Quality of care of patients hospitalized with acute coronary syndromes

Background: Measurement and improvement of quality of care is a priority issue in health care. Patients hospitalized with acute coronary syndromes (ACS) constitute a high-risk population whose care, if shown to be suboptimal on the basis of available research evidence, may benefit from quality improvement interventions. Aim: To evaluate the quality of in-hospital care for patients with ACS, using explicit quality indicators. Methods: Retrospective case note review was undertaken of 397 patients admitted to three teaching hospitals in Brisbane, Queensland, Australia, between 1 October 2000 and 17 April 2001. The main out-come measures were 12 process-of-care quality indicators, calculated as either: (i) the proportion of all patients who received specific interventions or (ii) the proportion of ideal patients who received -specific interventions (i.e. patients with clear indi-cations and lacking contraindications). Results: Quality indicators with values above 80% included: (i) patient selection for thrombolysis (100%) and discharge prescription of beta-blockers (84%), (ii) antiplatelet agents (94%) and (iii) lipid-lowering agents (82%). Indicators with values between 50% and 80% included: (i) timely per-formance of electrocardiogram (ECG) on admission (61%), (ii) early coronary angiography (75%), (iii) measurement of serum lipids (71%) and (iv) discharge prescription of angiotensin-converting-enzyme (ACE) inhibitors (73%). Indicators with values <50% included: (i) timely administration of thrombolysis (35%), (ii) non-invasive risk assessment (23%) and (ii) formal in-hospital and post-hospital cardiac rehabilitation (47% and 7%, respectively). Conclusion: There were delays in performing ECG and administering thrombolysis to patients who presented to emergency departments with ACS. Improvement is warranted in use of non-invasive procedures for identifying high-risk patients who may benefit from coronary revascularization as well as use of serum lipid measurements, ACE inhibitors and cardiac rehabilitation.

Rootstocks influence 'Hass' avocado fruit quality and fruit minerals

To determine the potential for rootstocks to improve avocado quality, 'Hass' fruit from trees on seedling 'Velvick' (SV), clonal 'Velvick' (CV) or clonal 'Duke 7' (CD) rootstocks were harvested in 1999 and 2000, ripened at 20 C immediately after harvest (non-stored) or stored at 5 C for four weeks (stored), and then fruit quality and mineral concentrations determined. In 2000, non-stored CV fruit had lower severity of body rots (5% of flesh volume affected, caused mainly by Colletotrichum gloeosporioides) than CD fruit (20%), while body rots severity in stored CV fruit was 20% compared with 38% in stored CD fruit. Stored CV fruit had less severe diffuse discoloration (3% and 9% in 1999 and 2000, respectively) than CD fruit (7% and 20%, respectively). Stored CV fruit also had less severe vascular browning (19%) than CD fruit (33%) in 2000. In both seasons, CV fruit had 15-19% higher flesh calcium concentrations, 17-22% higher flesh boron concentrations, and 14-15% lower flesh nitrogen concentrations than CD fruit. In 2000, CV fruit also had 27% more skin calcium and 14% less skin nitrogen than CD fruit. There were no effects of rootstock on yield, canopy volume, measured length of non-suberized roots, average fruit weight, fruit length: width ratio, skin thickness, dry matter, proportion of the fruit skin purple-black when ripe, or seed mass: fruit weight ratio. These results suggest that there is potential to improve 'Hass' avocado quality through rootstock selection, and that tree and fruit mineral concentrations have a role in this relationship.

Quality of Life and Colorectal Cancer: a Review

Objectives: To describe what is known of quality of life for colorectal cancer patients, to review what has been done in the Australian setting and to identify emerging directions for future research to address current gaps in knowledge. Method: A literature search (using Medline, PsychInfo, CINAHL and Sociological Abstracts) was conducted and 41 articles identified for review. Results: Three key areas relating to quality of life in colorectal cancer patients emerged from the literature review: the definition and measurement of quality of life; predictors of quality of life; and the relationship of quality of life to survival. Results of existing studies are inconsistent in relation to quality of life over time and its relationship to survival. Small sample sizes and methodological limitations make interpretation difficult. Conclusions: There is a need for large-scale, longitudinal, population-based studies describing the quality of life experienced by colorectal cancer patients and its determinants. Measurement and simultaneous adjustment for potential confounding factors would productively advance knowledge in this area, as would an analysis of the economic cost of morbidity to the community and an assessment of the cost effectiveness of proposed interventions. Implications: As the Australian population ages, the prevalence of colorectal cancer within the community will increase. This burden of disease presents as a priority area for public health research. An improved understanding of quality of life and its predictors will inform the development and design of supportive interventions for those affected by the disease.

Improving the physical status and quality of life of women treated for breast cancer: A pilot study of a structured exercise intervention

Background and Objectives: This pilot project assessed the acceptability of a mixed-type, moderate-intensity exercise programme following breast cancer treatment, and the impact on presence of lymphoedema, fitness, body composition, fatigue, mood and quality of life. Methods: Ten women completed the programme and measures of fitness (submaximal ergometer test), body composition (bio-electrical impedance), lympoedema (bio-electrical impedance and arm circumferences), fatigue (revised Piper Fatigue Scale), mood (Hospital Anxiety and Depression Scale), quality of life (FACT-B) and general well-being, at baseline, completion of the programme, and 6-week and 3-month follow-up. Results: Participation in the programme caused no adverse effect on the presence of lymphoedema. There was a trend towards reduction in fatigue and improved quality of life across the testing phases. Women rated the programme extremely favourably, citing benefits of the support of other women, trained guidance, and the opportunity to experience different types of exercise. Conclusions: A mixed-type, moderate-intensity exercise program in a group format is acceptable to women following breast cancer treatment, with the potential to reduce fatigue and improve quality of life, without exacerbating or precipitating lymphoedema. This pilot work needs to be confirmed in larger randomised studies. (C) 2004 Wiley-Liss, Inc.

Effect of environment and genotype on bread-making quality of spring-sown spring wheat cultivars in China

Improvement of end-use quality in bread wheat depends on a thorough understanding of current wheat quality and the influences of genotype (G), environment (E), and genotype by environment interaction (G x E) on quality traits. Thirty-nine spring-sown spring wheat (SSSW) cultivars and advanced lines from China were grown in four agro-ecological zones comprising seven locations during the 1998 and 1999 cropping seasons. Data on 12 major bread-making quality traits were used to investigate the effect of G, E, and G x E on these traits. Wide range variability for protein quantity and quality, starch quality parameters and milling quality in Chinese SSSW was observed. Genotype and environment were found to significantly influence all quality parameters as major effects. Kernel hardness, flour yield, Zeleny sedimentation value and mixograph properties were mainly influenced by the genetic variance components, while thousand kernel weight, test weight, and falling number were mostly influenced by the environmental variance components. Genotype, environment, and their interaction had important effects on test weight, mixing development time and RVA parameters. Cultivars originating from Zone VI (northeast) generally expressed high kernel hardness, good starch quality, but poor milling and medium to weak mixograph performance; those from Zone VII (north) medium to good gluten and starch quality, but low milling quality; those from Zone VIII (central northwest) medium milling and starch quality, and medium to strong mixograph performance; those from Zone IX (western/southwestern Qinghai-Tibetan Plateau) medium milling quality, but poor gluten strength and starch parameters; and those from Zone X (northwest) high milling quality, strong mixograph properties, but low protein content. Samples from Harbin are characterized by good gluten and starch quality, but medium to poor milling quality; those from Hongxinglong by strong mixograph properties, medium to high milling quality, but medium to poor starch quality and medium to low protein content; those from Hohhot by good gluten but poor milling quality; those from Linhe by weak gluten quality, medium to poor milling quality; those from Lanzhou by poor bread-making and starch quality; those from Yongning by acceptable bread-making and starch quality and good milling quality; and those from Urumqi by good milling quality, medium gluten quality and good starch pasting parameters. Our findings suggest that Chinese SSSW quality could be greatly enhanced through genetic improvement for targeted well-characterized production environments.

Eradicating feral cats to protect Galapagos Land Iguanas: methods and strategies

A three-year programme to eradicate Feral Cats Felis catus from the island of Baltra in the Galapagos archipelago achieved good results by Initially poisoning with sodium monofluoroacetate (compound 1080) then trapping or shooting the remaining cats. The poisoning campaign removed 90% of the cats, its success being attributable to pre-baiting with unpolsoned baits to accustom cats to eating baits and placing enough baits to ensure that all cats encountered several baits within their home range. This, together with the use of metaclopromide (Pileran) as an anti-emetic, overcame a problem associated with poor retention of 1080 in thawed fish baits that limited the dose available to 1 mg 1080lbait, a quality Insufficient to kill large cats. Removal of the remaining cats was delayed by a weather-Induced irruption of Black Rats Rattus rattus and House Mice Mus musculus that enabled recruitment of kittens in 2002, but made cats more susceptible to trapping and shooting in 2003 when rodent populations collapsed. Since July 2003 no sign of a cat has been detected on Baltra despite extensive searching and monitoring throughout 2004. As cat abundance has decreased there have been more locally-bred Juvenile iguanas (Conolophus subcristatus) seen during annual censuses. However, such recruitment may reflect the increasing maturity and higher fecundity of iguanas repatriated from 1991 onwards rather than being a direct result of reduced cat predation alone. More time is necessary to determine the benefits of reduced cat predation on the Iguana population.

A new method for conservation planning for the persistence of multiple species

Although the aim of conservation planning is the persistence of biodiversity, current methods trade-off ecological realism at a species level in favour of including multiple species and landscape features. For conservation planning to be relevant, the impact of landscape configuration on population processes and the viability of species needs to be considered. We present a novel method for selecting reserve systems that maximize persistence across multiple species, subject to a conservation budget. We use a spatially explicit metapopulation model to estimate extinction risk, a function of the ecology of the species and the amount, quality and configuration of habitat. We compare our new method with more traditional, area-based reserve selection methods, using a ten-species case study, and find that the expected loss of species is reduced 20-fold. Unlike previous methods, we avoid designating arbitrary weightings between reserve size and configuration; rather, our method is based on population processes and is grounded in ecological theory.

Quality-of-life in children and adolescents with cystic fibrosis managed in both regional outreach and cystic fibrosis center settings in Queensland

To assess the health-related quality-of-life (HRQOL) of children/adolescents with cystic fibrosis (CF) and compare HRQOL in children managed by cystic fibrosis outreach service (CFOS) with those treated in a cystic fibrosis center (CFC). To compare HRQOL of children with CF in Queensland with previously published HRQOL data from the United States and examine the relationship between HRQOL scores and pulmonary function. Study design: Participants were children/adolescents with CF and their parents managed by the Royal Children’s Hospital Queensland at a CFC or CFOS. Two HRQOL surveys were used: PedsQL™ and Cystic Fibrosis Questionnaire (CFQ). Results: There were 91 CFC and 71 CFOS participants with similar demographics. PedsQL™ total summary score was statistically higher in CFOS, P = .05. There was no significant difference in CFQ scores between groups. Queensland parents reported lower HRQOL for their children compared with US parents (P

Measurement and stability of FTY720 in human whole blood by high-performance liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry

We report here a validated method for the quantification of a new immunosuppressant drug FTY720, using HPLC-tandem mass spectrometry. Whole blood samples (500 mu l) were subjected to liquid-liquid extraction, in the presence of an internal standard (Y-32919). Mass spectrometric detection was by selected reaction monitoring with an atmospheric pressure chemical ionization source in positive ionization mode (FTY720: m/z 308.3 -> 255.3). The assay was linear from 0.2 to 25 mu g/l (r(2) > 0.997, n = 5). The inter- and intra-day analytical recovery and imprecision for quality control samples (0.5, 7 and 15 mu g/l) were 95.8-103.2 and < 5.5%, respectively. At the lower limit of quantification (0.2 mu g/l) the interand intra-day analytical recovery was 99.0-102.8% with imprecision of < 7.6% (n = 5). The assay had a mean relative recovery of 100.5 +/- 5.8% (n = 15). Extracted samples were stable for 16 h. IFTY720 quality control samples were stable at room temperature for 16 h at 4 degrees C for at least 8 days and when taken through at least three freeze-thaw cycles. In conclusion, the method described displays analytical performance characteristics that are suitable for pharmacokinetic studies in humans. (c) 2006 Elsevier B.V. All rights reserved.

Quality of service in flexible workflows through process constraints

Workflow technology has delivered effectively for a large class of business processes, providing the requisite control and monitoring functions. At the same time, this technology has been the target of much criticism due to its limited ability to cope with dynamically changing business conditions which require business processes to be adapted frequently, and/or its limited ability to model business processes which cannot be entirely predefined. Requirements indicate the need for generic solutions where a balance between process control and flexibility may be achieved. In this paper we present a framework that allows the workflow to execute on the basis of a partially specified model where the full specification of the model is made at runtime, and may be unique to each instance. This framework is based on the notion of process constraints. Where as process constraints may be specified for any aspect of the workflow, such as structural, temporal, etc. our focus in this paper is on a constraint which allows dynamic selection of activities for inclusion in a given instance. We call these cardinality constraints, and this paper will discuss their specification and validation requirements.

Mapping structural parameters and species composition of riparian vegetation using IKONOS and Landsat ETM+ data in Australian tropical savannahs

Government agencies responsible for riparian environments are assessing the utility of remote sensing for mapping and monitoring vegetation structural parameters. The objective of this work was to evaluate Ikonos and Landsat-7 ETM+ imagery for mapping structural parameters and species composition of riparian vegetation in Australian tropical savannahs for a section of Keelbottom Creek, Queensland, Australia. Vegetation indices and image texture from Ikonos data were used for estimating leaf area index (R-2 = 0.13) and canopy percentage foliage cover (R-2 = 0.86). Pan-sharpened Ikonos data were used to map riparian species composition (overall accuracy = 55 percent) and riparian zone width (accuracy within +/- 3 m). Tree crowns could not be automatically delineated due to the lack of contrast between canopies and adjacent grass cover. The ETM+ imagery was suited for mapping the extent of riparian zones. Results presented demonstrate the capabilities of high and moderate spatial resolution imagery for mapping properties of riparian zones.

Spatial, temporal, and human dimensions of air pollution in Brisbane

Arriving in Brisbane some six years ago, I could not help being impressed by what may be prosaically described as its atmospheric amenity resources. Perhaps this in part was due to my recent experiences in major urban centres in North America, but since that time, that sparkling quality and the blue skies seem to have progressively diminished. Unfortunately, there is also objective evidence available to suggest that this apparent deterioration is not merely the result of habituation of the senses. Air pollution data for the city show trends of increasing concentrations of those very substances that have destroyed the attractiveness of major population centres elsewhere, with climates initially as salubrious. Indeed, present figures indicate that photochemical smog in unacceptably high concentrations is rapidly becoming endemic also over Brisbane. These regrettable developments should come as no surprise. The society at large has not been inclined to respond purposefully to warnings of impending environmental problems, despite the experiences and publicity from overseas and even from other cities within Australia. Nor, up to the present, have certain politicians and government officials displayed stances beyond those necessary for the maintenance of a decorum of concern. At this stage, there still exists the possibility for meaningful government action without the embarrassment of losing political favour with the electorate. To the contrary, there is every chance that such action may be turned to advantage with increased public enlightenment. It would be more than a pity to miss perhaps the final remaining opportunity: Queensland is one of the few remaining places in the world with sufficient resources to permit both rational development and high environmental quality. The choice appears to be one of making a relatively minor investment now for a large financial and social gain the near future, or, permitting Brisbane to degenerate gradually into just another stagnated Los Angeles or Sydney. The present monograph attempts to introduce the problem by reviewing the available research on air quality in the Brisbane area. It also tries to elucidate some seemingly obvious, but so far unapplied management approaches. By necessity, such a broad treatment needs to make inroads into extensive ranges of subject areas, including political and legal practices to public perceptions, scientific measurement and statistical analysis to dynamics of air flow. Clearly, it does not pretend to be definitive in any of these fields, but it does try to emphasize those adjustable facets of the human use system of natural resources, too often neglected in favour of air pollution control technology. The crossing of disciplinary boundaries, however, needs no apology: air quality problems are ubiquitous, touching upon space, time and human interaction.