The European Society of Breast Cancer Specialists (EUSOMA) has fostered a voluntary certification process for breast centres to establish minimum standards and ensure specialist multidisciplinary ...care. Prospectively collected anonymous information on primary breast cancer cases diagnosed and treated in the units is transferred annually to a central EUSOMA data warehouse for continuous monitoring of quality indicators (QIs) to improve quality of care. Units have to comply with the EUSOMA Breast Centre guidelines and are audited by peers. The database was started in 2006 and includes over 110,000 cancers from breast centres located in Germany, Switzerland, Belgium, Austria, The Netherlands, Spain, Portugal and Italy. The aim of the present study is assessing time trends of QIs in EUSOMA-certified breast centres over the decade 2006–2015.
Previously defined QIs were calculated for 22 EUSOMA-certified breast centres (46122 patients) during 2006–2015.
On the average of all units, the minimum standard of care was achieved in 8 of 13 main EUSOMA QIs in 2006 and in all in 2015. All QIs, except removal of at least 10 lymph nodes at axillary clearance and oestrogen receptor–negative tumours (T > 1 cm or N+) receiving adjuvant chemotherapy, improved significantly in this period. The desirable target was reached for two QIs in 2006 and for 7 of 13 QIs in 2015.
The EUSOMA model of audit and monitoring QIs functions well in different European health systems and results in better performance of QIs over the last decade. QIs should be evaluated and adapted on a regular basis, as guidelines change over time.
•The time trends of quality indicators in EUSOMA-certified breast centres over the decade 2006–2015 are evaluated.•The EUSOMA model of audit and monitoring QIs functions well in different European health systems.•Audit and measuring quality indicators result in better performance.
Optical spectroscopic identification of the nature of 21 unidentified southern hard X-ray objects is reported here in the framework of our campaign aimed at determining the nature of newly-discovered ...and/or unidentified sources detected by INTEGRAL. Our results show that 5 of these objects are magnetic Cataclysmic Variables (CVs), 4 are High-Mass X-ray Binaries (HMXBs; one of which is in the Large Magellanic Cloud) and 12 are Active Galactic Nuclei (AGNs). When feasible, the main physical parameters for these hard X-ray sources are also computed using the multiwavelength information available in the literature. These identifications further underscore the importance of INTEGRAL in the study of the hard X-ray spectrum of AGNs, HMXBs and CVs, and the usefulness of a strategy of catalogues cross- correlation plus optical spectroscopy to securely pinpoint the actual nature of the X-ray sources detected with INTEGRAL.
Summary Background Up-to-date information on the causes of child deaths is crucial to guide global efforts to improve child survival. We report new estimates for 2008 of the major causes of death in ...children younger than 5 years. Methods We used multicause proportionate mortality models to estimate deaths in neonates aged 0–27 days and children aged 1–59 months, and selected single-cause disease models and analysis of vital registration data when available to estimate causes of child deaths. New data from China and India permitted national data to be used for these countries instead of predictions based on global statistical models, as was done previously. We estimated proportional causes of death for 193 countries, and by application of these proportions to the country-specific mortality rates in children younger than 5 years and birth rates, the numbers of deaths by cause were calculated for countries, regions, and the world. Findings Of the estimated 8·795 million deaths in children younger than 5 years worldwide in 2008, infectious diseases caused 68% (5·970 million), with the largest percentages due to pneumonia (18%, 1·575 million, uncertainty range UR 1·046 million–1·874 million), diarrhoea (15%, 1·336 million, 0·822 million–2·004 million), and malaria (8%, 0·732 million, 0·601 million–0·851 million). 41% (3·575 million) of deaths occurred in neonates, and the most important single causes were preterm birth complications (12%, 1·033 million, UR 0·717 million–1·216 million), birth asphyxia (9%, 0·814 million, 0·563 million–0·997 million), sepsis (6%, 0·521 million, 0·356 million–0·735 million), and pneumonia (4%, 0·386 million, 0·264 million–0·545 million). 49% (4·294 million) of child deaths occurred in five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China. Interpretation These country-specific estimates of the major causes of child deaths should help to focus national programmes and donor assistance. Achievement of Millennium Development Goal 4, to reduce child mortality by two-thirds, is only possible if the high numbers of deaths are addressed by maternal, newborn, and child health interventions. Funding WHO, UNICEF, and Bill & Melinda Gates Foundation.
The European Society of Breast Cancer Specialists (EUSOMA) requires that the breast centers' core team includes a trained person responsible for data collection and analysis. We addressed a ...questionnaire to the data managers of the EUSOMA breast centers network in order to acquire information with regard to their education, training, role, activity, recognition, and satisfaction. Breast centers' data managers are highly educated individuals with a variety of backgrounds carrying out, more frequently part‐time and as temporary employees, a job for which they received little specific training. These findings support the importance of defining a core curriculum and a training program.
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•Long term biological biogas upgrading reactor system was monitored.•Biogas upgrading performance reached 99% methane content after two-year operation.•Dominant methanogen changed ...from Methanoculleus sp. to Methanothermobacter sp.•Increment in abundance of homoacetogens was correlated to high acetate production.
Microbial dynamics in an upgrading biogas reactor system undergoing a more than two years-period at stable operating conditions were explored. The carbon dioxide generated during biomass degradation in the first reactor of the system was converted to methane into the secondary reactor by addition of external hydrogen. Considering the overall efficiency, the long-term operation period resulted in an improved biogas upgrading performance (99% methane content). However, a remarkable accumulation of acetate was revealed, indicating the enhancement of homoacetogenic activity. For this reason, a shift in the anaerobic digestion microbiome was expected and evaluated by 16S rRNA amplicon analysis. Results demonstrated that the most abundant archaeal species identified in the first time point, Candidatus Methanoculleus thermohydrogenotrophicum, was replaced by Methanothermobacter thermautotrophicus, becoming dominant after the community adaptation. The most interesting taxonomic units were clustered by relative abundance and six main long-term adaptation trends were found, characterizing functionally related microbes (e.g. homoacetogens).
We have analysed the NRAO Very Large Array Sky Survey and Sydney University Molonglo Sky Survey data at 1.4 GHz and 843 MHz for a well-defined complete sample of hard X-ray AGN observed by INTEGRAL. ...A large number (70/79) of sources are detected in the radio band, showing a wide range of radio morphologies, from unresolved or slightly resolved cores to extended emission over several hundreds of kpc scales. The radio fluxes have been correlated with the 2–10 keV and 20–100 keV emission, revealing significant correlations with slopes consistent with those expected for radiatively efficient accreting systems. The high-energy emission coming from the inner accretion regions correlates with the radio emission averaged over hundreds of kpc scales (i.e. thousands of years).
ABSTRACT
About 6 per cent of radio galaxies (RGs) can reach linear sizes larger than 0.7 Mpc, and are then classified as giant radio galaxies (GRGs). The conditions that make possible the formation ...of such big structures are still not clear – either core accretion properties or environmental factors. Recent studies have shown that GRGs can be up to four times more abundant in hard X-ray selected (i.e. from INTEGRAL/IBIS and Swift/BAT at >20 keV) RG samples. Moreover, a high fraction of young radio sources found in their cores suggest a recently restarted activity, as suggested from the discrepancy between the measured jet and lobes power, with respect to the one expected from core X-ray luminosity. Here, we present a radio morphological study of a sample of 15 hard X-ray selected GRGs, discussing low-frequency images from our GMRT campaign complemented with others from the literature: among them, 7/15 show evidence of restarted radio activity either in the form of double–double/X-shaped morphology, or as a cocoon emission embedding more recent jets. This, together with the objects from this sample already found hosting a young radio source in their core, suggests that at least 13 over 15 of these hard X-ray selected GRGs show features that are consistent with the possibility of restarted radio activity.
In this paper, we report on the fourth soft gamma-ray source catalog obtained with the IBIS gamma-ray imager on board the INTEGRAL satellite. The scientific data set is based on more than 70 Ms of ...high-quality observations performed during the first five and a half years of the Core Program and public observations. Compared to previous IBIS surveys, this catalog includes a substantially increased coverage of extragalactic fields, and comprises more than 700 high-energy sources detected in the energy range 17-100 keV, including both transients and faint persistent objects that can only be revealed with longer exposure times. A comparison is provided with the latest Swift/BAT survey results. Based on observations with INTEGRAL, an ESA project with instruments and Science Data Centre funded by ESA member states (especially the PI countries: Denmark, France, Germany, Italy, Switzerland, Spain), Czech Republic, and Poland, and with the participation of Russia and the USA.
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► Quercetin raw materials may present different degree of hydration. ► Thermal stability of quercetin in the solid state depends on its degree of hydration. ► Quercetin dehydrate is ...thermodynamically more stable than the other crystal forms.
In the present work three samples of quercetin raw materials (QCTa, QCTb and QCTc), purchased from different Brazilian suppliers, were characterized employing scanning electron microscopy, Raman spectroscopy, simultaneous thermogravimetry and infrared spectroscopy, differential scanning calorimetry, and variable temperature-powder X-ray diffraction, in order to know their physicochemical properties, specially the thermal stability in solid state. The results demonstrated that the raw materials of quercetin analyzed present distinct crystalline structures, ascribed to the different degree of hydration of their crystal lattice. The thermal stability of these quercetin raw materials in the solid state was highly dependent on their degree of hydration, where QCTa (quercetin dihydrate) was thermodynamically more stable than the other two samples.
Giant radio galaxies (GRG) are the largest single entities in the universe, having a projected linear size exceeding 0.7 Mpc, which implies that they are also quite old objects. They are not common, ...representing a fraction of only ∼6% in samples of bright radio galaxies. While a census of about 300 of these objects has been built in the past years, still no light has been shed on the conditions necessary to allow such an exceptional growth, whether of environmental nature or linked to the inner accretion properties. Recent studies found that samples of radio galaxies selected from hard X-ray active galactic nuclei catalogs selected from the International Gamma-Ray Astrophysics Laboratory (INTEGRAL)/the Imager on Board the INTEGRAL Satellite and Swift/the Burst Alert Telescope (thus at energies >20 keV) present a fraction of GRG four times larger than what is found in radio-selected samples. We present radio observations of 15 nuclei of hard-X-ray-selected GRG, finding for the first time a large fraction (61%) of young radio sources at the center of Mpc-scale structures. Being at the center of GRG, these young nuclei may be undergoing a restarting activity episode, suggesting a link between the detected hard X-ray emission-due to the ongoing accretion-and the reactivation of the jets.
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