GloEC: a hierarchical-aware global model for predicting enzyme function.

The annotation of enzyme function is a fundamental challenge in industrial biotechnology and pathologies. Numerous computational methods have been proposed to predict enzyme function by annotating enzyme labels with Enzyme Commission number. However, the existing methods face difficulties in modelling the hierarchical structure of enzyme label in a global view. Moreover, they haven't gone entirely to leverage the mutual interactions between different levels of enzyme label. In this paper, we formulate the hierarchy of enzyme label as a directed enzyme graph and propose a hierarchy-GCN (Graph Convolutional Network) encoder to globally model enzyme label dependency on the enzyme graph. Based on the enzyme hierarchy encoder, we develop an end-to-end hierarchical-aware global model named GloEC to predict enzyme function. GloEC learns hierarchical-aware enzyme label embeddings via the hierarchy-GCN encoder and conducts deductive fusion of label-aware enzyme features to predict enzyme labels. Meanwhile, our hierarchy-GCN encoder is designed to bidirectionally compute to investigate the enzyme label correlation information in both bottom-up and top-down manners, which has not been explored in enzyme function prediction. Comparative experiments on three benchmark datasets show that GloEC achieves better predictive performance as compared to the existing methods. The case studies also demonstrate that GloEC is capable of effectively predicting the function of isoenzyme. GloEC is available at: https://github.com/hyr0771/GloEC.

Evidential deep learning for trustworthy prediction of enzyme commission number.

The rapid growth of uncharacterized enzymes and their functional diversity urge accurate and trustworthy computational functional annotation tools. However, current state-of-the-art models lack trustworthiness on the prediction of the multilabel classification problem with thousands of classes. Here, we demonstrate that a novel evidential deep learning model (named ECPICK) makes trustworthy predictions of enzyme commission (EC) numbers with data-driven domain-relevant evidence, which results in significantly enhanced predictive power and the capability to discover potential new motif sites. ECPICK learns complex sequential patterns of amino acids and their hierarchical structures from 20 million enzyme data. ECPICK identifies significant amino acids that contribute to the prediction without multiple sequence alignment. Our intensive assessment showed not only outstanding enhancement of predictive performance on the largest databases of Uniprot, Protein Data Bank (PDB) and Kyoto Encyclopedia of Genes and Genomes (KEGG), but also a capability to discover new motif sites in microorganisms. ECPICK is a reliable EC number prediction tool to identify protein functions of an increasing number of uncharacterized enzymes.

Series on the Lancet Oncology Commission on Global Cancer Surgery: Introduction-Intent and Content.

BACKGROUND: Surgery plays a key role in the multi-disciplinary cancer care pathway. Nearly 80% of patients with solid tumors will require surgical intervention during the course of their disease. Unfortunately, the vast majority of these patients do not have access to safe, timely, high-quality, and affordable cancer surgical care. The first Lancet Oncology Commission on Global Cancer Surgery shone a light on this grave situation and outlined some strategies to address them. The second Lancet Oncology Commission on Global Cancer Surgery (TLO- II) was conceived to continue the work of its predecessor by developing a roadmap of practical solutions to propel improvements in cancer surgical care globally. METHODS: The Commission was developed by involving approximately 50 cancer care leaders and experts from different parts of the world to ensure diversity of input and global applicability. RESULTS: The Commission identified nine solutional domains that are considered essential to deliver safe, timely, high-quality, and affordable cancer surgical care. These nine domains were further refined to develop solutions specific to each of the six World Health Organization regions. Based on the above solutions, we developed eight action items that are intended to propel improvements in cancer surgical care on the global stage. CONCLUSIONS: The second Lancet Oncology Commission on Global Cancer Surgery builds on the first Commission by developing a pragmatic roadmap of practical solutions that we hope will ensure access to safe, timely, high-quality, and affordable cancer surgical care for everyone regardless of their socioeconomic status or geographic location.

People Endorse Harsher Policies in Principle Than in Practice: Asymmetric Beliefs About Which Errors to Prevent Versus Fix.

Countless policies are crafted with the intention of punishing all who do wrong or rewarding only those who do right. However, this requires accommodating certain mistakes: some who do not deserve to be punished might be, and some who deserve to be rewarded might not be. Six preregistered experiments (N = 3,484 U.S. adults) reveal that people are more willing to accept this trade-off in principle, before errors occur, than in practice, after errors occur. The result is an asymmetry such that for punishments, people believe it is more important to prevent false negatives (e.g., criminals escaping justice) than to fix them, and more important to fix false positives (e.g., wrongful convictions) than to prevent them. For rewards, people believe it is more important to prevent false positives (e.g., welfare fraud) than to fix them and more important to fix false negatives (e.g., improperly denied benefits) than to prevent them.

Dietary quality and dietary greenhouse gas emissions in the USA: a comparison of the planetary health diet index, healthy eating index-2015, and dietary approaches to stop hypertension.

BACKGROUND: The Planetary Health Diet Index (PHDI) measures adherence to the dietary pattern presented by the EAT-Lancet Commission, which aligns health and sustainability targets. There is a need to understand how PHDI scores correlate with dietary greenhouse gas emissions (GHGE) and how this differs from the carbon footprints of scores on established dietary recommendations. The objectives of this study were to compare how the PHDI, Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to (a) dietary GHGE and (b) to examine the influence of PHDI food components on dietary GHGE. METHODS: We used life cycle assessment data from the Database of Food Recall Impacts on the Environment for Nutrition and Dietary Studies to calculate the mean dietary GHGE of 8,128 adult participants in the 2015-2016 and 2017-2018 cycles of the National Health and Nutrition Examination Survey (NHANES). Poisson regression was used to estimate the association of (a) quintiles of diet score and (b) standardized dietary index Z-scores with dietary GHGE for PHDI, HEI-2015, and DASH scores. In secondary analyses, we used Poisson regression to assess the influence of individual PHDI component scores on dietary GHGE. RESULTS: We found that higher dietary quality on all three indices was correlated with lower dietary GHGE. The magnitude of the dietary quality-dietary GHGE relationship was larger for PHDI [-0.4, 95% CI (-0.5, -0.3) kg CO2 equivalents per one standard deviation change] and for DASH [-0.5, (-0.4, -0.6) kg CO2-equivalents] than for HEI-2015 [-0.2, (-0.2, -0.3) kg CO2-equivalents]. When examining PHDI component scores, we found that diet-related GHGE were driven largely by red and processed meat intake. CONCLUSIONS: Improved dietary quality has the potential to lower the emissions impacts of US diets. Future efforts to promote healthy, sustainable diets could apply the recommendations of the established DASH guidelines as well as the new guidance provided by the PHDI to increase their environmental benefits.

The Effectiveness of the Case Manager-Centered Collaborative Care Model with Computer-Assisted Assessment on Quality Indicators for the Care of Dementia.

INTRODUCTION: This study aimed to investigate the influence of case management and its corresponding computer-assisted assessment system on the quality improvement of dementia care. METHODS: This observational study enrolled 2029 patients and their caregivers at Changhua Christian Hospital in Taiwan. Physicians who made the diagnosis of dementia would introduce the patient and caregiver dyad to the case manager-centered collaborative care team after obtaining agreement. The achievement rates of 11 quality indicators (QIs) comprising timely diagnostic evaluations, regular screens of cognition and neuropsychiatric symptoms, caregiver support, and proper medication prescriptions were counted. Different timeframes (≤4 months, 4 months-1 year, 1-2 years, 2-3 years, or ≥3 years) from diagnosis of dementia to collaborative care intervention were compared. RESULTS: A significantly higher attainment rate was achieved for patients with earlier entry into the collaborative team model, including QIs about timely diagnosis and regular screening, and caregiver support. The QIs regarding dementia medication prescriptions and documentation of the risk of antipsychotics remained similar regardless of the time of entry into the model. The completion rates of QIs also improved after the information system was launched. CONCLUSIONS: Physician-case manager co-management in the setting of a collaborative care model with a computer-assisted assessment system helps improve QI achievement for dementia care.

Perspectives on the essential skills of healthcare decision making in children and adolescents with intellectual disability.

BACKGROUND: Involvement in healthcare decisions is associated with better health outcomes for patients. For children and adolescents with intellectual disability, parents and healthcare professionals need to balance listening to a child's wishes with the responsibility of keeping them safe. However, there is a scarcity of literature evaluating how to effectively involve them in decision making. In this context, we review the concept of health literacy, focusing on the skills of healthcare decision making for children and adolescents with intellectual disability. METHODS: We describe the concept of health literacy and models explaining shared decision making (individuals and healthcare professionals collaborate in decision making process) and supported decision making (when a trusted person supports the individual to collaborate with the healthcare professional in the decision-making process), and a rapid review of the literature evaluating their efficacy. We discuss healthcare decision making for children and adolescents with intellectual disability in the context of relevant recommendations from the recent Disability Royal Commission into Violence, Abuse, Neglect, and Exploitation of People with Disability in Australia. RESULTS: Health literacy skills enable individuals to access, understand, appraise, remember and use health information and services. Shared decision making has been described for children with chronic conditions and supported decision making for adults with intellectual disability. Decision-making contributes to how individuals appraise and use healthcare. The rapid review found very limited evidence of outcomes where children and adolescents with intellectual disability have been supported to contribute to their healthcare decisions. Recommendations from the Disability Royal Commission highlight current needs for greater efforts to support and build the capacity of individuals with disability to be involved in the decisions that affect their life, including healthcare decision making. CONCLUSIONS: Existing rights frameworks and healthcare standards confirm the importance of providing all people with the opportunities to learn and practise health literacy skills including decision making. There is little literature examining interventions for healthcare decision making for children with intellectual disability. Childhood is a critical time for the development of skills and autonomy. Evidence for how children and adolescents with intellectual disability can learn and practice healthcare decision-making skills in preparation for adulthood is needed to reduce inequities in their autonomy.

A Criminological Perspective on the Sexual Victimization of Older Adults.

PURPOSE OF REVIEW: This review presents recent research on the sexual abuse of older adults and examines this phenomenon from a criminological perspective. Much of the previous work has neglected to consider the entirety of the crime-commission process. Therefore, the work highlighted in this review showcases important information regarding the individual who committed the crime, the victim, and the criminal event as a whole. RECENT FINDINGS: Comparative studies suggest that the motivations of people who commit sexually victimize older adults are vast and can include those that are sexually and anger motivated, while the victims present with unique vulnerabilities, such as disabilities and spending most of their time at home, that make them more susceptible to excessive violence. People who commit sexual abuse against older adults are a heterogenous group, and the context of victim vulnerabilities is key to understanding why they are targeted. Specific prevention and investigative practices can be formed to better address this crime and protect older adults from future victimization.

Return on investment in science: twenty years of European Commission funded research in Alzheimer's dementia, breast cancer and prostate cancer.

Alzheimer's disease (AD), breast cancer (BC) and prostate cancer (PC) continue to be high in the research and innovation agenda of the European Commission (EC). This is due to their exceptionally large burden to the national health systems, the profound economic effects of opportunity costs attributable to decreased working ability, premature mortality and the ever-increasing demand for both hospital and home-based medical care. Over the last two decades, the EC has been steadily increasing both the number of proposals being funded and the amounts of financial resources being allocated to these fields of research. This trend has continued throughout four consecutive science funding cycles, namely framework programme (FP)5, FP6, FP7 and Horizon 2020 (H2020). We performed a retrospective assessment of the outputs and outcomes of EC funding in AD, BC and PC research over the 1999-2019 period by means of selected indicators. These indicators were assessed for their ability to screen the past, present and future for an array of causal relationships and long-term trends in clinical, epidemiological and public health sphere, while considering also the broader socioeconomic impact of funded research on the society at large. This analysis shows that public-private partnerships with large industry and university-based consortia have led to some of the most impactful proposals being funded over the analysed time period. New pharmaceuticals, small molecules and monoclonal antibodies alike, along with screening and prevention, have been the most prominent sources of innovation in BC and PC, extending patients' survival and enhancing their quality of life. Unlike oncology, dementia drug development has been way less successful, with only minor improvements related to the quality of supportive medical care for symptoms and more sensitive diagnostics, without any ground-breaking disease-modifying treatment(s). Significant progresses in imaging diagnostics and nanotechnology have been largely driven by the participation of medical device industry multinational companies. Clinical trials funded by the EC were conducted, leading to the development of brand-new drug molecules featuring novel mechanisms of action. Some prominent cases of breakthrough discoveries serve as evidence for the European capability to generate cutting-edge technological innovation in biomedicine. Less productive areas of research may be reconsidered as priorities when shaping the new agenda for forthcoming science funding programmes.

"Do not take that medication": negative prospective memory in Korsakoff's syndrome.

BACKGROUND: While prospective memory (i.e., the ability to execute a future plan) has been extensively researched, little is known about negative prospective memory (i.e., the ability to remember not to execute a future plan) in Korsakoff's syndrome (KS). We thus evaluated both prospective memory and negative prospective memory in KS, as well as the relationship between both types of prospective memory and inhibition. METHODS: Patients with KS and control participants were invited to press a button on the keyboard (i.e., prospective memory) or not to press a button when a cue word (e.g., negative prospective memory) was encountered. RESULTS: The analysis demonstrated that patients with KS had more prospective memory errors (i.e., forgetting to click the keyboard when the instruction was to do so) than control participants. The analysis also demonstrated that patients with KS had more negative prospective memory errors (i.e., clicking the keyboard when the instruction was not to do so) than control participants. Similar levels of commissions and omissions were observed in patients with KS than in control participants. Interestingly, prospective and negative prospective performances were significantly correlated with performance on an inhibition assessment task. DISCUSSION: Our study demonstrates that KS is characterized by not only difficulty in remembering to execute a future intention but also by difficulty in remembering not to execute a future intention. A decline in negative prospective memory in KS can be associated with difficulty in inhibiting no longer appropriate previously learned intentions.

Comparing Federal Communications Commission and Microsoft Estimates of Broadband Access for Mental Health Video Telemedicine Among Veterans: Retrospective Cohort Study.

BACKGROUND: The COVID-19 pandemic highlighted the importance of telemedicine in health care. However, video telemedicine requires adequate broadband internet speeds. As video-based telemedicine grows, variations in broadband access must be accurately measured and characterized. OBJECTIVE: This study aims to compare the Federal Communications Commission (FCC) and Microsoft US broadband use data sources to measure county-level broadband access among veterans receiving mental health care from the Veterans Health Administration (VHA). METHODS: Retrospective observational cohort study using administrative data to identify mental health visits from January 1, 2019, to December 31, 2020, among 1161 VHA mental health clinics. The exposure is county-level broadband percentages calculated as the percentage of the county population with access to adequate broadband speeds (ie, download >25 megabits per second) as measured by the FCC and Microsoft. All veterans receiving VHA mental health services during the study period were included and categorized based on their use of video mental health visits. Broadband access was compared between and within data sources, stratified by video versus no video telemedicine use. RESULTS: Over the 2-year study period, 1,474,024 veterans with VHA mental health visits were identified. Average broadband percentages varied by source (FCC mean 91.3%, SD 12.5% vs Microsoft mean 48.2%, SD 18.1%; P<.001). Within each data source, broadband percentages generally increased from 2019 to 2020. Adjusted regression analyses estimated the change after pandemic onset versus before the pandemic in quarterly county-based mental health visit counts at prespecified broadband percentages. Using FCC model estimates, given all other covariates are constant and assuming an FCC percentage set at 70%, the incidence rate ratio (IRR) of county-level quarterly mental video visits during the COVID-19 pandemic was 6.81 times (95% CI 6.49-7.13) the rate before the pandemic. In comparison, the model using Microsoft data exhibited a stronger association (IRR 7.28; 95% CI 6.78-7.81). This relationship held across all broadband access levels assessed. CONCLUSIONS: This study found FCC broadband data estimated higher and less variable county-level broadband percentages compared to those estimated using Microsoft data. Regardless of the data source, veterans without mental health video visits lived in counties with lower broadband access, highlighting the need for accurate broadband speeds to prioritize infrastructure and intervention development based on the greatest community-level impacts. Future work should link broadband access to differences in clinical outcomes.

Early evidence of implementation of District Residency Programme: experiences and challenges of residents in Rajasthan, India.

BACKGROUND: District Residency Programme (DRP) was introduced by National Medical Commission as mandatory three-months training program for postgraduate residents. The program was for the first time implemented in April 2023 in Rajasthan. However, it ran into several teething problems, especially for residents. With a lack of any precedence, this study was planned to explore experiences and challenges of residents posted in DRP. METHODS: Cross-sectional study was conducted at 12 DRP sites attached to SMS Medical College, Jaipur between August-October 2023. A self-administered questionnaire was used to collect information from residents who had completed DRP. Questions were scored on a five-point Likert scale. Mann-Whitney U test and Kruskal-Wallis H test was used to show association. RESULTS: Only around 17% residents felt that the learning objectives of DRP were fulfilled and nearly 60% residents felt isolated from academic activities and parent department. Over half of the residents were never posted with their concerned specialty services. Around four-fifth residents felt concerned about safety at least sometimes and more than three-fourth residents were dissatisfied with basic amenities. Kruskal-Wallis and Mann-Whitney tests showed significant association of gender and specialisation strata with multiple outcome variables. CONCLUSION: The study finds high degree of dissatisfaction among residents towards learning objectives, academic learning, and basic amenities during DRP. There was also a clear lack of specialty-exposure and high concerns of safety, especially for female residents. The study findings should alarm and inform policymakers and administrators to improve DRP implementation so as to better achieve laid objectives.

Developing and transferring a children's surgical training program from India to Africa a south-to-south global initiative.

PURPOSE: The availability of children's surgical care in lower middle-income countries is lacking. The authors describe a hub and spoke global training initiative in children's surgery for adult teams from district hospitals (spokes) comprising general and orthopaedic surgeons, anaesthetists, and nurses and specialist children's surgical trainers from tertiary centres (hubs) in delivering the course. METHODS: The training course developed in Vellore, trained several sets of district hospital adult teams and trainer teams in India. Six specialist children's surgical trainer teams were invited from African countries to the course delivered in Vellore, India. The aim was to train them to deliver the course in their countries. RESULTS: Participants underwent a precourse 'train the trainer' program, observed and assessed the suitability of the district hospital training course. The program received positive feedback, government supported planning of similar courses in some of the countries and discussions in others. CONCLUSION: The availability of children's surgical care is similarly limited in the Asian and African continent, and the regions have shared challenges of disease burden, lack of access, poverty, deficient infrastructure, and trained human resources. They would benefit from this 'South to South' collaboration to impart training skills and modules to the children's surgical trainers.

Trophy, souvenir, or simple theft? Taking items from the victim in sexual homicide.

Although most people have heard the terms 'souvenirs', 'trophies', and 'mementos', discussed in books and movies on the true crimes of sexual murderers, limited research has delved into the phenomenon of theft in sexual homicide (SH). Using a sample of 762 SH cases coming from the Sexual Homicide International Database, the current study examines the crime-commission process of the pre-crime, crime, and post-crime phases of sexual homicide offenders (SHOs) who engaged in theft during a SH. Additionally, this study seeks to determine if a specific type of SHO engages in this behaviour over others. Results from the sequential logistic regression indicate that victims who are 16 years or older, were strangers to the SHO, and were sex workers were more likely to be victims of theft. Additionally, results indicate that the presence of sadism made it more likely the SHO would engage in theft from the victim and/or crime scene. Findings suggest there is a group of SHOs who engage in theft not for monetary purposes but due to the paraphilia of the offender. These findings can inform the police investigation of these crimes.

Checkmating the Nutri-Score: Will Food Patriotism Prevent the Harmonization of Front-of-Pack Labeling Schemes within the EU?

Front-of-pack labeling schemes are an effective but contested regulatory approach to nudge consumers towards healthy food choices. The Nutri-Score, being implemented by seven European countries, is one of the most elaborated and evidence-based examples. Therefore, the Nutri-Score has been deemed as the frontrunner within the EU Commission's attempt to harmonize front-of-pack labeling among EU member states under its Farm-to-Fork strategy (F2F) by the end of 2022. However, the endeavor is on the brink of failure due to massive resistance by Mediterranean member states and parts of the food industry capitalizing on patriotic narratives (e.g. Made in Italy). This comment investigates the Nutri-Score saga from a political and commercial determinants of health lens. It argues that an EU-wide roll-out of the label hinges on the specific interplay between political structures and stakeholder agency. As shown, the EU's weak decision-making power has been exploited by the No-Nutri-Score alliance.

The role of cue salience in prospective memory commission errors in nonperformed nonfocal tasks.

Prospective memory (PM) refers to the ability to remember to execute an intention in the future without having a permanent reminder. These intentions can be performed when they are not relevant or become no-longer needed, the so-called "commission errors". The present study aims to understand the effect of cue salience on PM commission errors with unperformed intentions and on the ongoing task performance-associated costs. Through a between-subjects design, eighty-one participants were assigned to 3 conditions: the no-PM condition, which served as control, and the salient and nonsalient conditions, which were asked to perform a lexical decision task and an incomplete nonfocal prospective memory task (i.e. no PM cues were presented). Subsequently, participants were instructed to no longer execute the prospective intention. In the second phase, a lexical decision task occurred again, including irrelevant PM cues, which should not be answered as such. In the salient condition, cues were salient (i.e. presented in red or blue background). In contrast, in the nonsalient condition, PM cues appeared on a black background, as any other stimuli. In the no-PM control condition, participants only performed an LDT. A commission error occurred when the (irrelevant) intention was performed in this second phase. Results showed that more participants performed a commission error in the presence of salient cues, even when PM intentions became irrelevant. Additionally, when cues were not salient, participants took longer to answer the LDT, as reasoned by the spontaneous retrieval theory. These findings are discussed according to the dual-mechanism account.

[Correlation between defects in medical care and data of causal analysis]. / Vzaimosvyaz' mezhdu defektami meditsinskoi pomoshchi i dannymi prichinno-sledstvennogo analiza.

The article is devoted to the current legal responsibility of medical staff. It is noted that this issue has not been sufficiently studied and requires further research. The article identifies an attempt to assess statistically significant correlation between defects of medical care provision and data of causal analysis as a research task. The practical experience on 215 conclusions of commission forensic medical examinations, in which doctors of surgical specialties were considered on «medical cases¼, has been summarized. A high statistically significant correlation between defects in treatment, diagnosis, organization of medical care, management of medical records and data of causal relationship has been established on the basis of performed scientific researches. The idea that, despite possible subjectivism, the causal relationship is confirmed by factual data on revealed defects in medical care obtained from the study, has been proven.

Assessing hospital differences in low-risk cesarean delivery metrics in Florida.

BACKGROUND: Unnecessary cesarean deliveries lead to increased maternal and neonatal morbidities and mortalities. In 2020, Florida had a cesarean delivery rate of 35.9%, the third highest in the nation. An effective quality improvement strategy to reduce overall cesarean delivery rates is to decrease primary cesarean deliveries in low-risk births (nulliparous, term, singleton, vertex). Of note, 3 nationally accepted hospital measures of low-risk cesarean delivery rates include the nulliparous, term, singleton, vertex; Joint Commission; and Society for Maternal-Fetal Medicine metrics. Comparing metrics is necessary because accurate and timely measurement is essential to support multihospital quality improvement efforts to reduce low-risk cesarean delivery rates and improve the quality of maternal care. OBJECTIVE: This study aimed to assess differences in hospital low-risk cesarean delivery rates in Florida using 5 different metrics of low-risk cesarean delivery rate based on (1) risk methodology, nulliparous, term, singleton, vertex; Joint Commission; and Society for Maternal-Fetal Medicine metrics, and (2) data source, linked birth certificate and hospital discharge records and hospital discharge records only. STUDY DESIGN: This was a population-based study of live Florida births from 2016 to 2019 to compare 5 approaches to calculating low-risk cesarean delivery rates. Analyses were performed using linked birth certificate data and inpatient hospital discharge data. The 5 low-risk cesarean delivery measures were defined as follows: nulliparous, term, singleton, vertex birth certificate; Joint Commission-linked used Joint Commission exclusions; Society for Maternal-Fetal Medicine-linked used Society for Maternal-Fetal Medicine exclusions; Joint Commission hospital discharge with Joint Commission exclusions; and Society for Maternal-Fetal Medicine hospital discharge with Society for Maternal-Fetal Medicine exclusions. Nulliparous, term, singleton, vertex birth certificate was based on data from birth certificates and not using linked hospital discharge data. Designated as nulliparous, term, singleton, vertex, it does not exclude other high-risk conditions. The second and third measures (Joint Commission-linked used Joint Commission exclusions and Society for Maternal-Fetal Medicine-linked used Society for Maternal-Fetal Medicine exclusions) use data elements from the full-linked dataset to designate nulliparous, term, singleton, vertex and excluded several high-risk conditions. The last 2 measures (Joint Commission hospital discharge with Joint Commission exclusions; and Society for Maternal-Fetal Medicine hospital discharge with Society for Maternal-Fetal Medicine exclusions) were based on data from hospital discharge data only and not using linked birth certificate data. These measures generally reflect term, singleton, and vertex because parity could not be assessed adequately on hospital discharge data. Hospital differences between these 5 measures were calculated overall and by neonatal intensive care unit level. RESULTS: Overall, the median of hospital low-risk cesarean rates decreased across the measures, from NTSV-BC 30.7%, to Joint Commission linked 29.1%, and Society for Maternal Fetal Medicine hospital discharge 29.2% with a large decrease to Joint Commission hospital discharge 19.4% and Society for Maternal Fetal Medicine hospital discharge 18.1%. A similar trend was seen by neonatal intensive care unit level. For each of the measures, level II had the highest median low-risk cesarean rates (nulliparous. term, singleton, vertex birth certificate) 32.7%, Joint Commission linked (31.4%), Society for Maternal Fetal Medicine linked: 31.1%, Society for Maternal Fetal Medicine hospital discharge 19.3%), except for level III Joint Commission hospital discharge (20.0%). A comparison of the median number of low-risk births overall and by neonatal intensive care unit level showed a decreasing number across the linked and hospital discharge measures. Again, a wide gap in low-risk cesarean delivery rates was identified between linked measures and hospital discharge measures. However, this gap narrowed as hospital rates increased. CONCLUSION: Quality monitoring of low-risk cesarean delivery rates measured by the nulliparous, term, singleton, vertex metric using the birth certificate was fairly accurate and provided timely assessment for use by Florida hospitals. The nulliparous, term, singleton, vertex birth certificate rates were comparable with low-risk metrics using the linked data source. Overall, metrics used within the same data source had similar rates, with the Society for Maternal-Fetal Medicine metric having the lowest rates. Across data sources, metrics using hospital discharge data only resulted in substantially underestimated rates because of the inclusion of multiparous women and should be interpreted with caution.

The European Kidney Health Alliance (EKHA) and the Decade of the KidneyTM.

The European Kidney Health Alliance (EKHA) is an advocacy organization that defends the case of the kidney patients and the nephrological community at the level of the European Union (EU), and from there, top to bottom, also at the national level of the EU member states and the EU-associated countries. The Decade of the KidneyTM is a global initiative launched by the American Association of Kidney Patients (AAKP) to create greater awareness and organize patient demands for long overdue innovation in kidney care. This article describes the medical and patient burden of kidney disease, the history of EKHA, its major activities and tools for policy action, and the need for innovation of kidney care. We then describe the Decade of the KidneyTM initiative, the rationale behind why EKHA joined this activity to emanate parallel action at the European side, the novel professionalized structure of EKHA, and its immediate targets. The final aim is to align all major stakeholders for an action plan on kidney disease comparable to Europe's successful Beating Cancer Plan, with the additional intent that the EKHA model is applied also by the respective national kidney-related societies to create a broad mobilization at all levels. The ultimate aims are that the EU considers chronic kidney disease (CKD) as a major health and health-economic problem, to consequently have CKD included as a key health research target by the European Commission, and to improve quality of life and outcomes for all kidney patients.

An update on asthma diagnosis.

OBJECTIVE: Asthma imposes a significant health and socioeconomic burden with an average prevalence impacting 5-10% of the global population. The aim of this narrative review is to update the current literature on topics related to asthma diagnosis. DATA SOURCES: Original research articles were identified from PubMed using the search terms "asthma diagnosis" and "asthma misdiagnosis". STUDY SELECTIONS: Recently published articles (n = 51) detailing the diagnosis, misdiagnosis of asthma, and the updated recommendations of the European and international asthma guidelines. RESULTS: Emerging evidence revealed that asthma might represent a rather heterogenous clinical entity with varying underlying molecular mechanisms. Attempts have been made to unravel these traits to better provide accurate diagnosis and a more efficient patient-based management approach. The lack of a gold standard test for asthma diagnosis has contributed to its over- and underdiagnosis. This is problematic, given that overdiagnosis might lead to delay of both diagnosis and prompt treatment of other diseases, while underdiagnosis might substantially impact quality of life due to progression of asthma by increased rate of exacerbations and airway remodeling. In addition to poor asthma control and potential patient harm, asthma misdiagnosis is also associated with excessive costs. As a result, current international guidelines emphasize the need for a standardized approach to diagnosis, including objective measurements prior to treatment. CONCLUSION: Future research is warranted to define the optimal diagnostic and treatable traits approach especially for patients with severe asthma, as they may benefit from the advent of newly targeted asthma management.