The role of GP’s compensation schemes in diabetes care: evidence from panel data

The design of incentive schemes that improve quality of care is a central issue for the healthcare sector. Nowadays we observe many pay-for-performance programs, where payment is contingent on meeting indicators of provider effort, but also other alternative strategies have been introduced, for example programs rewarding physicians for participation in diseases management plans. Although it has been recognised that incentive-based remuneration schemes can have an impact on GP behaviour, there is still weak empirical evidence on the extent to which such programs influence health outcomes. We investigate the impact of financial incentives in Regional and Local Health Authority contracts for primary care in the Italian Region Emilia Romagna for the years 2003-05. We focus on avoidable hospitalisations (Ambulatory Care Sensitive Conditions) for patients affected by type 2 diabetes mellitus, for which the assumption of responsibility and the adoption of clinical guidelines are specifically rewarded. We estimate a panel count data model using a Negative Binomial distribution to test the hypothesis that, other things equal, patients under the responsibility of GPs receiving a higher share of their income through these programs are less likely to experience avoidable hospitalisations. Our findings support the hypothesis that financial transfers may contribute to improve quality of care, even when they are not based on the ex-post verification of performances.

Impacto de los residuos de ivermectina en los procesos tecnológicos de la leche y sus derivados

Se evaluó la estabilidad química de los residuos de ivermectina (IVM, fármaco antiparasitario) en leches bovina y ovina. La estabilidad del fármaco se midió mediante cromatografía liquida de alta performance analizando muestras de leche con residuos de IVM antes y después del tratamiento térmico. Además se evaluó, mediante la prueba del yogur y estudios microbiológicos de recuento de bacterias lácticas, el efecto de los residuos sobre la viabilidad de las bacterias ácido lácticas. Los residuos de IVM en leche demostraron ser estables a los tratamientos térmicos utilizados en la industria láctea de pasteurización: baja temperatura/largo tiempo (LTLT 65ºC, 30 min) y alta temperatura/corto tiempo (HTST 75ºC, 15 s). Los procesos de industrialización de la leche basados en la actividad de las bacterias lácticas tampoco fueron afectados por la presencia de residuos de IVM. Las concentraciones evaluadas no modificaron el incremento de la acidez en la prueba del yogur y no disminuyeron los recuentos de bacterias lácticas presentes en muestras de yogures elaborados con residuos del antiparasitario. El impacto de los residuos de fármacos antiparasitarios en los procesos tecnológicos de elaboración de alimentos y en la salud del consumidor a largo plazo debe ser cuidadosamente analizado.Chemical stability of ivermectin residues (IVM, antiparasitic drug) in cattle and sheep milk was evaluated. IVM residues were measured in milk samples before and after heat treatment by high performance liquid chromatography. Additionally, the effect of drug residues on the lactic acid fermentation was assessed by testing the viability and counts of lactic acid bacteria. IVM concentrations in milk were stable after standard procedures used in dairy industry LTLT pasteurization (65°C, 30 min) and HTST (75°C, 15 s). Industrial milk processing based on the activity of lactic acid bacteria was not affected by the presence of IVM residues. IVM concentrations did not affect the increment of acidity nor the number of lactic acid bacteria in yogurt samples. The impact of the residues of antiparasitic drugs in technological processes of food processing and consumer health must be carefully analyzed to avoid long-term consequences

The identification of informative genes from multiple datasets with increasing complexity

Background In microarray data analysis, factors such as data quality, biological variation, and the increasingly multi-layered nature of more complex biological systems complicates the modelling of regulatory networks that can represent and capture the interactions among genes. We believe that the use of multiple datasets derived from related biological systems leads to more robust models. Therefore, we developed a novel framework for modelling regulatory networks that involves training and evaluation on independent datasets. Our approach includes the following steps: (1) ordering the datasets based on their level of noise and informativeness; (2) selection of a Bayesian classifier with an appropriate level of complexity by evaluation of predictive performance on independent data sets; (3) comparing the different gene selections and the influence of increasing the model complexity; (4) functional analysis of the informative genes. Results In this paper, we identify the most appropriate model complexity using cross-validation and independent test set validation for predicting gene expression in three published datasets related to myogenesis and muscle differentiation. Furthermore, we demonstrate that models trained on simpler datasets can be used to identify interactions among genes and select the most informative. We also show that these models can explain the myogenesis-related genes (genes of interest) significantly better than others (P < 0.004) since the improvement in their rankings is much more pronounced. Finally, after further evaluating our results on synthetic datasets, we show that our approach outperforms a concordance method by Lai et al. in identifying informative genes from multiple datasets with increasing complexity whilst additionally modelling the interaction between genes. Conclusions We show that Bayesian networks derived from simpler controlled systems have better performance than those trained on datasets from more complex biological systems. Further, we present that highly predictive and consistent genes, from the pool of differentially expressed genes, across independent datasets are more likely to be fundamentally involved in the biological process under study. We conclude that networks trained on simpler controlled systems, such as in vitro experiments, can be used to model and capture interactions among genes in more complex datasets, such as in vivo experiments, where these interactions would otherwise be concealed by a multitude of other ongoing events

The small GTPase Rab29 is a common regulator of immune synapse assembly and ciliogenesis

Acknowledgements We wish to thank Jorge Galán, Gregory Pazour, Derek Toomre, Giuliano Callaini, Joel Rosenbaum, Alessandra Boletta and Francesco Blasi for generously providing reagents and for productive discussions, and Sonia Grassini for technical assistance. The work was carried out with the financial support of Telethon (GGP11021) and AIRC.Peer reviewedPostprin

p130Cas is an essential transducer element in ErbB2 transformation

The ErbB2 oncogene is often overexpressed in breast tumors and associated with poor clinical outcome. p130Cas represents a nodal scaffold protein regulating cell survival, migration, and proliferation in normal and pathological cells. The functional role of p130Cas in ErbB2-dependent breast tumorigenesis was assessed by its silencing in breast cancer cells derived from mouse mammary tumors overexpressing ErbB2 (N202-1A cells), and by its reexpression in ErbB2-transformed p130Cas-null mouse embryonic fibroblasts. We demonstrate that p130Cas is necessary for ErbB2-dependent foci formation, anchorage-independent growth, and in vivo growth of orthotopic N202-1A tumors. Moreover, intranipple injection of p130Cas-stabilized siRNAs in the mammary gland of Balbc-NeuT mice decreases the growth of spontaneous tumors. In ErbB2-transformed cells, p130Cas is a crucial component of a functional molecular complex consisting of ErbB2, c-Src, and Fak. In human mammary cells, MCF10A.B2, the concomitant activation of ErbB2, and p130Cas overexpression sustain and strengthen signaling, leading to Rac1 activation and MMP9 secretion, thus providing invasive properties. Consistently, p130Cas drives N202-1A cell in vivo lung metastases colonization. These results demonstrate that p130Cas is an essential transducer in ErbB2 transformation and highlight its potential use as a novel therapeutic target in ErbB2 positive human breast cancers.-Cabodi, S., Tinnirello, A., Bisaro, B., Tornillo, G., Camacho-Leal, M. P., Forni, G., Cojoca, R., Iezzi, M., Amici, A., Montani, M., Eva, A., Di Stefano, P., Muthuswamy, S. K., Tarone, G., Turco, E., Defilippi, P. p130Cas is an essential transducer element in ErbB2 transformation

Triplet Exciton Generation in Bulk-Heterojunction Solar Cells based on Endohedral Fullerenes

Organic bulk-heterojunctions (BHJ) and solar cells containing the trimetallic nitride endohedral fullerene 1-[3-(2-ethyl)hexoxy carbonyl]propyl-1-phenyl-Lu3N@C80 (Lu3N@C80-PCBEH) show an open circuit voltage (VOC) 0.3 V higher than similar devices with [6,6]-phenyl-C[61]-butyric acid methyl ester (PC61BM). To fully exploit the potential of this acceptor molecule with respect to the power conversion efficiency (PCE) of solar cells, the short circuit current (JSC) should be improved to become competitive with the state of the art solar cells. Here, we address factors influencing the JSC in blends containing the high voltage absorber Lu3N@C80-PCBEH in view of both photogeneration but also transport and extraction of charge carriers. We apply optical, charge carrier extraction, morphology, and spin-sensitive techniques. In blends containing Lu3N@C80-PCBEH, we found 2 times weaker photoluminescence quenching, remainders of interchain excitons, and, most remarkably, triplet excitons formed on the polymer chain, which were absent in the reference P3HT:PC61BM blends. We show that electron back transfer to the triplet state along with the lower exciton dissociation yield due to intramolecular charge transfer in Lu3N@C80-PCBEH are responsible for the reduced photocurrent

Primary stability of dental implants in low-density (10 and 20 pcf) polyurethane foam blocks : Conical vs cylindrical implants

Background: The aim of the present study was to compare, in low-density polyurethane blocks, the primary implant stability values (micromobility) and removal torque values of three different implant geometries in two different bone densities representing the structure of the human posterior jaws. Methods: A total of 60 implants were used in the present investigation: Twenty implants for each of three groups (group A, group B, and group C), in both polyurethane 10 pcf and 20 pcf densities. The insertion torque, pull-out torque, and implant stability quotient (ISQ) values were obtained. Results: No differences were found in the values of Group A and Group B implants. In both these groups, the insertion torques were quite low in the 10 pcf blocks. Better results were found in the 20 pcf blocks, which showed very good stability of the implants. The pull-out values were slightly lower than the insertion torque values. High ISQ values were found in Group A and B implants. Lower values were present in Group C implants. Conclusions: The present investigation evaluated implants with different geometries that are available on the market, and not experimental implants specifically created for the study. The authors aimed to simulate real clinical conditions (poor-density bone or immediate post-extraction implants) in which knowledge of dental implant features, which may be useful in increasing the primary stability, may help the oral surgeon during the surgery planning

Physico-Mechanical Performances of Mortars Prepared with Sorted Earthquake Rubble: The Role of CDW Type and Contained Crystalline Phases

Construction and demolition waste (CDW) from earthquake rubbles was used here as recycled aggregates (RA) in cementitious binders. The materials were sorted in six groups: concrete (CO), natural stone (NS), tile (TI), brick (BR), perforated brick (PF) and roof tile (RT). The abundance (wt.%) of crystalline phases in each RA type was determined by X-ray Powder Diffraction (XRPD). Each group of RAs was used alone (100 wt.% of RA) and mixed with quartz-rich virgin aggregates (VA) to prepare 13 types of mortars (12 specimens per type): one reference mortar (RM) with only VA, six recycled aggregate mortars (RAM) and six recycled-plus-virgin aggregate mortars (RVAM). The physical and mechanical properties of aggregates and mortars reflect the type and abundance of crystalline phases in each CDW group. Recycled mortars rich in concrete, natural stones and tiles have better mechanical performance than mortars prepared with recycled bricks, perforated bricks and roof tiles. For each RA, RVAMs have superior mechanical characteristics than the corresponding RAM. Since the type and amount of phases contained in recycled aggregates strongly control the mechanical performance of new construction materials, they should be routinely quantified as reported here, in addition to other physical features (water absorption, density, etc.). The separation of heterogeneous CDW into homogeneous RA groups is necessary for the production of new construction materials with stable and predictable performances to ensure CDW recycling, especially in areas hit by major adverse events, where large amounts of still valuable materials could be used for reconstruction processes

Maxillary sinus augmentation with three different biomaterials: Histological, histomorphometric, clinical, and patient-reported outcomes from a randomized controlled trial

Background: Lateral maxillary sinus augmentation (MSA) is a predictable bone regeneration technique in case of atrophy of the posterior-upper maxilla. Aimed at obtaining quantity and quality of bone suitable for receiving osseointegrated implants, its success is largely due to the skill of the surgeon, but also to the characteristics of the biomaterial used. Methods: Twenty-four patients needing MSA were included in the study. The patients were randomly allocated to three different groups: anorganic bovine bone mineral as control, tricalcium phosphate with or without hyaluronic acid (HA) as test groups. Nine months after MSA, bone biopsies were harvested for the histomorphometric analysis. Secondary outcomes were mean bone gain, intraoperative and postoperative complications, implant insertion torque, implant failure, and patient-reported outcome measures. Results: Although the percentage of new bone was not statistically different between the three groups (P =.191), the percentages of residual biomaterial was significantly higher (P &lt;.000) and nonmineralized tissue significantly lower (P &lt;.000) in the control than in the test groups. Test groups did not differ significantly from each other for all histomorphometric parameters. The implant insertion torque was significantly higher in the control group (P &lt;.0005). The rest of the secondary outcomes were not significantly different between the groups. Conclusion: MSA is a safe and predictable procedure in terms of histological, clinical, and PROAMs, regardless of the biomaterial used. The addition of HA did not influence the outcomes