Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes

Objective To investigate the impact of factors outside the control of primary care on performance indicators proposed as measures of the quality of primary care. Design Multiple regression analysis relating admission rates standardised for age and sex for asthma, diabetes, and epilepsy to socioeconomic population characteristics and to the supply of secondary care resources. Setting 90 family health services authorities in England, 1989-90 to 1994-5. Results At health authority level socioeconomic characteristics, health status, and secondary care supply factors explained 45% of the variation in admission rates for asthma, 33% for diabetes, and 55% for epilepsy. When health authorities were ranked, only four of the 10 with the highest age-sex standardised admission rates for asthma in 1994-5 remained in the top 10 when allowance was made for socioeconomic characteristics, health status, and secondary care supply factors. There was also substantial year to year variation in the rates. Conclusion Health outcomes should relate to crude rates of adverse events in the population. These give the best indication of the size of a health problem. Performance indicators, however, should relate to those aspects of care which can be altered by the staff whose performance is being measured

Gaia Data Release 1. Cross-match with external catalogues - Algorithm and results

Although the Gaia catalogue on its own will be a very powerful tool, it is the combination of this highly accurate archive with other archives that will truly open up amazing possibilities for astronomical research. The advanced interoperation of archives is based on cross-matching, leaving the user with the feeling of working with one single data archive. The data retrieval should work not only across data archives, but also across wavelength domains. The first step for seamless data access is the computation of the cross-match between Gaia and external surveys. The matching of astronomical catalogues is a complex and challenging problem both scientifically and technologically (especially when matching large surveys like Gaia). We describe the cross-match algorithm used to pre-compute the match of Gaia Data Release 1 (DR1) with a selected list of large publicly available optical and IR surveys. The overall principles of the adopted cross-match algorithm are outlined. Details are given on the developed algorithm, including the methods used to account for position errors, proper motions, and environment; to define the neighbours; and to define the figure of merit used to select the most probable counterpart. Statistics on the results are also given. The results of the cross-match are part of the official Gaia DR1 catalogue.Comment: 18 pages, 8 figures. Accepted for publication by A&

Studying the evolution of AGB stars in the Gaia epoch

We present asymptotic giant branch (AGB) models of solar metallicity, to allow the interpretation of observations of Galactic AGB stars, whose distances should be soon available after the first release of the Gaia catalogue. We find an abrupt change in the AGB physical and chemical properties, occurring at the threshold mass to ignite hot bottom burning,i.e. $3.5M_{\odot}$. Stars with mass below $3.5 M_{\odot}$ reach the C-star stage and eject into the interstellar medium gas enriched in carbon , nitrogen and $^{17}O$. The higher mass counterparts evolve at large luminosities, between $3\times 10^4 L_{\odot}$ and $10^5 L_{\odot}$. The mass expelled from the massive AGB stars shows the imprinting of proton-capture nucleosynthesis, with considerable production of nitrogen and sodium and destruction of $^{12}C$ and $^{18}O$. The comparison with the most recent results from other research groups are discussed, to evaluate the robustness of the present findings. Finally, we compare the models with recent observations of galactic AGB stars, outlining the possibility offered by Gaia to shed new light on the evolution properties of this class of objects.Comment: 21 pages, 11 figure, 3 tables, accepted for publication in MNRAS (2016 July 11

The greener, the better? Evidence from government contractors

Governments can support the green transition through green public procurement. Despite its strategic importance, the impact of this policy on firms remains unclear. Using US data, this paper provides the first empirical analysis of the causal effects of green contracts on corporate environmental and economic performance. We focus on an affirmative program for sustainable products, which represents one-sixth of the total federal procurement budget, and publicly traded firms, which account for one-third of total US emissions. Our results show that securing green contracts reduces emissions relative to firm size and increases productivity, with these effects persisting in the long run. We find no evidence that the program selects greener firms, nor that green public procurement sales crowd out private sales. We propose that increased R&D investment, incentivized by the program’s requirements, is a key mechanism behind these improvements

The Christmas 2018 eruption at Mt. Etna: enlightening how the volcano factory works through a multi‐parametric inspection

The 24–27 December 2018 flank eruption at Mount Etna (Southern Italy) has been investigated through a multidisciplinary approach in which olivine chemical zoning and diffusion chronometry data were integrated with models inferred by GNSS (Global Navigation Satellite System) measurements. Inspection of the olivine chemical zoning from core to rim allowed the identification of some dominant ways of transfer and interaction between magmas pertaining to different magmatic environments. Most of crystal cores are representative of crystallization at pressure of 290–230 and 160–120 MPa. Olivine rims suggest re‐equilibration at shallow pressure (≤30 MPa). Geodetic‐based models indicate pressurization of near‐vertical prolate spheroidal sources centered at ∼7.2 km below sea level (bsl) between 9 June 2017 and 28 June 2018 and later at ∼5.1 km bsl between 28 June 2018 and the eruption onset. Geodetic data also highlight a change in the inflation rate since late June 2018 and later around November 2018, which has been here related to both replenishment phases and magma uprising across the plumbing system. Timescales of magma replenishment are in agreement with prolonged recharge from deep levels upward to shallow environments started about 6 months before the eruption, with further replenishment involving the upper magmatic environments just 3–16 days before the eruption. At present, the eruptive activity at the volcano is primarily controlled by pressure imbalances affecting extensive sections of the plumbing system, with possibility to develop persistent eruptive activity at the summit versus flank eruptions depending on fortuitous interruptions of the steady magma recharge/discharge rate at shallow levels

A systematic review of criteria used to report complications in soft tissue and oncologic surgical clinical research studies in dogs and cats.

ObjectiveTo evaluate reporting of surgical complications and other adverse events in clinical research articles describing soft tissue and oncologic surgery in dogs and cats.Study designSystematic literature review.SampleEnglish-language articles describing soft tissue and oncologic surgeries in client-owned dogs and cats published in peer-reviewed journals from 2013 to 2016.MethodsCAB, AGRICOLA, and MEDLINE databases were searched for eligible articles. Article characteristics relevant to complications were abstracted and summarized, including reported events, definitions, criteria used to classify events according to severity and time frame, and relevant citations.ResultsOne hundred fifty-one articles involving 10 522 animals were included. Canine retrospective case series of dogs predominated. Ninety-two percent of articles mentioned complications in study results, but only 7.3% defined the term complication. Articles commonly described complications according to time frame and severity, but terminology and classification criteria were highly variable, conflicting between studies, or not provided. Most (58%) reported complications could have been graded with a published veterinary adverse event classification scheme, although common intraoperative complications were notable exceptions.ConclusionDefinitions and criteria used to classify and report soft tissue and oncologic surgical complications are often absent, incomplete, or contradictory among studies.Clinical significanceLack of consistent terminology contributes to inadequate communication of important information about surgical complications. Standardization of terminology and consistency in severity scoring will improve comparative evaluation of clinical research results

Violent paroxysmal activity drives self-feeding magma replenishment at Mt. Etna

A new sequence of eruptions occurred at Mt. Etna volcano during the first half of 2017, after almost 8 months of quiescence. These episodes had low-to-mild intensity and markedly differ from the violent paroxysms occurred at the Voragine Crater (VOR) during December 2015 and May 2016. Despite the general weak explosive nature of the eruptions, the activity during 2017 revealed unusually complex dynamics of magma ascent and interaction. Detection and investigation of such dynamics required a multidisciplinary approach in which bulk rock compositions, crystal chemical zoning, diffusion chronometry and ground deformation data have been combined. Bulk rock major and trace elements suggest that the 2017 magmas followed a differentiation path similar to that experienced by magmas erupted at Mt. Etna during the 2015–16 eruptions at VOR. Olivine core compositions and zoning patterns indicate the presence of multiple magmatic environments at depth that strictly interacted each other through some episodes of intrusion and mixing before and during the 2017 eruptive events. Timescales retrieved from diffusion chronometry on olivine normal and reverse zoning correlate well with the ground deformation stages detected through geodetic data and associated models, thus allowing to track the evolution through time of the 2017 volcanic activity. Combination of all petrological and geodetic observations supports the idea that dynamics of magma transfer driving the eruptive episodes of 2017 have been a direct consequence of the violent eruptions occurred at VOR on May 2016, which boosted the ascent of new magma from depth and improved the efficiency of the plumbing system to transfer it upward to the surface. We propose a mechanism of self-feeding replenishment of the volcano plumbing system during 2017, where magma recharge from depth is triggered by sudden unloading of the magma column consequential to the violent paroxysmal activity occurred on May 2016 at VOR

Clinicopathological characteristics of histiocytic sarcoma affecting the central nervous system in dogs.

BackgroundHistiocytic sarcoma affecting the central nervous system (CNS HS) in dogs may present as primary or disseminated disease, often characterized by inflammation. Prognosis is poor, and imaging differentiation from other CNS tumors can be problematic.ObjectiveTo characterize the clinicopathological inflammatory features, breed predisposition, and survival in dogs with CNS HS.AnimalsOne hundred two dogs with HS, 62 dogs with meningioma.MethodsRetrospective case series. Records were reviewed for results of cerebrospinal fluid (CSF) analysis, CBC, treatment, and outcome data.ResultsPredisposition for CNS HS was seen in Bernese Mountain Dogs, Golden Retrievers, Rottweilers, Corgis, and Shetland Sheepdogs (P ≤ .001). Corgis and Shetland Sheepdogs had predominantly primary tumors; Rottweilers had exclusively disseminated tumors. Marked CSF inflammation was characteristic of primary rather than disseminated HS, and neoplastic cells were detected in CSF of 52% of affected dogs. Increased neutrophil to lymphocyte ratios were seen in all groups relative to controls (P <.008) but not among tumor subtypes. Definitive versus palliative treatment resulted in improved survival times (P < .001), but overall prognosis was poor.Conclusions and clinical importanceClinicopathological differences between primary and disseminated HS suggest that tumor biological behavior and origin may be different. Corgis and Shetland Sheepdogs are predisposed to primary CNS HS, characterized by inflammatory CSF. High total nucleated cell count and the presence of neoplastic cells support the use of CSF analysis as a valuable diagnostic test. Prognosis for CNS HS is poor, but further evaluation of inflammatory mechanisms may provide novel therapeutic opportunities

Monitoring Tropical Forest Recovery Capacity Using RADAR Satellite Images

Recent extreme droughts combined with accelerating human exploitation are pushing tropical forests to the point where they cannot recover, making them vulnerable to large unprecedented wildfires. This causes an urgent need to monitor the recovery capacity of tropical forests. While time series-based break detection approaches have demonstrated potential to measure tropical forest recovery capacity, they have not yet been applied over large amounts of satellite data. To address this challenge, the SURF computing infrastructure, i.e., the SPIDER cluster and the Sentinel-1 data cube prepared by the EODC GmbH was used. Those resources were available within the C-SCALE project as a part of a use case defined and designed together with EOSC experts. The provided resources were extremely useful for the RETURN use case. This aims at exploring time series of satellite radar (Sentinel-1) images from the EU Copernicus Earth Observation (EO) Programme to understand the recovery capacity of the Amazon rainforest. The outcomes of the RETURN research are important to help identify areas with slower forest recovery in the Amazon basin and potentially understand their causes