiten System wurden die thermischen Reaktionen zwischen den Flammschutzadditiven BDP und Zinkborat sowie ihren Einfluss auf den thermischen Abbau eines PC/ABS-Blends untersucht. Der thermisch belastete Rückstand wird unabhängig von der Atmosphäre von amorphen Phosphatgruppen dominiert. Dabei konnten die während der Temperprozesse gebildeten Verbindungen &#945; Zn3(PO4)2 und BPO4 als Folge einer Festphasenreaktion zwischen den eingesetzten Flammschutzadditiven identifiziert werden, wobei das &#945; Zn3(PO4)2/BPO4 Verhältnis als Indikator für einen aeroben bzw. anaeroben Abbauprozess dient, der für die Feuerrückstände eindeutig einen anaeroben Abbau liefert.This study aims at the structural characterisation of embedded flame retardants and polymers. Analysis includes determination of the phase contents as well as description of their mutual interactions as a function of their thermal history in different atmospheres (air and nitrogen). Solid-state NMR spectroscopy is the most important tool applied in this thesis. This technique enables structural information about the amorphous state of the decomposed products, determination of the thermal and thermo-oxidative conversion in different amorphous and crystalline structures, and predictions about the short-range order of the observed nuclei. In this context measurements of single pulse (SP), rotor-synchronised spin echo (RSE) and cross polarisation (CP) experiments, as well as REDOR (Rotational echo double resonance) and TRAPDOR- (Transfer of population in double resonance) have been conducted. Additionally, 11B SP and 31P RSE experiments have been used to study quantitatively the borate and both phosphorus and phosphate contents in the solid residues. Particular emphasis was put on quantifying crystalline and non-crystalline phosphate phases. The first system consists of a combination of the flame retardants red phosphorus (Pred) and Mg(OH)2 in HIPS. From the results of extensive NMR experiments it was deduced that most of inserted red phosphorus remains in amorphous phosphates phases (ortho, pyro, and chain/ring phosphates) besides some crystalline phosphate phases. Decomposition characteristics such as temperature and the availability of oxygen (N2 atmosphere/air) show a significant influence on the decomposition process and the formation of phosphate phases (crystalline/amorphous). By comparing the results of the annealing processes to the results of the cone calorimeter measurements an anaerobic decomposition way was confirmed. In a second system, thermal reactions between the two flame retardants BDP and zinc borate as well their influence on the thermal decomposition of a PC/ABS blend were investigated. The thermally residues are independently of the atmosphere dominated by amorphous phosphate units. During the thermal decomposition the formation of &#945;-Zn3(PO4)2 and BPO4 could be identified as solid reaction products of the inserted flame retardants. In addition, the &#945; Zn3(PO4)2/BPO4 ratio served as an indicator of aerobic or anaerobic decomposition processes, proving an anaerobic decomposition mechanism for the fire residues

Pay for Performance and Contractual Choice: the case of General Practitioners in England

The Quality and Outcomes Framework (QOF) is a Pay-for-Performance scheme introduced in England in 2004 to reward primary care providers. This incentive scheme provides financial incentives that reward the overall performance of a practice, not individual effort. Consequently, an important question is how the QOF may affect contractual choices, quality provision and doctor mobility in the primary healthcare labour market. The paper provides a simple theoretical model that shows that the introduction and further strengthening of the scheme may have induced practices to compete for the best doctors and modified their choices in terms of contractual agreements with practitioners. We test the implications of this model using a linkage between Doctors Census data and practices’ characteristics from 2003 to 2007. We use linear multilevel models with random intercept and we account for sample selection. We find that after the introduction of the QOF efficient doctors are more likely to become partners and mobility among doctors has increased. The strengthening of the scheme in 2005 is associated with an increase in the quality of primary care and a reduction in access to the market for new doctors