Swiss quality and outcomes framework: quality indicators for diabetes management in Swiss primary care based on electronic medical records.

BACKGROUND: Most industrialized countries are faced with a growing population of patients with chronic diseases and multimorbidity. Evidence performance gaps have been recognized in the treatment of this vulnerable patient group. In England, the Quality and Outcomes Framework (QOF) - based on incentivized quality indicators - has been established to narrow the gap. OBJECTIVE: We evaluated to what extent clinical data, extracted from electronic medical records (EMRs) of Swiss general practitioners, can be used as quality indicators in terms of a Swiss Quality and Outcomes Framework (SQOF) for diabetes care adopted from the QOF of the UK National Health Service (NHS). METHODS: We searched the FIRE database (Family Medicine ICPC Research Using Electronic Medical Records) for patients suffering from diabetes type 1 or type 2. Eligible data were matched with the diabetes indicator set of the NHS QOF and compared with the results in England. RESULTS: A total of 11 out of 17 diabetes indicators could be adopted for the SQOF; 46 practices with 1,781 diabetes patients were included. The practices fulfilled the SQOF diabetes indicator set with 46.9% overall, with highest compliance for blood pressure measurements (97.8% of all practices) and lowest compliance for influenza immunization (45.7%). Our study practices showed higher variation across all indicators and between practices compared to England, but lacking structured data limited calculation of scores and comparability. CONCLUSIONS: Our results show that it is technically feasible to establish a diabetes QOF in Swiss primary care based on EMRs. However, a high amount of missing data made it impossible to evaluate the actual quality of care. For a nationwide introduction, standards for electronic medical documentation and EMR use need to be set. It should also be acknowledged that important dimensions of suffering from one or more chronic diseases such as health-related quality of life are not reflected within a system focusing only on somatic aspects of a disease.

Using seasonal landscape models to predict space use and migratory patterns of an arctic ungulate.

BACKGROUND: Caribou in the Western Arctic Herd undertake one of the longest, remaining intact migrations of terrestrial mammals in the world. They are also the most important subsistence resource for many northern rural residents, who rely on the caribou's migratory movements to bring them near for harvest. Migratory geography has never been static, but subsistence harvesters have reported recent shifts in migration away from areas where they traditionally occurred. The reasons behind these changes are not well-understood, but may be related to rapid climate change and anthropogenic disturbances. METHODS: To predict changes in distribution and shifting migratory areas over the past decade, we used GPS telemetry data from adult females to develop predictive ecological niche models of caribou across northwestern Alaska. We employed the machine-learning algorithm, TreeNet, to analyze interactive, multivariate relationships between telemetry locations and 37 spatial environmental layers and to predict the distributions of caribou during spring, calving season, insect-harassment season, late summer, fall, and winter from 2009 to 2017. Model results were analyzed to identify regions of repeated predicted use, quantify mean longitude, predict land cover selection, and track migratory changes over time. RESULTS: Distribution models accurately predicted caribou at a spatially-explicit, 500-m scale. Model analyses identified migratory areas that shifted annually across the region, but which predicted 4 main areas of repeated use. Niche models were defined largely by non-linear relationships with coastally-influenced, climatic variables, especially snow-free date, potential evapo-transpiration, growing season length, proximity to sea ice, winter precipitation and fall temperature. Proximity to roads and communities were also important and we predicted caribou to generally occur more than 20-100 km from these features. CONCLUSIONS: Western Arctic Herd caribou were predicted to occur in warmer, snow-free and treeless areas that may provide conditions conducive for efficient travel and foraging. Rapidly changing seasonal climates and coastal influences that determine forage availability, and human impediments that slow or divert movements are related to geographically and phenologically dynamic migration patterns that may periodically shift caribou away from traditional harvest areas. An enhanced understanding of the geographic behavior of caribou over time could inform traditional harvests and help conserve important Western Arctic caribou migratory areas.

Cost and Utility of Routine Contrast-Enhanced Neck MRA in a Pediatric MRI Stroke Evaluation Protocol.

BACKGROUND AND PURPOSE: Cervical arterial dissection is one of the frequent causes of pediatric arterial ischemic stroke. Out of concern for missing cervical arterial dissection in patients in whom pediatric stroke is suspected, our tertiary children's hospital added contrast-enhanced 3D neck MR angiography to every pediatric stoke work-up. This research investigated whether the routine use of contrast-enhanced neck MRA in our MR imaging stroke protocol ever detected a cervical arterial abnormality when the DWI, SWI/gradient recalled-echo, or circle of Willis MRA findings from the brain MR imaging were reported as normal. MATERIALS AND METHODS: The institutional PACS data base was searched for stroke protocol MRIs that included DWI, gradient recalled-echo or SWI, circle of Willis MRA, and 3D contrast-enhanced neck MRA in patients younger than 18 years of age with examinations performed between September 2010 and June 2017. RESULTS: In only a single case (0.15%) were the DWI, SWI/gradient recalled-echo, or circle of Willis MRA findings all separately reported as normal and the contrast-enhanced neck MRA findings reported as abnormal. To reach these findings, we screened 681 patients, which would have resulted in an estimated >$200,000 in Medicare charges and $80,000 in of out-of-pocket cost to patients. CONCLUSIONS: In our large series, the addition of a routine contrast-enhanced neck MRA to our pediatric stroke MR imaging protocol was of extremely low yield. We believe the use of neck MRA should reasonably be limited to cases in which abnormalities are initially detected on standard brain sequences or to patients with atypical presentation or recurrent pathology.

Correction: Predicted Shifts in Small Mammal Distributions and Biodiversity in the Altered Future Environment of Alaska: An Open Access Data and Machine Learning Perspective.

[This corrects the article DOI: 10.1371/journal.pone.0132054.].

Predicted Shifts in Small Mammal Distributions and Biodiversity in the Altered Future Environment of Alaska: An Open Access Data and Machine Learning Perspective.

Climate change is acting to reallocate biomes, shift the distribution of species, and alter community assemblages in Alaska. Predictions regarding how these changes will affect the biodiversity and interspecific relationships of small mammals are necessary to pro-actively inform conservation planning. We used a set of online occurrence records and machine learning methods to create bioclimatic envelope models for 17 species of small mammals (rodents and shrews) across Alaska. Models formed the basis for sets of species-specific distribution maps for 2010 and were projected forward using the IPCC (Intergovernmental Panel on Climate Change) A2 scenario to predict distributions of the same species for 2100. We found that distributions of cold-climate, northern, and interior small mammal species experienced large decreases in area while shifting northward, upward in elevation, and inland across the state. In contrast, many southern and continental species expanded throughout Alaska, and also moved down-slope and toward the coast. Statewide community assemblages remained constant for 15 of the 17 species, but distributional shifts resulted in novel species assemblages in several regions. Overall biodiversity patterns were similar for both time frames, but followed general species distribution movement trends. Biodiversity losses occurred in the Yukon-Kuskokwim Delta and Seward Peninsula while the Beaufort Coastal Plain and western Brooks Range experienced modest gains in species richness as distributions shifted to form novel assemblages. Quantitative species distribution and biodiversity change projections should help land managers to develop adaptive strategies for conserving dispersal corridors, small mammal biodiversity, and ecosystem functionality into the future.

Responses of Sorghum and Pennisetum Species to the N(2)-Fixing Bacterium Azospirillum brasilense.

Three field inoculation experiments, two in Florida and one in New Mexico, were conducted with Azospirillum brasilense Cd. Each of the Florida experiments evaluated two crop species. One species in each of the Florida experiments responded to inoculation with a significant dry matter yield increases of 11 to 24% and nitrogen yield increases of 9 to 39%. No inoculation response was noted in the New Mexico experiment. The responding species were Sorghum bicolor (L.) Moench (sorghum) and the interspecific hybrid between Pennisetum americanum (L.) K. Schum. (pearl millet) and P. purpureum Schumach. (napiergrass). Nonresponding species were pearl millet (Florida) and Sorghum sudanense (Piper) Staph. (New Mexico). Acetylene reduction activity of inoculated plots in Florida was low, showing no increase over the natural uninoculated background rates and, in one case, was negatively correlated with yield. Acetylene reduction activity was not measured in New Mexico. In Florida, A. brasilense populations were found to decline from 5 x 10 to 5 x 10 bacteria g of soil in about 3 weeks (quadratic regressions). Continued decline to less than 10 by week 5 indicated that the inoculated bacteria did not become established in the soil in high numbers. The A. brasilense population declined at about the same rate in the New Mexico experiment. The erractic inoculation responses in these experiments are similar to those observed in earlier work at the University of Florida. The lack of acetylene reduction activity response to inoculation and the rapid population decline of the inoculated bacteria suggest that N(2) fixation is not the major mechanism causing yield responses after inoculation.