It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is ...used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers.
To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale.
We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies.
We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care.
Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis.
We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects.
The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes.
22q11.2 deletion syndrome (22q11.2DS) is the most common chromosomal interstitial-deletion disorder, occurring in approximately 1 in 2000 to 6000 live births. Affected individuals exhibit variable ...clinical phenotypes that can include velopharyngeal anomalies, heart defects, T-cell-related immune deficits, dysmorphic facial features, neurodevelopmental disorders, including autism, early cognitive decline, schizophrenia, and other psychiatric disorders. Developing comprehensive treatments for 22q11.2DS requires an understanding of both the psychophysiological and neural mechanisms driving clinical outcomes. Our project probes the core psychophysiological abnormalities of 22q11.2DS in parallel with molecular studies of stem cell-derived neurons to unravel the basic mechanisms and pathophysiology of 22q11.2-related psychiatric disorders, with a primary focus on psychotic disorders. Our study is guided by the central hypothesis that abnormal neural processing associates with psychophysiological processing and underlies clinical diagnosis and symptomatology. Here, we present the scientific background and justification for our study, sharing details of our study design and human data collection protocol.
Our study is recruiting individuals with 22q11.2DS and healthy comparison subjects between the ages of 16 and 60 years. We are employing an extensive psychophysiological assessment battery (e.g., EEG, evoked potential measures, and acoustic startle) to assess fundamental sensory detection, attention, and reactivity. To complement these unbiased measures of cognitive processing, we will develop stem-cell derived neurons and examine neuronal phenotypes relevant to neurotransmission. Clinical characterization of our 22q11.2DS and control participants relies on diagnostic and research domain criteria assessments, including standard Axis-I diagnostic and neurocognitive measures, following from the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) and the North American Prodrome Longitudinal Study (NAPLS) batteries. We are also collecting measures of autism spectrum (ASD) and attention deficit/hyperactivity disorder (ADHD)-related symptoms.
Studying 22q11.2DS in adolescence and adulthood via deep phenotyping across multiple clinical and biological domains may significantly increase our knowledge of its core disease processes. Our manuscript describes our ongoing study's protocol in detail. These paradigms could be adapted by clinical researchers studying 22q11.2DS, other CNV/single gene disorders, or idiopathic psychiatric syndromes, as well as by basic researchers who plan to incorporate biobehavioral outcome measures into their studies of 22q11.2DS.
The DMAPS upgrade of the Belle II vertex detector Babeluk, M.; Barbero, M.; Baudot, J. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
07/2024, Letnik:
1064
Journal Article
Recenzirano
The Belle II experiment at KEK in Japan considers an upgrade for the vertex detector system in line with the accelerator upgrade for higher luminosity at long shutdown 2 planned for 2028.
One ...proposal for the upgrade of the vertex detector called VTX aims to improve background robustness and reduce occupancy using small and fast pixels. VTX accommodates the OBELIX depleted monolithic active CMOS pixel sensor (DMAPS) on all five proposed layers. OBELIX is specifically developed for the VTX application and based on the TJ-Monopix2 chip initially developed to meet the requirements of the outer layers of the ATLAS inner tracker (ITk).
This paper will review recent tests of the TJ-Monopix2 chip as well as various design aspects of the OBELIX-1 chip currently under development.
In this present work, the concentration of 31 carbonyl compounds (CC) were determined in the atmosphere of Niterói City, RJ, Brazil, between January 9th and 14th, 2010, in 7 periods of two hours in ...each day. Rapid Resolution Liquid Chromatography with UV detection of the corresponding hydrazones was employed. Formaldehyde, acetaldehyde and acetone were found to be the most abundant CC in all the 42 samples. Experimental data showed one period of maximum concentration of CC that occurred between 10:00 and 12:00 h, regardless of the day, with concentrations varying between 16.20 and 52.30 μg m
−3. The ratios of the concentrations of acetaldehyde and formaldehyde were ≥1 in all periods and the mean ratio was 2.0. The results obtained were lower than those previously found in Rio de Janeiro City, indicating that Niterói is a less polluted area in terms of this criterion. This is a novel work related to the aspects that concern the determination of most CC in the atmosphere of Niterói City and medium size Brazilian cities.
Display omitted
► Carbonyl compound as atmospheric contaminants. ► Concentrations depend on day period and emission. ► Evaluation showed variation of concentration in different time intervals and along the week. ► Predominance of formaldehyde and acetaldehyde related to Brazilian automotive fuels.
Asymptomatic carotid stenosis (ACS) is associated with an increased risk of ischaemic stroke and myocardial infarction. Risk scores have been developed to detect individuals at high risk of ACS, ...thereby enabling targeted screening, but previous external validation showed scope for refinement of prediction by adding additional predictors. The aim of this study was to develop a novel risk score in a large contemporary screened population.
A prediction model was developed for moderate (≥50%) and severe (≥70%) ACS using data from 596 469 individuals who attended screening clinics. Variables that predicted the presence of ≥50% and ≥70% ACS independently were determined using multivariable logistic regression. Internal validation was performed using bootstrapping techniques. Discrimination was assessed using area under the receiver operating characteristic curves (AUROCs) and agreement between predicted and observed cases using calibration plots.
Predictors of ≥50% and ≥70% ACS were age, sex, current smoking, diabetes mellitus, prior stroke/transient ischaemic attack, coronary artery disease, peripheral arterial disease, blood pressure, and blood lipids. Models discriminated between participants with and without ACS reliably, with an AUROC of 0.78 (95% confidence interval CI 0.77–0.78) for ≥ 50% ACS and 0.82 (95% CI 0.81–0.82) for ≥ 70% ACS. The number needed to screen in the highest decile of predicted risk to detect one case with ≥50% ACS was 13 and that of ≥70% ACS was 58. Targeted screening of the highest decile identified 41% of cases with ≥50% ACS and 51% with ≥70% ACS.
The novel risk model predicted the prevalence of ACS reliably and performed better than previous models. Targeted screening among the highest decile of predicted risk identified around 40% of all cases with ≥50% ACS. Initiation or intensification of cardiovascular risk management in detected cases might help to reduce both carotid related ischaemic strokes and myocardial infarctions.
Background Significant asymptomatic carotid stenosis (ACS) is associated with higher risk of strokes. While the prevalence of moderate and severe ACS is low in the general population, prediction ...models may allow identification of individuals at increased risk, thereby enabling targeted screening. We identified established prediction models for ACS and externally validated them in a large screening population. Methods and Results Prediction models for prevalent cases with ≥50% ACS were identified in a systematic review (975 studies reviewed and 6 prediction models identified 3 for moderate and 3 for severe ACS) and then validated using data from 596 469 individuals who attended commercial vascular screening clinics in the United States and United Kingdom. We assessed discrimination and calibration. In the validation cohort, 11 178 (1.87%) participants had ≥50% ACS and 2033 (0.34%) had ≥70% ACS. The best model included age, sex, smoking, hypertension, hypercholesterolemia, diabetes mellitus, vascular and cerebrovascular disease, measured blood pressure, and blood lipids. The area under the receiver operating characteristic curve for this model was 0.75 (95% CI, 0.74-0.75) for ≥50% ACS and 0.78 (95% CI, 0.77-0.79) for ≥70% ACS. The prevalence of ≥50% ACS in the highest decile of risk was 6.51%, and 1.42% for ≥70% ACS. Targeted screening of the 10% highest risk identified 35% of cases with ≥50% ACS and 42% of cases with ≥70% ACS. Conclusions Individuals at high risk of significant ACS can be selected reliably using a prediction model. The best-performing prediction models identified over one third of all cases by targeted screening of individuals in the highest decile of risk only.
In tauopathies, phosphorylation, acetylation, cleavage and other modifications of tau drive intracellular generation of diverse forms of toxic tau aggregates and associated seeding activity, which ...have been implicated in subsequent synaptic failure and neurodegeneration. Suppression of this wide range of pathogenic species, seeding and toxicity mechanisms, while preserving the physiological roles of tau, presents a key therapeutic goal. Identification and targeting of signaling networks that influence a broad spectrum of tau pathogenic mechanisms might prevent or reverse synaptic degeneration and modify disease outcomes. The p75 neurotrophin receptor (p75
) modulates such networks, including activation of multiple tau kinases, calpain and rhoA-cofilin activity. The orally bioavailable small-molecule p75
modulator, LM11A-31, was administered to tau
mice for 3 months starting at 6 months of age, when tau pathology was well established. LM11A-31 was found to reduce: excess activation of hippocampal cdk5 and JNK kinases and calpain; excess cofilin phosphorylation, tau phosphorylation, acetylation and cleavage; accumulation of multiple forms of insoluble tau aggregates and filaments; and, microglial activation. Hippocampal extracts from treated mice had substantially reduced tau seeding activity. LM11A-31 treatment also led to a reversal of pyramidal neuron dendritic spine loss, decreased loss of dendritic complexity and improvement in performance of hippocampal behaviors. These studies identify a therapeutically tractable upstream signaling module regulating a wide spectrum of basic mechanisms underlying tauopathies.
This work aims to analyse the response to ground shaking of the Norcia intermountain basin (central Italy), where a temporary seismic network (Pilz and Parolai in Norcia basin (Italy) temporary ...seismic network. GFZ Data Services.
https://doi.org/10.14470/8u7554472182
,
2009
) was installed from January to May 2009, during the L’Aquila (Mw 6.1) seismic sequence. Here we present the results of the application of various empirical approaches for the evaluation of local site effects, considering hundreds of records relevant to earthquakes in the local magnitude range 3.0–5.4. The site amplification was estimated considering either the standard spectral-ratio (SSRs, Borcherdt in Bull Seismol Soc Am 60:29–61,
1970
) or the horizontal to vertical spectral-ratio technique (HVSRs, Lermo and Chavez-Garcia in Bull Seismol Soc Am 83:1501–1506,
1993
) techniques, applied to the S-phase and the S-wave coda of selected earthquakes. The results evidence the amplification of both horizontal and vertical components of ground motion at frequencies spanning from about 0.5 Hz, in the deepest part of the basin, to 4 Hz at basin edges. HVSRs show lower amplitudes than SSRs, due to the amplification of the vertical component, highlighting as the single station spectral technique, suitable to estimate the fundamental resonance frequency of the sites, is not able to reliably describe the actual seismic response. Considering the shape of the basin, possible predominant amplification with particular direction are investigated by rotated SSRs that allow to evidence in the central part of the studied area a prevailing amplification of the S-train waves along the 140°N direction. Finally, the generation of surface waves within the basin was investigated by the Multiple Filter Technique analysis (MFT, Dziewonski et al. in Bull Seismol Soc Am 59:427–444,
1969
), estimating the backazimuth of the identified surface waves using the method proposed by Baker and Stevens (Geophys Res Lett 31:L09611,
2004
.
https://doi.org/10.1029/2004GL019510
). In particular, the favourable conditions for the generation of surface waves inside the basin, have been evaluated by comparing records relevant to earthquakes with different sources and magnitudes recorded in the last twenty-year by the permanent NRC accelerometric station.
The aim of the Severe Psoriatic arthritis - Early intervEntion to control Disease trial is to compare outcomes in psoriatic arthritis (PsA) patients with poor prognostic factors treated with standard ...step-up conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), combination csDMARDs or a course of early biologics.
This multicentre UK trial was embedded within the MONITOR-PsA cohort, which uses a trial within cohort design.
Patients with newly diagnosed PsA and at least one poor prognostic factor (polyarthritis, C-reactive protein >5 mg/dL, health assessment questionnaire >1, radiographic erosions) were randomized equally and open-label to either standard care with 'step-up' csDMARD therapy, initial therapy with combination csDMARDs (methotrexate with either sulfasalazine or leflunomide) or to early biologics induction therapy (adalimumab plus methotrexate). The primary outcome is the PsA disease activity score at week 24.
Ethical approval for the study was granted by the South Central Research Ethics Committee (ref 18/SC/0107).
Treatment recommendations for PsA suggest more intensive therapy for those with poor prognostic factors but there are no studies that have previously used prognostic factors to guide therapy. Applying initial intensive therapy has shown improved outcomes in other inflammatory arthritides but has never been tried in PsA. Combination csDMARDs have shown some superiority over single therapies but there are limited data and concerns about side effects. Early use of biologics has also been shown to be superior to methotrexate but these drugs are costly and not usually funded first line. However, if a short course of biologics can rapidly suppress inflammation allowing treatment to be withdrawn and response maintained on methotrexate, this may be a cost-effective model for early use.
ClinicalTrials.gov (NCT03739853) and EudraCT (2017-004542-24).
PDF
